绝经后妇女冠心病与激素替代疗法

冠心病为绝经后妇女的重要死因之一。绝经后妇女性激素水平下降引起血脂谱的变化。使冠心病发病率达绝经前4倍，雌激素水平的下降还使机体的抗氧化能力减弱，同时一氧化氮合成酶活性受抑加速了动脉粥样硬化斑块的形成，激素替代疗法作为预防和治疗绝经后妇女冠心病的一项有力措施，值得在临床上广泛应用。     

激素补充疗法防治绝经后骨质疏松的进展

激素补充疗法防治绝经后骨质疏松的进展林守清中国协和医科大学北京协和医院妇产科（１００７３０）林守清教授激素补充疗法（ｈｏｒｍｏｎｅｒｅ－ｐｌａｃｅｍｅｎｔｔｈｅｒａｐｙ，ＨＲＴ）是以补充雌激素为中心，以解决与雌激素不足有关的健康问题为目的的一种治疗方...     

激素替代疗法与绝经后妇女冠心病预防新进展

绝经后性激素替代疗法一直被认为有益于冠心病的预防，但198年以来大规模临床研究的结果却与此有异。本文就近年性激素替代方法与冠心病预防的进展方面进行综述。     

绝经后妇女激素替代治疗的利与弊

绝经后骨质疏松和冠心病的增加引起人们对激素替代治疗的兴趣，雌激素替代治疗又可能引起子宫内膜癌和乳腺癌的增加本文对孕酮并雌激素是治疗是否可以抵销激素治疗的副作用，同时是否对抗雌激素治疗的正效应，如何衡量激素替代治疗的利与弊，激素替代治疗的适应症以及应注意的问题进行综述。     

绝经后激素治疗的利与弊

女性绝经后因卵巢功能减退直至完全丧失,对机体可产生广泛影响,表现为围绝经期症候群,与性激素有关的组织器官退化,还与骨质疏松症、心血管疾病及老年性痴呆等有关。     

对绝经后妇女冠心病雌激素替代治疗的新认识

长期以来人们相信雌激素对绝经期妇女心血管的保护作用,然而1998年年和2000年先后发表的大型随机循证临床试验HERS和ERA结果令人失望。2000年ACC会议建议患冠心病的绝经期妇女用激素替代疗法作为二级预防是不适宜的,但已经接受激素治疗的妇女继续应用激素还是可取的。     

上海地区绝经后妇女骨质疏松危险因素分析

目的 探讨上海地区绝经后妇女骨质疏松的危险因素.方法 2008年6月至2008年9月从上海城市社区中年龄在45～80岁的绝经后妇女中随机抽取曾经双能X线骨密度测量仪测定并经临床医生确诊为骨质疏松者250人作为患者组,随机抽取非骨质疏松者250人作为对照组进行病例-对照研究.结果 单因素Logistic回归分析结果显示,年龄、文化程度、职业、绝经年限、体质指数(BMI)、是否经常摄入高钙食物及晒太阳、既往有非外伤性骨折、经常跌倒、糖尿病、慢性胃病、胃肠切除和腹泻与骨质疏松有关.多元Logistic回归模型进行分析显示,年龄、绝经年限、营养状态与骨质疏松关系最密切.结论 上海地区绝经后妇女发生骨质疏松与多种因素有关,早绝经、BMI低及老年妇女尤其要注意骨质疏松的防治.     

雌激素替代疗法防治绝经后妇女冠心病60例临床观察

流行病学资料显示 ,绝经后妇女血脂紊乱是其冠心病发病的主要原因 ,因此 ,绝经后冠心病患者雌激素变化和血脂的关系已成为当前的研究热点之一。国外研究表明 ,应用雌激素替代疗法 (ERT)可以减少绝经后妇女心血管疾病的危险性本文试用 ERT治疗绝经后冠心病患者 ,以观察其临床疗效。资料与方法 :本文绝经后冠心病患者 12 0例 ,均符合《内科学》中冠心病的诊断标准 ,年龄 5 1～ 5 4岁 ,平均 5 2± 1.4岁 ;绝经时间 2～ 3年。无肝、肾及其他内分泌疾病 ,近 1个月无服用类固醇激素及降血脂药物史。随机分为两组 ,其中治疗组 6 0例 ,每日口服倍…     

