激素替代治疗对绝经后妇女骨代谢指标的影响

目的探讨激素替代治疗对绝经后妇女碱性磷酸酶(ALP)、骨钙素(BGP)及尿钙/肌酐(Ca/Cr)的影响。方法选择2018年6月-2019年6月该院收治的绝经后妇女75例为研究对象,随机数字表分为观察组和对照组。对照组37例患者行安慰剂治疗,观察组38例患者进行激素替代治疗。用药6个月后对两组患者的治疗效果进行评估,比较两组患者的骨代谢水平和骨密度。结果观察组患者中由于绝经时间不同,观察组患者的雌酮(E1)、雌二醇(E2)水平均高于对照组患者(P0.05),而睾酮(T)水平与对照组患者比较差异无统计学意义(P0.05);患者在接受药物治疗前,两组患者的骨代谢指标中ALP、BGP及Ca/Cr差异无统计学意义(P0.05),同时两组患者骨矿含量(BMC)水平与E1、E2呈正相关(P0.05);在连续药物治疗6个月后,观察组患者的骨代谢相关指数和BMC与药物治疗前相比均明显降低(P0.05),而对照组患者的骨代谢指数与药物治疗前无明显差异(P0.05),但BMC与药物治疗前相比小幅减少(P0.05);两组患者在治疗前骨密度生活水平无明显差异(P0.05),治疗后观察组患者的腰2、腰3的骨密度有所上升,对照组患者腰2、腰3、腰4以及股骨颈的骨密度均有所下降(P0.05)。结论激素替代治疗对绝经后妇女骨代谢及ALP、BGP及Ca/Cr的影响,能有效减少绝经妇女骨质疏松的发病率,值得推广应用。     

运动对绝经后妇女骨量和骨代谢影响情况分析

目的:探讨运动对绝经后妇女骨密度和骨代谢的影响,并与药物治疗进行对比。方法:141例绝经后健康妇女随机分成3组,对照组46例,不进行任何干预措施;运动组50例,每周进行4~5次中等强度的体育运动,每次1~2 h;用药组45例,每日服用倍美安1粒+去甲基睾丸素2mg,连续8周。监测桡骨骨密度、AKP、尿CA/CR、尿HYP/CR。结果:运动组运动1年后骨密度明显增高,血AKP升高,尿CA/CR、尿HYP/CR减少,无副作用,用药组显效快且迅速。结论:运动可以提高绝经后妇女骨密度,减少骨丢失,无副作用,费用低,易于被接受,是一种预防绝经后骨质疏松的安全有效的方法,值得大力推广,特别是对于经济条件较差的人群。     

绝经后骨质疏松症不同激素治疗方案对骨代谢的影响分析

目的 :研究不同激素治疗方案对绝经后骨质疏松患者骨代谢的影响分析.方法 :研究对象选取我院2014.06到2016.01期间收治的绝经后骨质疏松患者129例,采用随机数字法将其分为予甲、乙、丙三组,每组各43例,甲组给予戊酸雌二醇治疗,乙组则给予醋酸甲羟孕酮(M PA)治疗,丙组给予复方雌孕片治疗,用药6个月后均接受随访,比较三组治疗前后骨密度(BMD)水平、尿钙/尿肌酐(Ca/Cr)水平、骨钙素(BGP)水平.结果 :三组BM治疗前后比较,差异不显著(P均>0.05);甲组治疗前后Ca/Cr水平变化虽有下降,但差异不明显(P>0.05),乙、丙两组治疗前后Ca/Cr水平变化差异显著(P<0.01);三组骨钙素(BGP)治疗前后比较,甲组具有明显差异(P<0.01),乙、丙两组差异不显著(P>0.05).结论 :MPA可以促进绝经后骨质疏松妇女的骨转换和骨形成,从而防止骨的流失,戊酸雌二醇与复方雌孕能有效地抑制骨吸收.     

产后早期骨密度及骨代谢的变化

[目的]探讨产后早期骨密度与骨代谢的变化及其原因。[方法]产后3～7d妇女25例,对照组30例,用双能X线骨密度仪测定L1～L4椎体及左髋部股骨颈、沃氏区、股骨粗隆的骨密度,测血钙(Ca)、尿钙/肌酐(Ca/Cr)比值、尿羟脯氨酸/肌酐(HY/Cr)比值,分别计算各组数值进行比较。[结果]产后早期妇女腰椎L1的骨密度显著低于对照组,差异有统计学意义(P﹤0.05),L2～L4骨密度与对照组相比差异无统计学意义(P﹥0.05)。髋部各部位的骨密度均低于对照组,差异有统计学意义(P﹤0.05)。产后早期妇女血钙低于对照组,差异有统计学意义(P﹤0.05),尿钙/肌酐(Ca/Cr)比值与尿羟脯氨酸/肌酐(HY/Cr)比值高于对照组,差异有统计学意义(分别P﹤0.05,P﹤0.01)。[结论]产后早期妇女存在不同程度的骨量降低及骨代谢异常。     

