女性支气管哮喘的独特因素：绝经?性激素治疗?

支气管哮喘是一种常见的呼吸系统疾病,表现为反复发作的喘息、气急和胸闷等,发病急骤,病情多变,严重时危及生命,给个人和社会带来沉重的负担。女性支气管哮喘的独立影响因素包括过敏原、遗传和环境等,研究表明绝经及性激素治疗也可能是其重要的影响因素。目前国内关于绝经及性激素治疗与支气管哮喘的研究较少,临床医师对此认知不足,容易给围绝经期女性的支气管哮喘的预防和治疗造成困扰。通过总结国内外最新研究,综述绝经、性激素治疗对支气管哮喘发生的影响及作用机制,以期为临床医师提供诊疗指导,为围绝经期女性提供更好的三级预防服务。     

性激素替代治疗对围绝经期子宫肌瘤的影响

目的探讨性激素替代治疗对围绝经期子宫肌瘤的影响。方法回顾性分析我院收治的围绝经期子宫肌瘤患者68例的临床资料,并采用性激素替代疗法进行治疗,观察其疗效。结果患者通过性激素治疗后,子宫肌瘤略增大,差异无统计学意义(P0.05)。治疗后促卵泡生成素降低、雌激素升高,差异有统计学意义(P0.05)。结论对围绝经期子宫肌瘤的患者进行性激素替代治疗,虽然治疗后患者的子宫肌瘤在治疗前的基础上有所增大,但是可以有效改善患者在围绝经期的临床症状,提高患者的生活质量,应做好相关的随访工作。     

植物类药物治疗围绝经期综合征的研究进展

围绝经期综合征是每个女性都可能面临的问题,性激素治疗是围绝经期综合征经典的治疗手段,但因性激素使用的禁忌证及不良反应导致许多女性不能接受治疗,植物类药物因其在围绝经期综合征治疗中的安全性较高而倍受国内外学者的关注。近年来大量的临床研究肯定了部分种类药物的有效性,也对部分药物的作用提出质疑。本文对临床研究中常见的植物类药物的有效性及安全性进行总结归纳。     

多学科联合管理对女性围绝经期综合征的疗效分析

目的探讨围绝经期多学科联合管理对女性围绝经期综合征整体治疗效果的影响。方法观察性研究182例围绝经期综合征患者,随机分为观察组90例和对照组92例,两组患者均给予绝经激素补充治疗(MHT)6个月,观察组在MHT治疗的基础上进行多学科联合管理。填写改良Kupperman评分、焦虑自评量表(SAS)、抑郁自评量表(SDS),测定血清性激素水平。结果在激素补充治疗基础上联合多学科管理的围绝经期女性,治疗6个月后,其Kupperman评分及SAS、SDS评分下降程度、E2升高、FSH、LH下降程度,显著优于对照组。结论激素补充治疗的基础上联合多学科管理,可以显著缓解围绝经期妇女的躯体症状,还能够更好的改善焦虑、抑郁程度,提高围绝经期综合征患者的生存质量。     

第十二届国际更年期大会纪要

2008年5月19～23日在西班牙马德里召开了第十二届国际更年期大会。此次会议由国际更年期学会（International menopause society，IMS）主办。来自世界各国的数百名代表参加了这次会议，其中包括来自中国大陆的二十余名专家。会议的主题是妇女健康新挑战（New challenges in women＇s health）。内容涉及女性更年期的多个方面，如介绍新的临床研究、围绝经期和绝经期骨质疏松的预防、雄激素和女性性功能障碍、性激素及其治疗对大脑功能的影响、围绝经期心血管疾病的一级预防、绝经相关治疗的进展、生物一心理-文化因素对绝经和妇女健康的影响、绝经与代谢综合征以及胰岛素抵抗、激素治疗与乳腺癌、激素治疗与妇科肿瘤、卵巢早衰的处理、女性健康需求、更年期相关疾病治疗中的医患沟通、骨质疏松的治疗、绝经相关药物应用指南、激素之外的方法用于治疗更年期症状、乳腺癌的预防、     

卵巢癌治疗后的性激素应用

70%的卵巢癌患者初诊时已为中晚期,根治性手术往往需切除双侧附件.这对卵巢癌患者中相当比例的生育期妇女来说,由卵巢手术而去势不可避免在术后出现围绝经期综合征,严重影响其生活质量.性激素治疗(hormone therapy,HT)可以明显改善妇女绝经后的血管舒缩症状、泌尿生殖道萎缩、认知障碍、心血管症状、骨质疏松以及预防发生结肠癌,是治疗围绝经期综合征非常有效的方法.     

