左炔诺孕酮宫内缓释系统预防乳腺癌患者服用他莫西芬所致子宫内膜息肉分析

目的:探讨左炔诺孕酮宫内缓释系统预防乳腺癌患者服用他莫西芬所致子宫内膜息肉效果。方法:随诊103例围绝经期及绝经后服用他莫西芬妇女随机分成2组,其中55例在服用他莫西芬前放置曼月乐环,48例作为对照组。治疗前及他莫西芬治疗12个月后分别行经阴道超声检查子宫内膜厚度及宫腔镜检查子宫内膜病理。结果:放置曼月乐环组发生子宫内膜息肉风险明显低于对照组(1.8%∶15.5%,P=0.02),发生子宫黏膜下肌瘤风险两组间差异无统计学意义(1.8%∶3.4%,P=1.0)。结论:左炔诺孕酮宫内缓释系统降低乳腺癌患者服用他莫西芬所致子宫内膜息肉的发生。     

乳腺癌术后他莫昔芬治疗患者子宫及卵巢病变情况的研究

目的：研究乳腺癌术后使用他莫西芬（Tamoxifen,TAM）治疗后发生子宫及卵巢病变的危险性。方法：采用配对研究方法,选取嘉兴巾第一医院20042008年63例乳腺癌手术患者,并进行随访观察。结果：63例乳腺癌病人,最长随访52个月,最短随访34个月,期间无失访和死亡。其中,实验组（42例）发生子宫内膜病变11例,子宫肌瘤8例,卵巢囊肿5例;对照组（21例）发现子宫内膜病变4例,子宫肌瘤2例,卵巢囊肿3例。实验组和对照组子宫及卵巢病变发病率差异有统计学意义,绝经前后发病率差异也有统计学差异,病理检查未发现子宫内膜癌。结论：他莫两芬有可能是子宫和卵巢病变的发病危险因素,但由于目前他莫西芬仍是乳腺癌治疗一线药物,对于长期接受他莫西芬治疗的病例,要定期进行子宫内膜检查,加强监测,定期随访。     

宫腔镜子宫内膜切除术对服用他莫昔芬的绝经后乳腺癌术后患者子宫内膜增生的抑制作用

目的探讨宫腔镜子宫内膜切除术对服用他莫昔芬的绝经后乳腺癌患者子宫内膜增生的抑制作用。方法选取服用他莫昔芬的绝经后乳腺癌患者35例,比较宫腔镜子宫内膜切除术(transcervical resection of endometrium,TCRE)前后子宫内膜的变化。结果宫腔镜子宫内膜切除术后,患者子宫腔修复层厚度较术前明显下降,在随访期间无子宫内膜息肉复发。结论在服用他莫昔芬的绝经后乳腺癌患者中,宫腔镜子宫内膜切除术能明显抑制他莫昔芬引起的子宫内膜增生反应,降低子宫内膜息肉的复发。     

三苯氧胺对乳腺癌术后子宫内膜病变的影响

目的：观察乳腺癌患者术后长期服用三苯氧胺对子宫内膜病变的影响。方法：回顾性分析2002年1月至2004年6月166例乳腺癌患者手术后临床资料。其中102例为雌孕激素受体阳性者，并接受三苯氧胺内分泌治疗作为研究组；其余64例为雌孕激素受体阴性者，未接受三苯氧胺治疗作为对照组。所有患者定期复查阴道超声，发现子宫内膜病变可疑者予官腔镜检查和诊刮活检术。结果：研究组子宫内膜病变发生率为41．18％（42／102），对照组子宫内膜病变发生率为12．50％（8／64），组间差异有统计学意义（P〈0．01）。结论：长期服用三苯氧胺可增加乳腺癌患者术后子宫内膜病变发生率。     

