绝经后应用小剂量倍美力阴道细胞学评分与血清雌二醇的观察

绝经后因性激素水平低下而出现阴道萎缩，导致阴道干痛和性交困难，影响绝经后妇女生活质量。激素替代治疗（HRT）可以延缓或改善阴道的萎缩状况。为了观察小剂量倍美力（CE）对阴道的影响及与血清雌二醇（E2）及绝经时间（PMT）的关系，本研究检测1998年9月至1999年5月自愿接受小剂量CE配伍安宫黄体酮（MPA）64例妇女HRT前与HRT后半年的阴道细胞学评分（V分）及E。的变化，报道如下。资料与方法一、研究对象：自然绝经正年以上，有完整子宫，绝经后无阴道出血、从未使用过任何性激素类药物。年龄52．9I4．3（42～64）岁，绝经年…     

戊酸雌二醇/雌二醇环丙孕酮片用于围绝经期的临床观察

目的观察戊酸雌二醇/雌二醇环丙孕酮片用于围绝经期的临床效果。方法对有围绝经期症状患者59例采用戊酸雌二醇/雌二醇环丙孕酮片治疗。观察治疗前后雌二醇(E2)、卵泡刺激素(FSH)、子宫内膜厚度变化情况。结果治疗后E2、FSH、子宫内膜厚度等均有所改善,与治疗前比较差异均有统计学意义(P<0.05)。结论戊酸雌二醇/雌二醇环丙孕酮片用于围绝经期效果显著,无不良反应,值得临床推广应用。     

戊酸雌二醇用于绝经过渡期及绝经后妇女激素补充治疗的效果及风险评估

目的：分析戊酸雌二醇用于绝经过渡期及绝经后妇女激素补充治疗的效果并评估治疗风险。方法选择87例绝经过渡期及绝经后妇女,按相关标准予戊酸雌二醇贯序给药,分析治疗前后的Kupperman评分,检测雌二醇（E2）、卵泡刺激素（FSH）及血脂水平。彩超测定子宫内膜厚度及骨密度（BMD）,并观察服药后不良反应。结果激素补充治疗后绝经过渡期及绝经后妇女Kupperman 症状评分较治疗前显著降低（t＝10．58～12．47,均P＜0．05）;TC、TG及LDL-C分别为（4．94±0．78）mmol/L、（1．16±0．58）mmol/L及（2.17±0．45）mmol/L,均较治疗前显著降低（t＝11．42、13．56、12．18,均P＜0．05）。 FSH 下降至（19．7±8．5）IU/L,而E2水平治疗后升高至（76．3±11．3）pmol/L,与治疗前差异均有统计学意义（t＝22．44、21．05,均P＜0．05）。使用激素补充治疗后BMD为（0．77±0．20）g/cm2,平均子宫内膜增厚（7．0±1．4）mm,与治疗前差异均无统计学意义（t＝3．29、7．21,均P＞0．05）。未见严重不良反应。结论在掌握适应证、控制服药风险基础上,戊酸雌二醇激素补充治疗可明显改善妇女绝经过渡期及绝经后症状。     

探索戊酸雌二醇并用醋甲羟孕酮疗法的最佳方案

目的 :探索戊酸雌二醇 (E2 V )并用醋甲羟孕酮 (MPA)疗法的最佳方案。方法 :91名绝经后妇女分 5组。组 1(18人 )用碳酸钙 0 .5g ,tid ;组 2 (17人 )用E2 V 1mg ,qd ;组 3(17人 )用E2 V 1mg与MPA 1mg ,qd ;组 4 (2 0人 )用E2 V 1mg与MPA2mg ,qd和组 5 (19人 )用E2 V 1.5mg与MPA 2mg ,qd。均 po ,3mo。每日记录症状 ,用药前后测血雌二醇、子宫内膜厚度、子宫内膜细胞及病理学检查。结果 :E2 V 1mg ,qd与 1.5mg ,qd缓解绝经症状相似 ;治疗 3mo时组 2和组 3子宫内膜增厚 ,分别为(3.2±s 1.2 )mm和 (1.8± 0 .9)mm ,(P <0 .0 1) ;组 3,4 ,5阴道出血率分别为 2 9% ,5 0 % ,5 8% ;用药前后子宫内膜细胞病理学检查均无病变。结论 :有子宫绝经后妇女使用E2 V 1mg和MPA 2mg ,qd ,为最佳方案。     