绝经期女性雄激素变化与代谢综合征

女性在绝经后内分泌激素发生一系列改变.绝经后的低雌激素状态对心血管疾病、血脂代谢及骨密度的影响现已明确.近年来,雄激素对于绝经后女性代谢综合征的关系受到越来越多的关注.在对绝经过渡期睾酮和性激素结合蛋白的相关研究发现,女性绝经过渡期存在相对雄激素过多,该状态可能与绝经后代谢综合征发病风险的增加相关.本文对女性体内各种雄激素来源及其在绝经期的变化,和绝经期相关的雄激素水平改变与代谢综合征的关系进行综述.     

护理干预对改善围绝经期女性生活质量及满意度的影响

目的观察护理干预对改善围绝经期女性生活质量及满意度的影响。方法选取我院妇产科2014年2月~2014年9月收治的围绝经期女性患者60例作为研究对象,将其随机分成A组和B组,各30例。B组进行常规护理,A组采用护理干预。结果治疗后,A组睡眠质量、生活质量均高于B组,差异有统计学意义(P0.05)。结论护理干预对改善围绝经期女性生活质量的效果较好,值得临床推广。     

单核细胞/高密度脂蛋白胆固醇比值与绝经后女性代谢综合征的相关性

目的:探讨外周血单核细胞与高密度脂蛋白胆固醇比值(MHR)与围绝经期及绝经后女性代谢性疾病的关系。方法:纳入594例围绝经期及绝经后女性，探讨代谢综合征(MS)发生的危险因素以及MHR对MS的预测能力。结果:肥胖症前期组的MHR大于体重正常对照组(0.25 vs 0.21,P<0.001)。糖尿病前期组的MHR大于血糖正常对照组(0.24 vs 0.21,P=0.020)。MHR与BMI、MS相关(rs=0.270,P<0.001;rs=0.408,P<0.001)，与空腹血糖无相关性(rs=0.056,P=0.203)。MHR、NLR、尿酸、白细胞为MS发生的危险因素。MHR对围绝经期及绝经后女性MS患者的诊断界值为0.210×10⁹/mmol，曲线下面积(AUC)为0.760(95%CI为0.709～0.810,P<0.001)，敏感度为79.5%，特异度为62.1%;MHR联合NLR及尿酸的AUC为0.834 (95%CI为0.791～0.877,P<0.001)，敏感度为73.2%，特异度为79.9%。结论:MHR可反应体内糖...     

血液病清髓性化疗后卵巢早衰患者的围绝经期症状研究

目的了解女性血液病清髓性化疗后卵巢早衰患者性激素治疗(hormone therapy,HT)前后围绝经期症状的发生情况及自我认知。方法 2011年12月至2013年12月,就诊于北京大学人民医院妇科门诊的女性血液病清髓性化疗造血干细胞移植术后符合诊断标准的卵巢早衰患者142例。问卷形式调查其月经情况、性激素水平、围绝经期症状并评估激素治疗后围绝经期症状缓解特点。结果 1 142例患者中103例填写了改良的Kupperman评分表,82例出现了围绝经期症状(79.6%),Kupperman绝经指数评分(KMI)平均为13.50分,96例填写了焦虑/抑郁(HAD)评分量表,6例出现焦虑,平均8.83分,4例出现抑郁,平均8.33分;2 105例接受了激素类药物治疗(94.6%),随访95例接受HT治疗患者中71例有规律撤退性出血。51例诉月经量明显少于移植前月经量,且经血颜色变暗,差异有统计学意义(P=0.00,P0.05);3周期性激素治疗后KMI总分平均为6.7,且下降有统计学意义。结论 1血液疾病清髓性化疗剂量可导致卵巢功能提早衰竭;2性激素治疗也可以缓解清髓化疗后患者出现的围绝经期症状;3血液疾病清髓化疗后卵巢早衰患者对围绝经期症状的认知缺乏。     

Management of cardiovascular risk in the perimenopausal women: a consensus statement of European cardiologists and gynecologists.