大豆异黄酮减缓绝经后妇女骨丢失的临床效应

目的:确定大豆异黄酮减缓绝经后雌激素缺失状态下骨丢失的生理效应及其有效剂量。方法:以骨量正常或低减的绝经后妇女87人为研究对象,随机单盲分为大豆异黄酮84 mg/d和126 mg/d两个剂量组及安慰剂对照组,另以绝经后妇女10人给予7-炔诺酮2.5 mg/d作为阳性对照组,追踪24 w,测定腰椎、股骨颈和Ward,s三角区试验前后的骨密度值。结果:试验后安慰剂对照组腰椎骨密度较试验前显著下降(P<0.05), 大豆异黄酮两组及雌激素对照组各部位骨密度试验前后无显著变化 (P>0.05);协方差分析表明,试验后大豆异黄酮126 mg/d组、和雌激素对照组腰椎部位骨密度均值及其变化率显著高于安慰剂组(P<0.05),回归分析表明大豆异黄酮对各部位的骨密度变化率均有显著的正向作用(P<0.05)。结论:大豆异黄酮84～126 mg/d可减缓绝经后妇女骨的丢失,维持骨密度的相对稳定,其显效剂量是126 mg/d。     

长效避孕皮下埋植剂对生育妇女骨质的影响

为探讨长期缓释单孕激素对妇女骨代谢的影响,测定使用国产Ⅰ、Ⅱ型长效避孕皮下埋植剂和Norplant 3年以上妇女的骨密度及骨代谢指标。采用回顾、设对照组的研究方法,测定123例妇女骨密度(BMD)及其骨代谢指标血钙(Ca)、磷(P)、碱性磷酸酶(ALP)、骨钙素(BGP)、血清雌激素(E_2),尿钙(Ca)、尿肌肝(Cr)和尿羟脯氨酸(HYP)等。结果表明国产Ⅰ、Ⅱ型和Norplant组妇女骨峰值形成期(30～40岁)使用皮埋剂的三组妇女平均E_2水平有不同程度降低,但均在正常低限水平内,与对照组间无差别。除对照组外三组妇女平均E_2水平与BMD之间不呈线性关系;Norplant组妇女BMD和Ca/Cr、HTP/Cr的变化说明骨吸收过程增强。使用国产Ⅰ、Ⅱ型皮埋剂和Norplant妇女3年后平均E_2水平在正常低水平上波动,未造成BMD的变化及其它骨代谢指标的明显变化;三组皮埋剂妇女骨峰值形成期(30～40岁),骨密度处于正常水平范围。长效LNG缓释皮埋剂对育龄妇女在骨代谢方面是安全的。     

3种方案治疗绝经后骨质疏松疗效观察

目的:探讨3种不同方案治疗绝经后妇女骨质疏松的临床疗效。方法:将绝经后伴骨量减少妇女110例,随机分成3组。A组36例,钙尔奇D 1 200 mg/d+骨化三醇0.25μg/bid;B组39例,钙尔奇D 1 200 mg/d+骨化三醇0.25μg/bid+替勃龙1.25 mg/d;C组35例,钙尔奇D 1200 mg/d+骨化三醇0.25μg/bid+盐酸雷洛昔芬60 mg/d。3组妇女连续治疗1年。治疗前后测定腰椎第1~4节(L1~4)及股骨骨密度(BMD);同时检测血清骨碱性磷酸酶(BALP)及血清Ⅰ型前胶原肽(CTX)评价骨代谢指标。结果:①骨痛症状改善。3组妇女治疗1年后骨痛症状均得到改善,A、B、C组改善率分别为83%、92%、95%。②骨密度升高。3组妇女治疗后骨密度明显升高,分别与治疗前比较,差异均有统计学意义(P<0.05);治疗后1年B、C组妇女BMD均较A组显著升高,差异有统计学意义(P<0.01),但B、C两组间比较,差异无统计学意义(P>0.05)。③骨代谢指标。3组妇女治疗后BALP及CTX水平均较治疗前降低,差异有统计学意义(P<0.05);3组间比较,治疗1年后血清CTX水平,B组较C组显著下降,差异有统计学意义(P<0.01),B组较A组下降更为显著,差异有统计学意义(P<0.000 1)。结论:3种方案均可用于骨质疏松的治疗,降低骨转换、增加BMD、减少骨吸收。     