二苯乙烯苷的雌激素样作用及其对性未成熟小鼠子宫ER表达的影响

目的:探讨二苯乙烯苷(TSG)的雌激素样作用,以及其对性未成熟小鼠子宫雌激素受体(ER)表达的影响。方法:将60只性未成熟雌性昆明种小鼠随机分为正常组,阳性对照组(戊酸雌二醇,0.18 mg/kg),TSG低、高剂量组(50、150 mg/kg),TSG低、高剂量+戊酸雌二醇组(剂量同单用组)。正常组小鼠灌胃等体积水,各给药组小鼠灌胃相应药物溶液0.2 mL/10 g,早晚各1次,连续5d。末次给药次日,测定并计算各组小鼠子宫指数和体质量增幅;采用酶联免疫吸附测定法检测其血清雌激素[雌二醇(E_2)、黄体生成素(LH)、卵泡雌激素(FSH)]含量;采用苏木精-伊红染色法观察其子宫组织形态学特征,并检测子宫管径和子宫内膜厚度;采用免疫组织化学染色法检测其子宫组织中ER(ER-α、ER-β)的表达水平。结果:正常组小鼠子宫肌层排列平行、紧密,子宫上皮呈单层柱状,ER-α、ER-β表达较少;各给药组小鼠子宫管径、内膜及上皮均不同程度地增大、增厚或增生,ER-α、ER-β表达有所变化。与正常组比较,各给药组小鼠子宫指数(阳性对照组、TSG高剂量组、TSG各剂量+戊酸雌二醇组)、体质量增幅(阳性对照组、TSG高剂量组、TSG低剂量+戊酸雌二醇组)、子宫管径及内膜厚度(阳性对照组、TSG低剂量组、TSG各剂量+戊酸雌二醇组)、ER-α的表达量(阳性对照组、TSG各剂量+戊酸雌二醇组)、ER-β的表达量(阳性对照组、TSG高剂量组+戊酸雌二醇联用组)均显著升高,血清LH(阳性对照组、TSG高剂量组)、FSH(TSG低剂量+戊酸雌二醇组)水平均显著降低(P<0.05或P<0.01);TSG各剂量+戊酸雌二醇组小鼠子宫指数、子宫管径及内膜厚度、ER-α及ER-β的表达量以及TSG低剂量+戊酸雌二醇组小鼠体质量增幅、血清E_2含量均显著高于TSG同剂量单用组(P<0.05或P<0.01);TSG各剂量组小鼠子宫指数、子宫管径及内膜厚度、ER-α及ER-β的表达量,TSG各剂量+戊酸雌二醇组小鼠子宫管径、ER-β的表达量以及TSG低剂量组小鼠体质量增幅均显著低于阳性对照组,而TSG各剂量+戊酸雌二醇组小鼠血清LH水平均显著高于阳性对照组(P<0.05或P<0.01)。结论:TSG可一定程度地增加性未成熟小鼠的子宫指数和体质量,并调节其体内雌激素水平,增加子宫管径及内膜厚度,上调子宫组织中ER的表达,具有一定的雌激素样作用。但这种作用弱于戊酸雌二醇,且两者联合使用可能会拮抗戊酸雌二醇的作用。     