绝经后妇女骨代谢生化指标的临床观察及应用

目的 研究早期绝经后妇女4种骨生成和骨吸收生化指标的变化及与骨密度(BMD)的关系。方法将107例绝经后妇女分为对照组和治疗组(钙剂组，钙剂 利维爱组)。分别于治疗前和治疗后测定碱性磷酸酶(ALP)、骨钙素(OC)、抗酒石酸酸性磷酸酶(TrACP)、1型胶原羧基端端肽(CTx)。并与骨密度测定方法比较。结果对照组骨吸收生化指标1年后出现降低，治疗组于治疗后1个月和3个月出现不同程度的骨代谢生化指标的改变，TrACP和CTx改变早且显著。骨密度在治疗后3个月未见改变，1年后出现骨密度增加。结论骨密度测定对于早期监测骨质疏松症的治疗效果没有意义，TrACP和CTx可作为敏感的早期监测骨代谢变化生化指标。     

上海地区绝经后妇女骨质疏松危险因素分析

目的 探讨上海地区绝经后妇女骨质疏松的危险因素.方法 2008年6月至2008年9月从上海城市社区中年龄在45～80岁的绝经后妇女中随机抽取曾经双能X线骨密度测量仪测定并经临床医生确诊为骨质疏松者250人作为患者组,随机抽取非骨质疏松者250人作为对照组进行病例-对照研究.结果 单因素Logistic回归分析结果显示,年龄、文化程度、职业、绝经年限、体质指数(BMI)、是否经常摄入高钙食物及晒太阳、既往有非外伤性骨折、经常跌倒、糖尿病、慢性胃病、胃肠切除和腹泻与骨质疏松有关.多元Logistic回归模型进行分析显示,年龄、绝经年限、营养状态与骨质疏松关系最密切.结论 上海地区绝经后妇女发生骨质疏松与多种因素有关,早绝经、BMI低及老年妇女尤其要注意骨质疏松的防治.     

CALCIUM METABOLISM AND OSTEOPOROSIS IN CORTICOSTEROID-TREATED POSTMENOPAUSAL WOMEN

Abstract Osteoporosis is a common complication of corticosteroid therapy and it is associated with both decreased bone formation and increased bone resorption. We have measured radiocalcium absorption and the fasting urinary calciumkreatinine and hydroxy-prolinekreatinine ratios in 30 postmenopausal women receiving prednisolone therapy and compared the patients with normal spine radiographs (N= 14) with those whose spine radiographs showed osteoporosis (N=16). The osteoporotic cases had lower radiocalcium absorption (p < 0.001), higher fasting urinary calcium (p < 0.05), and higher fasting urinary hydroxyproline excretion (p < 0.001). As calcium absorption has a positive effect on calcium balance and urinary calcium a negative effect, the difference between these two variables was calculated in each case. This derived variable (radiocalcium absorption—fasting urinary calciumkreatinine) disclosed a greater difference between the osteoporotic and normal groups (p < 0.0001) than either variable alone.     

绝经后取宫内节育器235例临床分析

目的：为探讨与绝经的取环困难的相关因素。方法：对235例绝经后取环病例有关的取环年龄、绝经年数、术前雌激素应用以及取环原因等进行回顾性分析。结果：显示取环困难与年龄、绝经年数、取环原因及术前雌激素准备有关。结论：经后取环以断经1年左右为好,绝经1年以上取环前应用少最雌激素,可降低手术难度,提高手术成功率。     

CALCITONIN AND POSTMENOPAUSAL OSTEOPOROSIS

Fasting serum calcitonin levels were measured in 54 postmenopausal women who had for 10 years been taking part in a double blind trial to assess the effect of the synthetic oestrogen, mestranol, on postmenopausal bone loss. There were no differences in calcitonin levels between mestranol treated and placebo groups. Fifteen of the women were challenged with a calcium infusion to measure the secretory reserve of calcitonin. Oestrogen treatment did not increase the calcitonin response to calcium infusion. The three patients who exhibited the greatest responses were placebo treated. Bone density was measured by gamma-ray absorptiometry over the ten year period and the annual rate of change of bone density calculated. No correlation could be found between basal calcitonin level or calcitonin reserve and change in bone density. Our results indicate that postmenopausal osteoporosis is not caused by a deficiency of calcitonin and that the action of oestrogen therapy to prevent bone loss does not involve calcitonin.     