绝经后骨质疏松补肾健脾化瘀治疗的临床研究

目的观察补肾健脾化瘀治疗对绝经后骨质疏松骨量、骨代谢标志物以及疼痛程度的影响。方法选择2014年10月-2015年10月于一汽总医院骨质疏松诊疗中心就诊的绝经10年内骨质疏松患者158例,采用随机数字表法将患者分为补肾健脾化瘀组88例和对照组70例。于实验开始及6个月后检测腰椎和股骨颈骨密度(BMD),检测尿钙/肌酐(Ca/Cr)、尿羟脯氨酸/肌酐(HYP/Cr)、骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRACP),并分别于实验开始前、1个月、2个月、4个月、6个月及结束后2周时测定疼痛强度。结果 1补肾健脾化瘀组实验结束时,腰椎L1-4 BMD、股骨颈BMD均明显提高(P0.05)。对照组两部位的BMD比较无统计学差异(P0.05)。2补肾健脾化瘀组尿Ca/Cr、尿HYP/Cr、BALP、TRACP均较治疗前降低(P0.05),而对照组无明显变化(P0.05)。31个月后,补肾健脾化瘀组疼痛评分已明显下降(P0.05),在2个月、4个月及结束时疼痛评分持续下降,且停药2周后疼痛强度无明显加重。对照组疼痛程度与实验开始时比较无明显变化(P0.05)。结论补肾健脾活血化瘀治疗可通过调节骨转换水平提高BMD,改善骨质疏松疼痛,延缓或阻断绝经后骨的流失。     

某些血、尿生化指标与妇女骨密度的关系

目的探讨某些血尿生化指标与健康妇女骨密度的关系。方法用单光子骨密度仪测定妇女非优势侧前臂桡骨远端1／10处及中下1／3处骨密度,并测定了空腹10小时后的清晨2小时尿钙（Ca）、尿羟脯氨酸（Hyp）,尿肌酐（Cr）及血清碱性磷酸酶（AKP）含量。结果血清AKP、尿Hyp／Cr随增龄而增加,绝经后更明显,且均与骨密度呈明显负相关。尿Ca／Cr亦随增龄而增加,绝经后更为明显,但与骨密度无明显相关。结论血清AKP、空腹尿Hyp／Cr可作为反映骨转换状态的指标。     

使用醋酸甲孕酮避孕针对骨质代谢和卵巢功能影响的研究

目的:研究长效醋酸甲孕酮避孕针(DMPA)对生育年龄妇女骨质代谢和卵巢功能影响。方法:选择自愿使用DMPA避孕者30例为实验组,采用避孕套避孕者30例为对照组。①测定两组血清碱性磷酸酶(AKP)、尿钙/肌酐(Ca/cr)、尿羟脯氨酸/肌酐(HYP/Cr);②测定非惯用臂桡尺骨骨密度(BMD)和桡尺骨超远端骨矿含量(BMC);③实验组于用药满一年时,对照组于月经周期第5天采用放免法测定血清性激素值;④实验组于首次用药当日及用药满一年,对照组于月经周期第5天B超监测卵泡发育状况;⑤实验组用药满一年时作阴道脱落细胞检查。结果:两组骨代谢生化指标及桡尺骨骨密度无显著性差异(P>0.05);实验组血清性激素值相当于正常育龄妇女卵泡早期水平,实验组有96.7％研究对象的卵巢内无卵泡或有小卵泡,最大卵泡直径≤1.5cm,卵泡发育状况相当于正常妇女卵泡早期水平,阴道脱落细胞检查显示雌激素水平无低落。结论:使用DMPA一年对骨质代谢无影响;DMPA使用者卵巢功能相当于正常育龄妇女卵泡早期水平。     

Menopausal hormone replacement therapy

In this paper, the evolution of postmenopausal hormone replacement is reviewed, with an evidence-based approach and particular emphasis on the Heart and Estrogen/Progestin Replacement Study and Women's Health Initiative reports. This therapy will continue to evolve and have pertinence for women with menopausal symptoms and for osteoporosis prevention in selected patients.     

Effects of danazol on mineral homeostasis in normal postmenopausal women: preliminary communication.