子宫内膜萎缩疗法治疗青春期功血362例临床研究

目的：探讨子宫内膜萎缩疗法治疗青春期功血（DUB）的止血效果。方法：将362例平均分为观察组（采用炔诺酮、戊酸雌二醇联合疗法止血）和对照组（单用炔诺酮子宫内膜萎缩疗法止血），两组各181例，比较两组的止血效果。结果：观察组和对照组止血有效率分别为96．13％（174／181）和92．27％（167／181），两组比较差异无统计学意义（踟105）；观察组和对照组控制出血时间分别为（28．69±14．87）h和（29．72±15．34）h，两组比较差异无统计学意义（踟．05）。观察组和对照组的完全止血时间分别为（32．80±19．10）h和（47．30±18．60）h，两组比较差异有统计学意义（／9〈0．05）。观察组和对照组的住院天数平均为（6．10±2．80）d和（6．9±2．60）d，观察组住院时间短于对照组（P〈0．01）。结论：炔诺酮止血疗法和炔诺酮、戊酸雌二醇联合疗法治疗青春期功血效果均较好，但炔诺酮、戊酸雌二醇联合疗法治疗效果更佳。     

冥想训练配合健康教育对低剂量激素替代治疗围绝经期综合征临床效果的影响

目的：探讨小剂量激素替代治疗（ HRT）配合冥想训练及健康教育对围绝经期综合征临床疗效的影响。方法选择符合围绝经期综合征临床诊断的患者90例,以就诊时间随机分为2组,每组45例。Ⅰ组为低剂量HRT （口服利维爱片）配合冥想训练及健康教育;Ⅱ组为小剂量HRT（口服利维爱片）。利维爱片连服28 d为1周期,共3周期。完成治疗后3个月、6个月观察绝经症状变化（改良kuppernann指数）及性激素水平。结果完成治疗3个月、6个月后进行随访,Ⅰ组患者kuppernann评分低于Ⅱ组,且差异有统计学意义（ P ＜0?．05）。性激素水平Ⅰ组、Ⅱ组治疗后与治疗前比较差异有统计学意义（ P ＜0．05）;治疗后Ⅰ组与Ⅱ组比较差异有统计学意义（ P ＜0．05）。结论冥想训练及健康教育能改变人的认知与不合理的思维方式,能显著提高低剂量HRT围绝经期综合征临床疗效,是围绝经期综合征治疗和保健中不可缺少的措施。     

替勃龙联合甲硝唑治疗老年性阴道炎的疗效观察

目的：观察替勃龙（利维爱）联合甲硝唑治疗老年性阴道炎的临床疗效。方法将老年性阴道炎患者64例随机分为观察组34例和对照组30例。观察组给予利维爱联合甲硝唑治疗,对照组给予甲硝唑治疗,对比2组患者治疗效果及血清指标、子宫内膜厚度改善情况。结果观察组总有效率为94.12%显著高于对照组的76.67%,差异有统计学意义（P ﹤0.05）。对照组治疗前后血清 FSH、E2及子宫内膜厚度均无显著改善（P ﹥0.05）,观察组治疗后 FSH 显著下降,E2显著升高,子宫内膜厚度显著增大,差异均有统计学意义（P ﹤0.05）。结论在老年性阴道炎治疗中,利维爱联合甲硝唑可发挥显著治疗效果,可对患者临床症状予以有效改善,显著提高患者生活质量,值得在临床中推广。     