小剂量孕激素在单纯性子宫内膜增生治疗中的应用

目的：探讨小剂量孕激素对单纯性子宫内膜增生患者的临床症状、子宫内膜情况的影响。方法：选取2009年10月-2011年6月病理诊断为子宫内膜单纯增生患者76例,于分段诊刮术后第15天及下两次月经周期第15天给予小剂量孕激素治疗10d,共3个周期,观察经期、月经周期、子宫内膜变化。结果：小剂量孕激素治疗后患者月经周期踢显规律,经期逐渐缩短,月经量明显减少,经期前子宫内膜厚度变薄,与治疗前比较差异具有统计学意义（P〈0.05）;治疗后增殖期子宫内膜6例（7．9％）,分泌期子宫内膜66例（86．8％）,仍为单纯型增生者4例（5．3％）,转化率为94．7％（72／76）;治疗后多数患者无不良反应。结论：3个月的小剂量孕激素可有效治疗子宫内膜单纯型增生。     

子宫内膜异位症患者孕激素抵抗的研究进展

子宫内膜异位症(endometriosis, EMS)患者不孕症的发生率高达30%～50%, 常见的病因包括输卵管及盆腔因素、内分泌紊乱、卵子质量异常、炎症、免疫失调以及子宫内膜容受性低下。近年来研究表明, 子宫内膜孕激素抵抗与容受性低下密切相关, EMS患者子宫内膜孕激素受体(progesterone receptor, PR)表达下降、PRA/PRB失调、孕激素下游信号通路的多个分子表达异常、PR表观遗传学改变以及子宫内膜慢性炎症等因素造成子宫内膜对孕激素反应低下, 导致孕激素诱导的基因表达下降、雌孕激素调节的内膜容受性相关蛋白表达低下、子宫内膜结构改变、蜕膜化不足等, 最终胚胎着床失败。本文对EMS患者子宫内膜孕激素抵抗的发生机制及作用效应进行详细综述, 以期为探索改善EMS患者子宫内膜容受性的治疗方法提供理论依据。     

32例子宫内膜不典型增生患者孕激素治疗的效果

目的:探讨子宫内膜不典型增生患者应用孕激素治疗保留子宫的效果。方法:对2001～2007年宁夏回族自治区平罗县中医院收治的32例35岁以下的子宫内膜不典型增生患者,其中轻度不典型增生18例,中度9例,重度不典型增生5例。采用醋酸甲羟孕酮进行治疗,治疗前和治疗后3个月进行诊断性刮宫,根据病理结果评价疗效。结果:采用孕激素治疗后,32例子宫内膜不典型增生患者总缓解率为70.0%,总有效率为30.0%,其中轻、中、重度患者缓解率分别为83.3%、66.7%和60.0%,有效率分别为16.7%、33.3%和40.0%,1例患者应用孕激素治疗缓解后复发。结论:对于要求保留子宫的子宫内膜不典型增生的年轻患者,孕激素可以作为一种治疗选择。     

宫腔镜下子宫内膜息肉摘除术后给予孕激素治疗对息肉复发的预防价值

目的探讨宫腔镜下子宫内膜息肉摘除术后给予孕激素治疗对息肉复发的预防价值。方法选取2016年6月至2017年6月于我院行宫腔镜下子宫内膜息肉摘除术的子宫内膜息肉患者56例,随机分为两组各28例。对照组行宫腔镜下子宫内膜息肉摘除术后不作任何处理,观察组在宫腔镜下子宫内膜息肉摘除术后给予复方醋酸环丙孕酮片治疗。比较两组患者治疗后的异常子宫出血、息肉复发情况及治疗前后的子宫内膜厚度。结果治疗6个月后,观察组异常子宫出血改善率为89.29%,高于对照组的64.29%(P <0.05);观察组的息肉复发率为3.57%,低于对照组的28.57%(P <0.05)。治疗前,两组患者的子宫内膜厚度比较差异无统计学意义(P>0.05);治疗6个月后,两组患者子宫内膜厚度比较差异有统计学意义(P <0.05)。结论宫腔镜下子宫内膜息肉摘除术后给予孕激素治疗能够有效改善患者的子宫出血情况,降低息肉复发率,改善子宫内膜厚度。     