SEX HORMONE BINDING GLOBULIN IN POSTMENOPAUSAL WOMEN: A PREDICTOR OF OSTEOPOROSIS SUPERIOR TO ENDOGENOUS OESTROGENS

To quantify the role of endogenous oestrogen activity in osteoporosis we measured relative metacarpal cortical area (RCA), body mass, serum oestrone, oestradiol, androstenedione, and sex hormone binding globulin (SHBG) in 746 postmenopausal women aged 53 to 76 years, sampled from the general population. The occurrence of fractures and the rate of loss of RCA (delta-RCA) were determined over the previous 9 years. Both RCA and delta-RCA were significantly related to body mass, serum oestrone, oestradiol, and SHBG. The influence of the first three variables appeared to be bone preserving, whereas the latter appeared to be bone wasting. Serum oestradiol, SHBG and body mass proved to have an independent relationship with RCA in multivariate regression analysis. The relationship to delta-RCA was statistically independent for serum SHBG only. Serum androstenedione was unrelated to either RCA or delta-RCA. In the total study population, body mass, serum oestrone, oestradiol and SHBG were not related to the occurrence of fractures over the previous 9 years. In the subgroup of 249 elderly women, aged 65-76 years, SHBG levels were significantly higher for women with type I osteoporotic fractures (vertebral and forearm fractures) as compared to controls. The results suggest a bone wasting influence of SHBG in postmenopausal women, possibly resulting in an increased risk of type I osteoporotic fractures in elderly women.     

EFFECTS OF TREATMENT WITH OESTRADIOL/LEVONORGESTREL ON BONE, LIPOPROTEINS AND HORMONE STATUS IN POSTMENOPAUSAL WOMEN

The aim of the study was to investigate the effects of an oestradiol/levonorgestrel regimen, administered parenterally, on bone metabolism, bone density, lipoprotein metabolism and hormone status. Twenty-five women who had undergone a surgical menopause had an oestradiol/levonorgestrel-containing vaginal ring pessary in situ for 6 months. Within the first month there were sustained changes in the biochemical indices of bone metabolism in keeping with a marked reduction in bone turnover and decrease in bone resorption. Bone mineral content in the distal forearm was measured in 14 patients and a small increase was noted in every patient. Levonorgestrel was well absorbed and the serum levels remained almost constant throughout treatment. There was a gradual increase in serum total oestradiol which became significant at 6 months. Dialysable oestradiol levels rose from 2.6% of total oestradiol at 0 time to 3.3% at 1 month with no further change thereafter. SHBG levels were 23% of pretreatment levels at 6 months. There were sustained decreases in triglyceride, VLDL and HDL cholesterol levels and a transient fall in LDL cholesterol. Total HDL, HDL2 and HDL3 cholesterol levels were reduced by 25, 40 and 21% respectively. The results suggest that levonorgestrel exerts a protective influence on bone either directly or by its effect on the proportion of oestradiol circulating in the free, physiologically active form. The effects on lipoproteins were predominately those of the progestogen component, the lipoprotein risk factors for coronary heart disease being adversely affected.     

HYPERCORTISOLAEMIA AND LACK OF SKELETAL RESPONSE TO OESTROGEN IN POSTMENOPAUSAL WOMEN

Measurements of plasma ‘cortisol’ and metacarpal mineral content were made in seventy-two postmenopausal women of whom one half had been taking 20-40 μg mestranol daily for 1-3 years. Urinary free ‘cortisol’ (UFC) was also measured in just over one half of these women. Significant increases in plasma ‘cortisol’ and metacarpal mineral content were found in the mestranol treated women. The greatest bone mineral response was found in those women with plasma ‘cortisol’ concentrations in the range 36-45 μg/100 ml. A significant inverse relationship was found between UFC and metacarpal mineral change. These findings imply that failure of the skeleton to respond to oestrogen therapy might result from a relative increase in adrenocorticoid activity. It is suggested that the measurement of plasma ‘cortisol’ and UFC may be of value in monitoring the treatment of patients on long-term oestrogen therapy.     