戊酸雌二醇与黄体酮胶囊联用治疗无排卵型月经不调患者的临床研究

目的 探析戊酸雌二醇、黄体酮胶囊联用治疗无排卵型月经不调患者的临床效果。方法 从2020年5月至2022年5月医院妇产科诊治的无排卵型月经不调患者中选择50例为研究对象,按照数字随机表将其分为对照组和观察组,25例/组,对照组予以戊酸雌二醇治疗,观察组采用戊酸雌二醇、黄体酮胶囊治疗。比较两组治疗前后的性激素,包括促卵泡成熟激素(FSH)、雌二醇(E₂)、孕酮(P);同时统计两组临床治疗总有效率、不良反应率、月经时长、子宫内膜厚度及月经周期。结果 观察组治疗总有效率为96.00%,高于对照组的76.00%(P <0.05);观察组不良反应发生率为8.00%,低于对照组的16.00%,但差异无统计学意义(P> 0.05);观察组治疗后E₂、P水平较治疗前升高且高于对照组,且FSH水平较治疗前降低且低于对照组(P <0.05);观察组月经时长及月经周期均短于对照组,且子宫内膜厚度小于对照组(P <0.05)。结论 戊酸雌二醇、黄体酮胶囊联用治疗无排卵型月经不调患者能够有效改善性激素,缩短月经时长和月经周期,子宫内膜厚度减小,...     

坤泰胶囊联合克罗米芬在 PCOS 不孕症中促排卵的疗效观察

目的：研究坤泰胶囊联合克罗米芬（ clomifene citrate capsules,CC）对多囊卵巢综合征（ polycystic ovary syndrome,PCOS）引起的不孕症患者的促排卵疗效。方法前瞻性研究80例PCOS不孕症患者,试验组口服坤泰胶囊,2个月后联合应用CC促排卵1个周期,对照组单纯应用CC促排卵1个周期。比较2组患者基本资料,加用HMG的例数和剂量,诱排日子宫内膜的厚度和形态,排卵率和妊娠率。结果2组患者基本资料差异无统计学意义（P ＞0．05）。试验组诱排日子宫内膜厚度和“A”型内膜的比例均显著高于对照组,差异有统计学意义（ P ＜0．05）。而“B”型和“C”型内膜的比例2组差异无统计学意义（ P ＞0．05）。试验组与对照组排卵率分别为80．9％和57．5％,差异有统计学意义（ P ＜0．05）,试验组宫颈黏液评分显著高于对照组,试验组妊娠率（31．3％）高于对照组（30．4％）,但差异无统计学意义（ P ＞0．05）。结论坤泰胶囊对PCOS不孕症患者在促排卵方面对内膜、排卵、宫颈黏液性状及最终妊娠率均有积极作用,是一种可供选择的促排卵辅助药物。     

HRT and osteoporosis.

Osteoporosis is characterised by low bone mass, leading to an increased risk of fragility fracture, particularly in the femoral neck, vertebrae and radius. These fractures constitute a major public health problem in the Western world; the estimated annual cost to the health services of hip fracture alone is over 500 million pounds in the United Kingdom. Using population-based data from the USA, Cummings et al. have estimated that the lifetime risks of hip, vertebral and Colles' fractures in a 50 year old, white, postmenopausal woman are 16%, 32% and 15% respectively. Of these, vertebral fractures probably cause the most significant morbidity, since they occur at a younger age than hip fractures and may result in pain, deformity and disability for many years until death intervenes from other causes. Hip fractures occur most commonly in the eight and ninth decades of life and have a mortality at six months of around 15%, increased dependency occurring in the majority of survivors. Colles' fractures, although not usually associated with long-term morbidity, nevertheless cause considerable inconvenience and require hospital treatment.     

HRT,尚不可取代——访中华医学会妇产科学会绝经学组组长郁琦教授

2007年4月19日,Lancet在线提前发表了"百万妇女研究"(MWS)的最新结果,研究表明,激素补充治疗(HRT)可增加妇女患卵巢癌的风险,正在用HRT者较从未用者,风险增高了20%。用HRT少于5年者,其风险没有增加;过去曾用者与从未用HRT者的风险相似。各种类型的HRT之间,风险无显著差异。这一新的研究结果,让HRT的致癌风险,从原来的乳腺癌风险和子宫内膜癌风险,又扩大至卵巢癌。面对HRT这一新增加的风险,临床医生又该如何处之,HRT的应用会否走上一个转折点?本刊有幸采访到了中华医学会妇产科学分会绝经学组的组长、北京协和医院妇产科郁琦教授,郁教授向我们讲述了HRT的研究及应用现状,合理公正地评价了HRT在临床中的地位,并解答了我们心中的疑问。     

