激素替代治疗对绝经后妇女乳腺密度的影响——附150例分析

目的:探讨激素替代治疗(hormone replacement therapy,HRT)对绝经后妇女乳腺密度的影响.方法:150例绝经后妇女分为替勃龙组(A组,56例)、联合应用结合雌激素和甲羟孕酮组(B组,44例)和尼尔雌醇和甲羟孕酮序贯用药组(C组,50例)3组.其中A组予替勃龙2.5 mg,每日1次睡前口服;B组予结合雌激素0.625 mg和甲羟孕酮2.5 mg,每日1次睡前口服.C组予尼尔雌醇2 mg,每月1号和15号各1次睡前口服,每隔4次加用甲羟孕酮10 mg,每日1次睡前口服,连用10日.3组疗程均为1年.观察患者治疗前、后的围绝经期症状、乳腺致密度的改变情况,以及比较3组治疗期间乳房胀痛的发生情况.结果:3种HRT治疗方案均能减轻围绝经期症状.治疗期间,3组乳房胀痛发生率比较差异均有统计学意义(P＜0.05-0.01),以B组最高,C组次之,A组最低.A组治疗前、后乳腺致密度评分比较差异无统计学意义(P＞0.05);B组和C组治疗后的乳腺致密度评分均比治疗增高(P＜0.05-0.01);3组治疗后的乳腺致密度评分比较差异有统计学意义(P＜0.05),其中以B组最高,C组次之,A组最低.结论:HRT对绝经后妇女乳腺致密度有一定影响,采用替勃龙对乳腺致密度的影响较小.     

Quantitative ultrasound at the hand phalanges in women on hormone replacement therapy

The aim of the observational study was to evaluate the influence of hormone replacement therapy (HRT) on the results of quantitative ultrasound (US) at the hand phalanges in 732 women (mean age about 53 years). Among them were 228 postmenopausal women treated within 6 months after the last menstrual bleeding (group 1), 90 postmenopausal women taking HRT after a break between menopause and the onset of the therapy of about 2 years (group 2) and 414 controls. Mean age and body size did not differ significantly between groups studied. Years since menopause (YSM) did not differ significantly between group 2 and controls. Skeletal status was assessed using DBM Sonic 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS) in m/s. Ad-SoS was significantly higher in both groups on HRT than in controls (p < 0.000001), and in group 1 compared with group 2 (p < 0.05). The duration of HRT did not affect Ad-SoS values. The influence of age on Ad-SoS values was significantly weaker in women on HRT than in controls and YSM did not influence Ad-SoS value in postmenopausal women taking HRT. In controls, YSM negatively and significantly affected Ad-SoS value. In conclusion, HRT administered in perimenopause or early postmenopause had a significant influence on quantitative US measurements at the hand phalanges, and the difference between both treated groups suggests that HRT ought to be indicated directly after the last menstrual bleeding. (E-mail: osteolesna@poczta.onet.pl)     

绝经期妇女长期小剂量激素替代治疗的观察研究

目的观察激素替代治疗(HRT)绝经妇女的子宫、卵巢和乳腺的声像图表现、绝经期症状及性激素的变化,评价长期小剂量HRT的临床价值.方法82例长期HRT的绝经期妇女,其中服用尼尔雌醇(CEE3)38例、利维爱(OrgOD14)23例、倍美力(CE)21例,利用超声对其子宫、卵巢和乳腺进行观察,服药前及服药后每6个月检查1次,观察时间最短3年,最长10年,同时行Kupperman评分及性激素测定.结果HRT后子宫内膜厚度增加,治疗前后差异有显著性,治疗后平均子宫内膜厚度未超过5mm,卵巢和乳腺未发现占位性病变,绝经期症状均显著改善.结论绝经妇女长期小剂量HRT,具有副作用少、安全、有效、依从性高等优点,定期超声检查是一种很好的监测手段.     

运动对绝经后女性骨密度的影响

目的：观察运动对绝经后女性骨密度的影响。方法：绝经后女性106名分为运动组37例和对照组69例。运动组进行广场舞、爬山、慢跑等运动干预,对照组未进行任何干预。采用双能X线吸收仪测试其全身及各部位骨矿含量（BMC）和骨密度（BMD）,并进行比较。结果：运动干预8个月后,运动组全身BMD和BMC值均较干预前及对照组明显增加（P＜0．05）,而对照组全身BMD和BMC值均较8个月前下降,但差异无统计学意义。运动组胸椎的BMD、BMC和盆骨的BMC均较干预前及对照组明显增加（P＜0．05）,而腰椎的BMD、BMC和盆骨的BMD干预后差异无统计学意义;对照组干预后腰椎、盆骨的BMD、BMC均较8个月前明显下降（P＜0．05）,而胸椎的BMD、BMC 8个月前后差异无统计学意义。运动组上肢优势侧BMD、BMC和下肢双侧BMD、BMC均较干预前及对照组明显增加（ P＜0．05）,而上肢非优势侧BMD、BMC干预前后差异无统计学意义;对照组上肢非优势侧BMD、BMC均较8个月前及上肢优势侧BMD明显下降（P＜0．05）,而上肢优势侧BMC和下肢双侧BMD、BMC 8个月前后差异无统计学意义。结论：常规运动可显著提高绝经后女性胸椎 BM D和BM C ,而只能维持其腰椎和盆骨的BM D、BM C;上下肢、优势侧与非优势侧活动不均衡可影响相关部位 BM D和BM C的变化。     

Desogestrel in hormone replacement therapy: long-term effects on bone, calcium and lipid metabolism, climacteric symptoms, and bleeding