乳腺癌患者术后子宫内膜病变的发生率及危险因素分析

目的 探讨乳腺癌患者术后子宫内膜病变发生情况,并分析其危险因素。方法 纳入台州市立医院2017年8月—2019年8月收治的102例乳腺癌患者为研究对象,既往均行手术治疗,且术后有他莫昔芬治疗史,对患者临床资料进行回顾性分析。记录术后子宫内膜病变情况。根据患者术后是否发生子宫内膜病变,分成病变组、无病变组。比较两组临床特征,包括年龄、体质指数、绝经、子宫内膜厚度、他莫昔芬使用剂量、他莫昔芬用药时间、妊娠史、分娩史、阴道异常出血、糖尿病及高血压疾病,分析患者术后子宫内膜病变的单因素,经Logistic回归性分析确定子宫内膜病变的多因素。结果 在102例患者中,有75例(73.53%)发生子宫内膜病变,27例(26.47%)未发生病变。在75例内膜病变患者中,不典型增生17例(22.67%)及内膜息肉28例(37.33%)、肌瘤20例(26.67%)、内膜癌10例(13.33%)。绝经患者内膜病变率为88.64%,显著高于未绝经患者的62.07%(P<0.05)。在10例子宫内膜癌患者中,ⅠA期5例、ⅠB期3例、ⅡA期1例及ⅡB期1例。病变组绝经、他莫昔芬使用剂量为40 mg/d、他莫...     

神经肌肉刺激联合芬吗通对薄型子宫内膜型不孕患者子宫内膜形态及局部血运的影响

目的探究神经肌肉刺激联合芬吗通对薄型子宫内膜型不孕患者子宫内膜形态及局部血运的影响。方法选取2018年4月—2020年4月华中科技大学医院接诊的148例子宫内膜型不孕患者分为神经肌肉刺激组73例和联合芬吗通组75例,神经肌肉刺激组采用神经肌肉刺激仪进行治疗,联合芬吗通组在神经肌肉刺激的基础上加服芬吗通进行治疗。对比两组患者子宫内膜厚度、成熟卵泡平均直径、子宫内膜血流参数、子宫内膜形态、子宫内膜血流分型、治疗效果。结果与治疗前相比,治疗后子宫内膜厚度增厚、卵泡直径增大;子宫内膜血流参数PI、RI降低、PSV升高;子宫内膜形态A型占比升高,B型、C型降低;子宫内膜Ⅰ型、Ⅱ型占比降低,Ⅲ型升高,且联合组升高/降低幅度高于/低于神经肌肉刺激组,差异均有统计学意义(均P<0.05)。神经肌肉刺激组患者治疗总有效率83.56%明显低于联合芬吗通组的94.67%,差异有统计学意义(χ^(2)=4.731,P<0.05)。结论神经肌肉刺激联合芬吗通可有效抑制薄型子宫内膜型不孕者的临床症状,改善子宫内膜形态及局部血运的信号,可用于此病治疗。     

Survival impact of tamoxifen use for breast cancer risk reduction: projections from a patient-specific Markov model.

The authors estimate tamoxifen's impact on life expectancy among healthy women. A Markov model compared the effects of 5 years of tamoxifen on survival among 50-year-old postmenopausal women. Scenarios were explored using alternative assumptions with regard to tamoxifen's long-term effects on breast and endometrial cancer. Postmenopausal women without a uterus had substantial life expectancy gains from tamoxifen (1 to 4 months), whereas women with a uterus had such gains only if they were at a very high breast cancer risk. If tamoxifen's impact on endometrial cancer persists after treatment is discontinued, women at high risk for endometrial cancer have life expectancy losses from tamoxifen unless they are at a very high risk for breast cancer. The authors conclude that tamoxifen use among postmenopausal women is associated with substantial life expectancy gains. However, this benefit is modulated in women at increased endometrial cancer risk and depends on assumptions concerning tamoxifen's lingering effects on breast and endometrial cancer.     