Nanoparticle delivery for transdermal HRT

Nanomedicine is an emerging technology and the first nano-engineered medical products have come to light in the last decade. Transdermal drug delivery has significant advantages compared to other routes of drug administration. Nanoparticles unique physical and chemical properties enable transport of substances directly into the skin. The objective of this paper is to review different aspects of nanoparticle delivery, generally, and discuss its current use for transdermal hormone therapy. Transdermal estrogen therapy remains the most effective treatment for bothersome menopausal symptoms, particularly in those women for whom the potential adverse effects associated with “first pass” hepatic metabolism are to be avoided. Available alternatives for transdermal estrogen delivery include patches, gels, sprays and lotions. Other non-oral therapies which likewise avoid “first pass” hepatic metabolism include: subcutaneous implants and vaginal rings. Some of the transdermal products are associated with mild adverse skin effects such as redness and irritation, but more severe and bothersome consequences include blistering and tattooing. Even the mild adverse skin effects are frequently cited as reasons for discontinuation. Micellar nanoparticle estradiol emulsion (MNPEE) is a lotion-like therapy which constitutes an alternative transdermal delivery system not requiring the permeation enhancers or temporary skin digestion, both of which increase the possibility of irritation. MNPEE's advantages include low fluctuation of plasma estradiol concentrations, infrequent skin related adverse effects, and pleasant cosmetic-like moisturizing properties. The efficacy of MNPEE for management of menopausal vasomotor symptoms has been demonstrated in a randomized placebo controlled trial,¹ and the product is FDA approved for management of moderate to severe vasomotor symptoms. None of the observed adverse effects in the MNPEE group were statistically different from the placebo group.¹ Studies addressing inadvertent transference of estradiol to the male partners of menopausal women using this delivery technology have demonstrated small, but real amounts of transference, which do not exceed the normal physiological male estradiol range. MNPEE is safe and effective for treatment of vasomotor symptoms and represents the commercial validation of nanoparticle technology for transdermal delivery of estrogen therapy (ET) for postmenopausal women with vasomotor symptoms.     

HRT: developments in therapy.

Various forms of oestrogen have been available for use as Hormone Replacement Therapy (HRT) for approximately 50 years. However, there has been little change in the mode of administration until the last 10-15 years. Although the oral route has remained the mainstay of therapy, non-oral routes of administration have been developed. During the 1970s it became clear that use of unopposed oestrogens in women with an intact uterus resulted in an increase in risk of endometrial carcinoma and thus the current practice of adding a sequential progestogen each month, to prevent endometrial hyperplasia, was introduced. However, certain progestogens can cause side-effects and some of the metabolic changes which they induce are potentially undesirable. Thus the search continues for new oral progestogens which are more 'metabolically friendly' than those in current use. Additionally, non-oral delivery systems for progestogens have been studied, such as the transdermal route (patches) and local administration within the uterine cavity (progestogen-containing intra-uterine devices). Both these strategies may minimise their symptomatic, psychological and metabolic effects. Continuous (every day) administration of progestogens in combination with the oestrogen, or the use of new compounds (e.g. tibolone) may overcome the problem of regular withdrawal bleeding which some women find unacceptable. However, it remains to be determined whether such therapies are as efficacious as conventional oestrogen/sequential progesterone regimens.     

百万妇女研究:卵巢癌与HRT

绝经后卵巢激素替代治疗的应用正在减少,主要原因是由于有几项较为可信的研究报告指出,绝经后激素治疗与乳腺癌有关。在4月19日在线发表的Lancet杂志中,Valerie Beral和其同事报告了来自百万妇女研究(MWS)的最新结果。使用激素替代治疗(HRT)的妇女还将面临卵巢癌风险的增高,至少是在使用HRT期间如此。