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis and management of cardiovascular risk. Key risk factors that need to be controlled in the perimenopausal woman are hypertension, dyslipidemia, obesity and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older postmenopausal women can be applied to younger perimenopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older postmenopausal women no longer displaying menopausal symptoms. Both gynecologists and cardiovascular physicians have an important role to play in identifying perimenopausal women at risk of cardiovascular morbidity and mortality, and should work as a team to identify and manage risk factors, such as hypertension.     

Hormontherapie in der Peri- und Postmenopause und Malignomrisiko

Hormone therapy (HT) with sex steroids in perimenopausal and postmenopausal women is often used for relief of postmenopausal symptoms. A possible tumor growth is one of the concerns of physicians and patients who are considering HT. Many malignant diseases of the female genital tract and breasts are hormone-dependent. It is known that the duration and amount of estrogen exposure in women correlates with the risk of breast cancer. On the other hand treatment with estrogen receptor blockers and aromatase inhibitors is highly effective in the treatment and prevention of breast cancer. In this article the known relevant changes of various cancer risks due to sex steroids are presented. A detailed assessment of the overall evidence on this issue is given in the S3 guidelines on hormone therapy in perimenopausal and postmenopausal women.     

'Menopausal symptoms': associations with menopausal status and psychosocial factors

This study investigated the relative importance of psychosocial factors as opposed to menopausal status in relation to so-called 'menopausal symptoms' among a large sample of premenopausal, perimenopausal and (naturally and surgically) postmenopausal women (n = 4308) in The Netherlands. The incidence of psychological, somatic, vasomotor and sexual symptoms was assessed and related to menopausal status and to measures relating to coping behaviors, (body- and self-) esteem and quality of life. Among the findings were that vasomotor symptoms in particular, and loss of interest in sex to a lesser extent, were relatively strongly associated with menopausal status. Psychological and somatic symptoms, however, were found to be more closely associated with psychosocial factors (although perimenopausal women as a group were found to suffer them most). Findings are discussed and interpreted as further evidence that only vasomotor symptoms may rightly be called 'menopausal'.     

绝经早期激素与中药治疗对认知记忆和生存质量的影响

目的:研究绝经早期激素和中药治疗对认知记忆和生存质量的影响。方法:收集绝经早期妇女104例,随机分为激素组和中药组各52例,治疗1年,每3个月随访1次,由专人进行简易智能精神状态量表(MMSE)和绝经期生存质量量表评分。结果:激素组和中药组在治疗后6个月、9个月、12个月MMSE评分较治疗前均有显著性提高(P<0.05)。绝经期生存质量量表中的血管舒缩症状、心理状态、生理状态方面,二组在治疗后各时间点上均比治疗前有明显提高(P<0.05)。性生活方面,激素组用药6个月开始出现明显改善,而中药组用药12个月始有明显提高。结论:绝经早期低剂量激素替代疗法和中药治疗1年对改善认知记忆和提高生存质量均有效。     

Menopausal vasomotor symptoms: a review of causes, effects and evidence-based treatment options

Vasomotor symptoms are the most common medical complaint of perimenopausal and postmenopausal women. Frequent vasomotor symptoms can be disabling, affecting a woman's social life, psychological health, sense of well-being and ability to work. Women with hot flushes are more likely to experience disturbed sleep, depressive symptoms and significant reductions in quality of life as compared to asymptomatic women. Despite the prevalence and impact of these symptoms, the pathophysiology of hot flushes is unclear; however, estrogen withdrawal clearly plays an important role. It is postulated that declining estrogen concentrations may lead to changes in brain neurotransmitters and instability in the hypothalamic thermoregulatory center. The most effective therapy for relieving vasomotor symptoms and reducing their impact on quality of life is hormone therapy. Other options for women who decline hormone therapy include selective serotonin reuptake inhibitors and related agents. Most herbal therapies that have been evaluated in placebo-controlled trials have shown no clinically significant benefit.     