曼月乐预防他莫昔芬诱导子宫内膜息肉的可行性分析

目的 评价左诀诺孕酮释放系统(LNG-IUS)预防他莫昔芬诱导子宫内膜息肉的可行性.方法 选择2008年3月至2012年12月在重庆三峡中心医院就诊需要口服他莫昔芬的乳腺癌术后患者96例,随机分为试验组49例和对照组47例,分别给予子宫内置入LNG-IUS和空白对照,评价内膜组织学和子宫增殖情况.结果 所有患者均顺利接受治疗,无肿瘤复发病例;试验组和对照组分别有33和37、21和24、19和23、15和18例患者完成第1、2、3、4年随访;治疗后试验组良性息肉、内膜萎缩、内膜增生比例低于对照组(χ2值分别为4.30、45.77、4.35,均P<0.05),蜕膜化比例高于对照组(χ2=68.64,P<0.05),而子宫内膜炎比例组间比较差异无统计学意义(χ2=1.05,P>0.05);重复测量方差分析表明,不同组间比较结果差异有统计学意义(F=5.59,P=0.03),不同时点组间比较差异有统计学意义(F=7.00,P=0.01),时点×组间交互作用差异有统计学意义(F=9.39,P<0.00),表明两组内膜厚度和子宫重量随时间变化趋势不相同.结论 LNG-IUS能减少他莫昔芬治疗后子宫内膜息肉的生成,同时没有增加内膜恶变的风险.     

Ki67 ER及PR在乳腺癌患者服用他莫昔芬后子宫内膜的表达及其性激素水平的变化

目的:探讨乳腺癌患者服用他莫昔芬后子宫内膜的ER、PR和ki67表达特点及意义,子宫内膜厚度变化与时间、年龄的关系。方法:通过对48例服用他莫昔芬的乳腺癌患者,常规阴式B超检查子宫双附件的情况,B超提示子宫内膜>5 mm,做诊刮术,其中16例诊刮的内膜组织送病理,做免疫组化ER、PR和Ki67。设未用药组为对照组,对30例病理提示未见子宫内膜病变标本进行免疫组化染色,检测子宫内膜组织中ER、PR和Ki67表达,B超检测子宫内膜的厚度。结果:①乳腺癌患者的B超结果:子宫肌瘤23例(47.92%),卵巢囊肿9例(18.75%),子宫内膜息肉1例(2.08%),子宫肌腺症4例(8.33%)。②他莫昔芬组子宫内膜腺体上的ER表达要强于正常子宫内膜(分泌期)的表达。服用他莫昔芬组内膜PR表达强于分泌期内膜腺体上表达。③他莫昔芬组与对照组:PR腺体上的表达与Ki67的阳性率相关性最强。结论:ER、PR的表达与Ki67的表达呈现正相关。绝经后服用他莫昔芬乳癌患者子宫内膜易增厚。服用他莫昔芬后诊刮的子宫内膜ER、PR(+++)的比率很高,并与Ki67表达有关。B超提示发现服用他莫昔芬有子宫肌瘤、卵巢囊肿、子宫内膜息肉、子宫肌腺症等妇科并发症。绝经后乳癌患者内膜厚度更容易增厚。     

乳腺癌患者发生妇科肿瘤情况的随访研究

目的研究乳腺癌与妇科肿瘤卵巢癌、子宫内膜癌以及雌激素相关良性肿瘤之间的关系。方法回顾性分析603例乳腺癌患者,经随访调查,分析乳腺癌术后患者目前的生存状况,以及其患妇科肿瘤情况,进一步揭示乳腺癌患者发生妇科肿瘤的危险性是否增加,以及它们之间的内在联系。结果603例乳腺癌患者中共随访调查到548例,放弃治疗2例,其中手术治疗并规律化疗464例,口服他莫昔芬半年以上者237例,截至到随访日期死亡病例29例;患卵巢癌3例,输卵管癌1例,子宫内膜癌9例;卵巢囊肿14例,子宫肌瘤50例,子宫内膜息肉19例,子宫内膜增生3例。结论乳腺癌与妇科肿瘤之间存在共同的高危因素,如遗传因素以及乳腺癌内分泌治疗药物暴露等环境因素。     

Using multiple risk models with preventive interventions

An ideal preventive intervention would have negligible side effects and could be applied to the entire population, thus achieving maximal preventive impact. Unfortunately, many interventions have adverse effects and beneficial effects. For example, tamoxifen reduces the risk of breast cancer by about 50% and the risk of hip fracture by 45%, but increases the risk of stroke by about 60%; other serious adverse effects include endometrial cancer and pulmonary embolus. Hence, tamoxifen should only be given to the subset of the population with high enough risks of breast cancer and hip fracture such that the preventive benefits outweigh the risks. Recommendations for preventive use of tamoxifen have been based primarily on breast cancer risk. Age-specific and race-specific rates were considered for other health outcomes, but not risk models. In this paper, we investigate the extent to which modeling not only the risk of breast cancer, but also the risk of stroke, can improve the decision to take tamoxifen. These calculations also give insight into the relative benefits of improving the discriminatory accuracy of such risk models versus improving the preventive effectiveness or reducing the adverse risks of the intervention. Depending on the discriminatory accuracies of the risk models, there may be considerable advantage to modeling the risks of more than one health outcome. Published 2012. This article is a US Government work and is in the public domain in the USA.     