老年妇科恶性肿瘤化疗毒副反应的临床研究

目的探索老年妇科肿瘤化疗毒副反应的特点。方法回顾性分析比较了妇科肿瘤化疗的老年妇女23例和中青年妇女27例的化疗毒副反应。结果虽然患恶性妇科肿瘤的老年妇女有较多的合并症,但化疗的毒副反应与中青年无显著性差异。结论老年妇女经积极治疗原发病,能耐受化疗毒副反应。     

THE DIAGNOSTIC VALIDITY OF LOCAL AND TOTAL BONE MINERAL MEASUREMENTS IN POSTMENOPAUSAL OSTEOPOROSIS AND OSTEOARTHRITIS

Assessment of different forms of prevention and treatment of bone mineral loss depends upon valid and precise methods to assess bone mass. We have here studied four groups of women: 45 healthy premenopausal women, 37 healthy postmenopausal women, 21 women with osteoarthritis and 20 with hip fractures. Bone mass was measured in the spine and total body by dual photon absorptiometry and in two forearm sites (proximal and distal bone mineral content (BMC) by single photon absorptiometry. The long-term (1 year) reproducibility was 1.2% for proximal BMC, 1.6% for distal BMC, 5.5% for spinal BMC, and 2.1% for total body bone mass (TBBM). In the early postmenopausal years bone mass was mainly reduced in areas with a high content of trabecular bone. In elderly postmenopausal women and women with hip fractures bone mass was almost identical in all four sites studied. The osteoarthritic patients had an 18% reduction of bone mass in the forearms and in TBBM, whereas the spinal bone mass was only reduced by 6%. In all subgroups TBBM could be predicted from the forearm measurements with standard errors of estimates of 9-13%. When the osteoarthritic women were excluded spinal bone mass could be predicted from both forearm measurements with a standard error of 15% (r = 0.74). The distal forearm BMC seems to be a more accurate estimate of spinal bone mass than does the proximal measurement. Of the 20 patients with hip fracture 16 had a distal forearm value below the premenopausal normal range, whereas spinal bone mass was subnormal in only eight (P less than 0.05). We conclude that bone loss is universal in patients with hip fracture and measurements of forearm bone mass will meet most clinical and research demands.     

INFLUENCE OF OESTRADIOL AND PROGESTERONE ON PULSATILE LH SECRETION IN POSTMENOPAUSAL WOMEN

Pulsatile LH secretion was studied in six healthy postmenopausal women. Blood samples were obtained every 10 min during an 8-h saline infusion performed before and during the administration of transdermal oestradiol alone (E2; 50 micrograms/day) and in combination with vaginal progesterone (P; 100 mg twice daily). Plasma E2 and P levels reached values similar to those found in the early follicular phase and in the luteal phase of the menstrual cycle, respectively. The mean plasma LH levels significantly decreased (P less than 0.01) during transdermal E2 with and without vaginal P. A significant increase in the frequency (P less than 0.025) and the amplitude (P less than 0.05) of LH pulses was observed during transdermal E2. The administration of vaginal P to oestrongenized women significantly blunted the frequency (P less than 0.05) and enhanced the amplitude (P less than 0.05) of LH pulses. In all experimental conditions, the mean plasma LH levels showed a positive linear correlation with the amplitude of LH pulses. The present results show that peripheral levels of E2, similar to those of the early follicular phase of the menstrual cycle, can influence the pulsatile pattern of LH secretion, enhancing the frequency and the amplitude of LH pulses. In oestrogenized patients, the increase of peripheral P plasma levels to postovulatory values restored a pulsatile pattern of LH secretion similar to that of the early luteal phase of menstrual cycle.