The effects of danazol on calcium homeostasis in normal postmenopausal women was examined in a 14-day study utilizing a dosage of 800 mg per day. Danazol caused significant falls in plasma ionized calcium and in the fasting urinary calcium/creatinine ratio, indicating inhibition of bone resorption. Retention of phosphate was also observed as expected with this anabolic agent. The plasma total alkaline phosphatase was also depressed by the drug, which had no effect on hepatocellular function as measured by plasma AST. Certain effects induced by treatment with danazol were still apparent two weeks after cessation of treatment. The drug was well tolerated and androgenic side effects were not seen. It is suggested that the minimal dose regimen of danazol which exerts a calcium-sharing effect should be identified, and that this regimen should be considered for use in a prospective study of the effects of danazol on bone mineral content in the postmenopause.     

序贯联合应用雌孕激素治疗绝经相关症状与阴道出血模式的临床观察

目的:观察序贯联合应用雌孕激素治疗围绝经期及绝经早期绝经相关症状和调整月经周期的疗效与阴道出血的状况。方法:多中心研究有绝经相关问题的围绝经期或绝经早期妇女,应用倍美盈雌孕激素复方制剂治疗3个周期,观察治疗前后Creene症状评分、阴道出血情况、副反应、子宫及其内膜。结果:接纳研究对象107例,完成99例。Creene总评分及其亚项(心理、躯体、血管舒缩和性功能障碍等症状)均显著降低,治疗前总分为17.88±12.78,治疗后为4.15±4.54(P<0.01);用药第1、2、3个周期规律出血发生率分别为64.6％、61.6％、59.6％;不规律出血发生率为20.2％、27.3％、26.3％;无出血周期率15.2％、11.1％、14.1％;乳胀发生率32.3％～44.4％。继续随诊到的68例中,42.6％停药,57.4％继续雌孕激素治疗。结论:序贯联合应用倍美盈,可有效地缓解绝经相关症状,阴道出血较规律。治疗中不需记忆加孕激素的时间,简便易行。     

Bone remodelling is not affected by consumption of a sodium-rich carbonated mineral water in healthy postmenopausal women

This study was designed to investigate the possible effects of consuming Na-rich carbonated mineral water on bone remodelling and urinary mineral excretion in postmenopausal women. Women (n 18) included were amenorrhoeic (>1 year), healthy and not obese (BMI <30 kg/m2). No woman was taking oestrogen replacement therapy, mineral and vitamin supplements, phyto-oestrogens or medications known to affect bone and lipid metabolism. In two consecutive interventions that lasted 8 weeks each, women drank 1 litre of control mineral water daily and 1 litre of carbonated mineral water, rich in Na, HCO3- and Cl-, daily. Body weight and height were measured, BMI was calculated and blood pressure was measured. Blood samples were taken from fasting subjects and serum obtained to analyse the biochemical bone markers, procollagen I amino-terminal propeptide (PINP) and beta-carboxy-terminal telopeptide of collagen (beta-CTX). At the end of each period, 24 h urine samples were collected to determine Ca, Mg, P, Na+, K+, Cl-, urine excretion and urinary pH. No changes in body weight, BMI or blood pressure were observed during the experimental period. Ca excretion was lower after the intake of carbonated water than after intake of the control water (P=0.037) while P excretion was higher (P=0.015). Total urine, Na and Cl- excretion did not differ between the two periods but urinary pH was increased after the intake of carbonated mineral water. PINP and beta-CTX did not differ between the two periods. Daily consumption of 1 litre of Na-rich carbonated mineral water for 8 weeks does not affect bone remodelling in healthy postmenopausal women.     

Intake of dietary phytoestrogen and indices of antioxidant and bone metabolism of pre- and post-menopausal Korean women

A group of 101 women, aged 40-65 years consisted of 48 premenopausal subjects and 53 postmenopausal ones living in Daegu and Gyeongbuk area in Korea were evaluated with their general characteristics, lifestyle factors, nutrient and phytoestrogen intakes, blood and urinary indices concerning antioxidant status and bone metabolism. Body mass index (BMI), waist hip ratio (WHR) and systolic blood pressure (SBP) of the postmenopausal women were significantly higher (23.8, 0.86, and 126.9 mmHg, respectively) than those of the premenopausal women (22.6, 0.82, and 115.9 mmHg; respectively). Nutrient intakes of the postmenopausal and premenopausal groups were not different except lower fat intake and higher dietary fiber and iron intakes in the postmenopausal group. Daily total phytoestrogen intake was significantly higher in the postmenopausal group (48.54 mg) than the premenopausal (31.41 mg) and was resulted mostly from higher intakes of daidzein and genistein from soy and soy products (45.42 mg vs 28.91 mg). Serum genistein level and excretion of enterolactone, major lignan metabolite, were not very different between the two groups. Serum retinal and α- tocopherol levels were higher in the postmenopausal group but TBARS levels were not different between the two groups. Serum osteocalcin (7.18 ng/mL) and urinary deoxypyridinoline (7.15 nmol/mmol creatinine), in the postmenopausal group were significantly higher than those in the premenopausal group (4.80 ng/mL, 5.95 nmol/mmol creatinine). Urinary excretion of enterolactone was positively correlated with serum osetocalcin in premenopausal women and serum genistein negatively correlated with the urinary DPD in postmenopausal women. Dietary phytoestrogen intake was negatively correlated with serum level of TBARS in all subjects. It is concluded that the effect of total phytoestrogen intake is beneficial on body antioxidant status in all middle-aged women regardless of menopause but the effect on bone metabolism appears different by the type of the phytoestrogen and the menopausal state.     