围绝经期妇女抑郁症相关因素及预防策略

目的了解围绝经期妇女抑郁症的发病率、发病相关因素及预防策略。方法采用汉密顿抑郁量表、改良围绝经期症状评分表、生活事件量表、改良社会支持评定量表和一般资料调查表,于2007年1月至6月期间对广东地区112名围绝经期妇女进行调查。结果围绝经期妇女抑郁症的发生率为41.07%。经前期综合征、痛经程度、绝经、居住环境、抑郁史、生活事件量表总分、改良社会支持评定量表总分及Kupperman绝经指数是围绝经期妇女发生抑郁症的主要影响因素。结论围绝经期妇女抑郁症的发生率较高,除与性腺功能减退有关外,还与社会、家庭及精神因素有关。针对病因进行预防,可减少围绝经期妇女抑郁症的发生,提高妇女生活质量。     

Perimenopause and depression: strength of association, causal mechanisms and treatment recommendations

Perimenopause represents a significant transition in a woman's life. The evidence to support an association between perimenopause and depression is mixed, yet recent prospective studies have provided stronger evidence to support such an association. Interpretation of study data are complicated by methodological issues, such as a lack of standard definition for perimenopause or depression, reducing comparability. A variety of causal factors, including psychological, genetic and physiological, have been implicated in depression during perimenopause, which lends weight to a multifactorial model. Physicians should consider initiating dialogue about menopause and symptom relief at age 40 and screening perimenopausal women for depressive symptoms. Selective serotonin reuptake inhibitors are a first line of treatment for depression, but hormone therapy could be considered for women experiencing menopausal symptoms unless there are contraindications. Future research should focus on establishing temporality and studying these potential relationships among women of different ethnicities.     

青岛地区女性围绝经期症状流行病学调查分析

目的:调查青岛地区围绝经期女性围绝经期症状发生情况,并分析其相关危险因素。方法:2009年3月至2011年4月间分层调查青岛市区及近郊各社区1240名围绝经期女性,围绕围绝经期症状进行一般情况问卷调查。结果:(1)1240名围绝经期女性,平均初潮年龄(15.41±1.93)岁;平均绝经年龄(49.44±3.27)岁。(2)围绝经期的主要症状有健忘(76.6%),性欲减退(72.9%),性高潮障碍(63.3%),疲乏(59%);其次为易怒,入睡困难,情绪波动,睡眠障碍,心悸,阴道干燥,潮热,骨、关节、肌肉疼痛,尿急尿失禁,性交痛,皮肤感觉异常,眩晕,抑郁。(3)围绝经期症状的主要危险因素:健忘、焦虑、是否绝经、有无性生活、是否关注性生活、子女数、年龄、对绝经的态度(P<0.05)。结论:绝大多数围绝经期女性存在更年期症状,以轻度为主,应加强围绝经期保健工作,重视雌激素补充治疗及心理咨询。     

Changes in body composition at menopause--age,lifestyle or hormone deficiency?

One of the major concerns of perimenopausal women is obesity-and for a good reason. Both general and abdominal obesity as well as loss of skeletal muscle (sarcopenia) are accelerated through the menopausal transition and lifestyle changes as well as sex hormone deficiency play important roles. Most well conducted clinical trials have demonstrated hormone replacement therapy induced reversal or at least impairment of menopausal changes in body composition and the common worry that it causes weight gain is unsubstantiated. Coaching of weight loss in obese individuals is often a frustrating task but is nevertheless of immense importance because of the health hazards of obesity. Through the climacteric period, short-term hormone replacement therapy, with or without androgens for preservation of muscle mass, might inhibit obesity and this is likely to boost motivation for introduction of more comprehensive and long-lasting initiatives linked to persistent weight loss and long-term health benefit.