激素替代治疗对绝经妇女乳腺X线密度的影响

目的探讨不同方案激素替代治疗（HRT）对绝经妇女乳腺x线密度的影响及其临床意义。方法90例绝经后妇女随机分成3组：A组,每日结合雌激素（CEE）0．3mg＋孕激素醋酸甲羟孕酮（MPA）2mg＋钙尔奇D6001片;B组,每日CEE0．625mg＋MPA2mg＋钙尔奇D6001片;C绀,每日钙尔奇D6001片。用药1年,Wolfe和半定量法计算并比较j组乳腺X线密度及A、B绀用药前后乳腺X线密度的变化。结果用药1年,两种方法计算乳腺x线密度,三组中密度最高为B组,其次为A、C组,差异有统计学意义（P〈0．01）,A、B组乳腺x线密度分别与C绀比较,差异均有统计学意义（P〈0．ol或0．05）;B组乳腺x线密度较A组升高,但差异无统计学意义（P〉0．05）。A、B组用药前后自身比较,半定量法显示,A、B组用药后较用药前均增高（但前者P〉0．05,后者P〈0．01）;B组用药后增高程度较A组高,但两组间差异无统计学意义（P〉0．05）。结论HRT能增高乳腺x线密度,且增高程度可能与剂量相关,提示HRT对乳腺有不良反应,应用HRT宜选最小有效剂量。乳腺x线密度可作为HRT对乳腺影响的监测指标。     

Hormone replacement therapy and incidence of Alzheimer disease in older women: the Cache County Study

Context  Previous studies have shown a sex-specific increased risk of Alzheimer disease (AD) in women older than 80 years. Basic neuroscience findings suggest that hormone replacement therapy (HRT) could reduce a woman's risk of AD. Epidemiologic findings on AD and HRT are mixed. Objective  To examine the relationship between use of HRT and risk of AD among elderly women. Design, Setting, and Participants  Prospective study of incident dementia among 1357 men (mean age, 73.2 years) and 1889 women (mean age, 74.5 years) residing in a single county in Utah. Participants were first assessed in 1995-1997, with follow-up conducted in 1998-2000. History of women's current and former use of HRT, as well as of calcium and multivitamin supplements, was ascertained at the initial contact. Main Outcome Measure  Diagnosis of incident AD. Results  Thirty-five men (2.6%) and 88 women (4.7%) developed AD between the initial interview and time of the follow-up (3 years). Incidence among women increased after age 80 years and exceeded the risk among men of similar age (adjusted hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.22-3.86). Women who used HRT had a reduced risk of AD (26 cases among 1066 women) compared with non-HRT users (58 cases among 800 women) (adjusted HR, 0.59; 95% CI, 0.36-0.96). Risk varied with duration of HRT use, so that a woman's sex-specific increase in risk disappeared entirely with more than 10 years of treatment (7 cases among 427 women). Adjusted HRs were 0.41 (95% CI, 0.17-0.86) for HRT users compared with nonusers and 0.77 (95% CI, 0.31-1.67) compared with men. No similar effect was seen with calcium or multivitamin use. Almost all of the HRT-related reduction in incidence reflected former use of HRT (9 cases among 490 women; adjusted HR, 0.33 [95% CI, 0.15-0.65]). There was no effect with current HRT use (17 cases among 576 women; adjusted HR, 1.08 [95% CI, 0.59-1.91]) unless duration of treatment exceeded 10 years (6 cases among 344 women; adjusted HR, 0.55 [95% CI, 0.21-1.23]). Conclusions  Prior HRT use is associated with reduced risk of AD, but there is no apparent benefit with current HRT use unless such use has exceeded 10 years.      

激素治疗原发性肾病综合征的临床研究

〔目的〕探讨糖皮质激素在原发性肾病综合征的治疗过程中的作用。〔方法〕通过常规剂量甲泼尼龙、泼尼松序贯疗法与常规泼尼松疗法在原发性肾病综合征的治疗效果进行比较。〔结果〕常规剂量甲泼尼龙、泼尼松序贯疗法能较快的缓解患者的症状。〔结论〕该疗法缩短诱导缓解期,药物副作用较少,有良好的临床疗效。     

激素治疗增加绝经后健康妇女尿失禁的发病率和严重程度

问题：在绝经后健康妇女中，激素治疗（hormone therapy，HT）对尿失禁（urinary incontinence，UI）的效果如何？     

Hormone replacement therapy: a survey of Ontario physicians'' prescribing practices