绝经前合理应用维生素D和钙剂与绝经后妇女骨密度的关系

目的:调查绝经前后妇女的体成分与绝经年龄、身高及应用维生素D和钙剂后骨密度的关系。方法:采用1∶1配对设计方法,将196例妇女分为绝经期前未用维生素D和钙剂者和用维生素D和钙剂者两组,采用米尺和磅秤测量两组妇女的身高和体重,采用双能X线骨密度仪检测两组妇女的骨质疏松值,采用超声骨密度仪检测两组妇女的左侧跟骨的超声速度、骨硬度指数和低骨量。观察两族妇女体内骨密度指标。结果:绝经前后不同年龄组妇女体质指数、超声速度、骨硬度指数、低骨量及骨质疏松值比较差异有统计学意义(P<0.05)。应用维生素D和钙剂的妇女骨密度较未应用维生素D和钙剂的妇女同年龄组相比,骨质疏松值有所下降。结论:绝经前后妇女合理应用维生素D和钙剂安全、有效,可早期预防骨质疏松,值得推荐,特别适用于绝经后妇女。     

重组人甲状旁腺激素治疗绝经后骨质疏松妇女234例临床研究

目的:研究重组人甲状旁腺激素〔rhPTH(1-34)〕治疗绝经后骨质疏松妇女的临床疗效和安全性。方法:选取医院收治的绝经后骨质疏松妇女234例随机分为观察组和对照组,观察组112例患者每天皮下注射rhPTH(1-34)20μg(200 u),对照组122例患者每周肌肉注射依降钙素20 u。于治疗前和治疗后3、6个月分别检测两组患者的腰椎1～4和股骨颈的骨密度以及骨吸收和骨形成的生化指标,随访观察两组患者治疗过程中出现的不良反应。结果:观察组患者的腰椎1～4骨BMD改善程度高于对照组(P<0.05),BSAP、尿NTX/Cr改善程度均高于对照组(P<0.05);两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:与依降钙素相比,rhPTH(1-34)治疗绝经后骨质疏松妇女临床疗效安全、可靠,建议推广使用。     

雌激素及受体与绝经后骨质疏松症关系的研究进展

绝经后女性,体内雌激素水平急剧下降,骨吸收大于骨形成,骨量迅速丢失,骨密度(bone mineral density,BMD)下降,发生骨质疏松(Osteoporosis,op).雌激素替代疗法在防治绝经后骨质疏松症中具有重要作用.为更深刻地认识和探讨雌激素及雌激素受体(ER)和骨质疏松的关系,就二者在防治绝经后骨质疏松症的可能作用机制的研究进展作一综述.     

营养素干预对绝经妇女骨质疏松的影响

目的 观察血脂正常但骨密度降低的绝经妇女补充钙、维生素D和大豆异黄酮后，机体骨密度和血脂成分的变化。方法 2004年4月从武汉郊区绝经妇女中筛选血脂正常伴骨量减少或骨质疏松的绝经妇女60名，随机均分为两干预组，每组30人。一组给予液体钙（含维生素D）；一组给予液体钙（含维生素D）和大豆异黄酮，跟踪观察一年。测定每位受试对象骨骼骨密度和血脂成分。结果 试验结束后，补钙组和补钙＋大豆异黄酮组，全身及股骨颈的骨密度（BMD）都较基线时显著降低（P〈0．05），组间变化无显著性差异（P〉0．05）；而腰椎、大转子BMD与基线相比，略微升高，但尚无统计学差异。补钙和补钙＋大豆异黄酮均能显著降低血总胆固醇（P〈0．05）。结论 对已出现骨量减少的绝经后妇女补钙一年能降低绝经后BMD的丢失速率，但补充大豆异黄酮一年尚未观察到对BMD的保护作用。绝经妇女补充钙和大豆异黄酮补可能干扰机体的血脂代谢。