Breakthrough in breast cancer chemoprevention

Breast cancer is the most frequent female malignant disease in developed countries. Various approaches are being developed for breast cancer prevention. Medical prevention called chemoprevention is reviewed. Prior to any intervention estimation of breast cancer risk is mandatory. For practical reasons distinction of two risk groups is useful. In the high risk group inherited gene mutation showing high penetrance may be suspected, while in the medium risk group hormonal factors play an important role. The antiestrogen tamoxifen has been extensively investigated in breast cancer and also tested for the prevention of breast cancer. The results of four randomized tamoxifen prevention studies have been published. In the largest, American trial the number of invasive or "in situ" breast cancers was halved by tamoxifen. Particularly estrogen receptor positive and relatively good prognosis breast cancers were reduced. Similar results were obtained in the "International Breast Intervention Study". Tamoxifen has been registered for breast cancer prevention for high risk individuals in the United States. The Italian and English ("Royal Marsden Hospital") studies did not prove significant preventative effect for tamoxifen that may be explained by the characteristics of the study protocols and study populations. Increased rates of endometrial cancer, thromboembolic events and cataract were observed under tamoxifen treatment, especially over the age of 50. Prevention has an increased importance in gene mutation carriers. Besides prophylactic mastectomy and close surveillance tamoxifen and bilateral oophorectomy or the use of gonadotropin releasing-hormone analogs seem efficient in this group. Various new chemoprevention strategies are under testing. Raloxifene and the aromatase inhibitors show advantage in menopausal women, the retinoid fenretinide and the gonadotropin releasing-hormone analogs seem promising for premenopausal individuals. The use of these agents are investigated in clinical trials. It is likely that not one single method will be applied for breast cancer prevention in the future. Preferably individual prevention strategies based on individual risk assessment will be developed.     

Tamoxifen's clinical applications: old and new

The American Cancer Society estimates that this year more than 180, 000 women in the United States will develop breast cancer and more than 40,000 women will die of the disease. According to a National Cancer Institute model, 5 years of preventive therapy with tamoxifen citrate reduced the risk of invasive breast cancer by 49% (P<.00001) in women at increased risk for breast cancer. The reduction in risk was greater in women with a history of lobular carcinoma in situ (LCIS; 56% relative risk reduction) or atypical hyperplasia (86% relative risk reduction). It should be noted, however, that no benefit was found in 2 European studies using notably different risk evaluation models and entry criteria. Because elevated risks of uterine cancer and thromboembolic disease have been associated with tamoxifen therapy, appropriate counseling should be given to any woman considering tamoxifen as a means of reducing breast cancer risk. Arch Fam Med. 2000;9:906-912     

Selective estrogen-receptor modulators (SERM's) in postmenopausal women]

Selective oestrogen receptor modulators (SERMs) constitute a group of new drugs which mimic oestrogen in some organs and tissues but have an oestrogen antagonistic mode of action in other tissues. In postmenopausal women these compounds have a favourable effect on lipoprotein cholesterol levels in the blood and bone mineral density, thereby reducing fracture risk, especially in the vertebral column. In contrast to oestrogen therapy SERMs reduce the risk of mammary carcinoma. Currently tamoxifen and raloxifene are the best known SERMs. Tamoxifen increases endometrial hyperplasia and the risk of endometrial carcinoma. Raloxifene inhibits uterine tissue proliferation and does not appear to influence the endometrium directly. Raloxifene appears to be finding a place for itself in the treatment and prevention of osteoporosis in postmenopausal women. At this moment it is not yet possible to foresee what the impact of SERMs will be in the treatment and prevention of cardiovascular diseases and breast cancer.