BACKGROUND: Although much has been written about hormone replacement therapy (HRT), there are few clearcut recommendations on its use. The purpose of this study was to determine Ontario physicians' patterns of and reasons for prescribing HRT, their use of pretreatment investigations and their surveillance of HRT users, and to determine whether physicians' reported practice is consistent with existing recommendations. METHODS: A self-administered questionnaire was mailed to a nonproportional stratified sample of 327 Ontario physicians (23.9% gynecologists, 76.1% general practitioners/family physicians [GP/FPs]). Outcome measures were ranking of reasons for prescribing HRT, nature of preliminary testing, regimens prescribed, duration of HRT and frequency of follow-up. RESULTS: The response rate was 60.9% overall (70.9% of the gynecologists, 58.3% of the GP/FPs). Prevention of osteoporosis was reported by 97.4% as an important or very important reason for prescribing HRT; prevention of coronary artery disease was important or very important for 89.3%. When considering whether or not to prescribe HRT, 97.3% stated that breast cancer was an important or very important factor. When presented with hypothetical cases, 97.0% stated that they would prescribe combined estrogen-progestin for a symptomatic woman with an intact uterus; 13.6% stated that they would do so for a woman with no uterus. Most reported that they would prescribe HRT for 12 or more years (73.3%) and would follow up patients every 1 to 2 years (70.6%). INTERPRETATION: Despite controversy about HRT in the published literature, the Ontario physicians surveyed reported similar reasons and patterns of prescribing, pretreatment investigations, and surveillance of postmenopausal women using HRT. These results suggest that Ontario physicians' knowledge about HRT is consistent with recommendations in the published literature.     

学龄期儿童近视进展的纵向性研究

目的：2年随访期调查学龄期近视儿童屈光变化,获得近视进展状态和规律,探讨与近视进展相关的因素。方法120例8~13岁的近视儿童自愿入选本项研究,以睫状肌麻痹后自动电脑验光获得的屈光度数以及眼轴长度作为主要研究参数,跟踪随访测量,每6个月1次,至24个月,分析其近视进展的状况及年龄、初始度数、散光等因素在近视进展中所起的作用。结果（1）共92例完成随访,其中男54例,女38例,年龄（10.18±1.03）岁。初始度数：-（2.46±1.03）D,年平均进展度数-（0.69±0.29）D。眼轴的年平均变化值为（0.33±0.11）mm;（2）各个年龄组间的近视进展量有差异统计学意义（F=2.724, P=0.049）。年龄越小,近视进展得越快;（3）初始度数＞-2.00D的受试者近视进展量大于初始度数＜-2.00D的受试者（F=8.168, P=0.006）;（4）初始有散光的受试者近视进展量比初始无散光的稍大（F=4.107,P=0.046）。结论学龄期近视儿童年近视进展量明显,近视度数年进展量0.50~1.00D,年龄小、初始度数高、存在散光是近视进展的相关因素。     

正确应用性激素补充疗法促进绝经后妇女的健康

美国妇女健康研究 (Ｗｏｍｅｎ′ｓＨｅａｌｔｈＩｎｉｔｉａｔｉｖｅ ,ＷＨＩ)是一个大规模、复杂的临床研究[1] ,目的是针对在绝经后妇女中疾病和死亡最多见病因的预防和控制 ,包括 :癌症、心血管病和骨质疏松性骨折。ＷＨＩ开始于 1992年 ,计划于 2 0 0 7年结束 ,在美国国内设 4 0个临床中心 ,研究对象为 5 0～ 79岁的绝经后妇女。研究分两类 :临床随机对照研究和观察性研究 ,前者纳入研究对象约 645 0 0名 ,后者约 10 00 0 0名。临床随机对照研究评价 3种干预 :低脂饮食、性激素补充疗法 (ＨＲＴ)和钙及维生素Ｄ的补充。对第 1种干预 ,…     

女性乳腺炎决定因素的纵向评价

目的:纵向评估生育女性乳腺炎危险因素及金葡菌相关性。方法:前瞻性队列研究346例生育女性乳腺炎及金葡菌临床病情。分别于产前和产后8周共6个时间点问卷调查。收集母亲和婴儿口/鼻棉拭子,产后母乳样本,培养金黄色葡萄球菌。离散多变量风险回归模型(发病率比(IRR))评估乳腺炎风险因素。结果:20%(70/346)的产妇出现乳腺炎。乳头损伤(IRR 2.17,95%CI 1.21-3.91),乳汁过多(IRR 2.60,95%CI 1.58-4.29),使用乳罩(IRR 2.93,95%CI 1.72-5.01)均为乳腺炎高危因素。乳头(IRR 1.72,95%CI 1.04-2.85)或母乳(IRR 1.78,95%CI 1.08-12.92)感染金黄色葡萄球菌也增加乳腺炎风险,但非显著相关。结论:乳头损伤,乳汁过多,乳罩及金黄色葡萄球菌,均增加乳腺炎分风险。减少乳头损伤,有助于减少产妇乳房感染。