Seventy-three healthy, postmenopausal women, aged 45-54 years, were randomly assigned to one of three groups for 2 years of treatment: 17 beta-oestradiol 1.5 mg on days 1-12 and 17 beta-oestradiol 1.5 mg + desogestrel 150 micrograms on days 13-24 (E2/DG) or oestradiol valerate 2 mg on days 1-11 and oestradiol valerate 2 mg + medroxyprogesterone acetate 10 mg on days 12-21 (E2V/MPA) or placebo. Fifty-seven women (78%) completed the study. Bone mineral content of the distal regions of the forearms (measured by single photon absorptiometry, SPA) and bone mineral density of the spine (measured by dual energy X-ray absorptiometry, DXA) showed increases of 0.5-1% and 4-5%, respectively, in the hormone groups over 2 years. The placebo group exhibited a decrease in spinal bone density of 2% per year, and in the forearm of 2.5-3.5% per year. Biochemical estimates of bone turnover (serum alkaline phosphatase and fasting urinary calcium) decreased significantly to premenopausal levels in the hormone groups but remained unchanged in the placebo group. In both hormone groups total cholesterol decreased by about 9% (P less than 0.001), whereas low density lipoprotein cholesterol decreased by 16% in the E2/DG group and 20% in the E2V/MPA group (P less than 0.001). High density lipoprotein cholesterol showed only minor, insignificant changes in the hormone groups. The placebo group had virtually unchanged values. Climacteric symptoms, including hot flushes, were significantly reduced in both hormone groups. Bleeding occurred regularly in about 80% of the women.(ABSTRACT TRUNCATED AT 250 WORDS)     

绝经后妇女应用激素替代疗法的依从性研究

综述了国内外绝经后妇女应用激素替代疗法的依从性研究,从治疗的副反应、使用者对乳腺癌的惧怕、症状缓解、病人的自身状况、用药剂量及其他社会因素方面分析了影响激素替代疗法依从性的因素。     

低剂量雌激素替代疗法对围绝经期综合征患者激素水平及骨密度的影响

目的观察低剂量雌激素替代疗法对围绝经期综合征患者临床症状、激素水平及骨密度的影响。方法根据患者是否愿意接受雌激素替代疗法将105例围绝经期综合征患者分为试验组52例和对照组53例,对照组不接受任何药物治疗,试验组口服替勃龙,2.5 mg/次,1次/d,连续治疗6个月。结果试验组治疗后Kupperman各项评分均下降,卵泡刺激素(FSH)、黄体生成素(LH)水平下降,雌二醇(E2)水平升高,L1~4骨密度及股骨颈骨密度显著增加(P0.05或P0.01)。试验组未出现需要停药的不良反应,但子宫内膜厚度显著增加。结论低剂量雌激素替代疗法可有效改善围绝经期综合征患者临床症状,调节激素水平,增加骨密度值,但可能会增加患者子宫内膜厚度,临床应用时应采用最低有效剂量,确保安全性。     

激素补充治疗方案对围绝经期综合征患者体内性激素水平、子宫内膜厚度及骨密度的影响

目的 研究激素补充治疗方案对围绝经期综合征患者体内性激素水平、子宫内膜厚度及骨密度的影响.方法 前瞻性选取2017年5月至2019年8月柳州市妇幼保健院收治的100例围绝经期患者为对象,按照随机数字表法分为对照组和治疗组,各50例.对照组患者给予口服谷维素片对症治疗,治疗组患者给予口服芬吗通治疗,连续治疗28 d.观察...     

Post-menopausal hormone replacement therapy and stroke risk

This paper will review available data bearing on the relationship of post-menopausal hormone replacement therapy to the risk of first or recurrent ischaemic stroke. Although experimental data from both human and animal studies will be briefly mentioned, the bulk of evidence is from observational epidemiological studies. As such, the limitations of observational studies, particularly as applied to the health effects of post-menopausal hormone replacement therapy, will be emphasized. We conclude that there is no compelling consistent evidence that post-menopausal hormone replacement therapy either decreases or increases stroke risk. There are, however, reasons to be concerned that this therapy may contribute to stroke risk.     

雌二醇与孕激素预防绝经近期妇女骨量丢失的观察

目的探讨低剂量性激素治疗方案对绝经后妇女骨量丢失的影响。方法将85例绝经妇女随机分为3组,A组（30例）：每日服用戊酸雌二醇（E2V）1．0mg＋醋酸甲羟孕酮（MPA）2．0mg;B组（30例）：每日服用结合雌激素（CEE）0．45mg＋醋酸MPA2．0mg;C组（对照组,25例）：维生素（VitD）200IU／d;共服药12个月。各组均每日服用元素钙400mg。观察3组治疗前后第2—4腰椎骨（L2-4）骨密度、骨代谢生化指标尿N端交联多肽／肌酐（NTX／Cr）值,骨折发生率。结果治疗12个月时B组L2-4骨密度上升显著,A组与C组骨密度变化不明显;治疗6个月3组尿NTX／Cr值均下降,其中B组下降明显。除B组与C组尿NTX／Cr值间差异有统计学意义之外,其余各组间均无统计学意义。结论国产E2V1mg配伍MPA2mg／d可有效预防绝经后骨丢失。每日CEE0．45mg与MPA2H培合用对多数人较合适。     

Hormone replacement therapy in postmenopausal asthmatic women

OBJECTIVES: Assessment of mean 24 h oestradiol (E2) and oestrone (E1) concentration and basic FSH secretion in postmenopausal asthmatic women, before and after HRT use, and to identify any connections between changes in hormone concentrations and patients' clinical state. SUBJECTS: Postmenopausal women (55 asthmatic and 20 healthy, aged 48-60 years). METHOD: Serum hormone concentration was assessed by radioimmunoassay before HRT and after 6 months of transdermal 17beta-E2 and medroxyprogesterone acetate treatment (cyclical method). Intensification of menopausal symptoms was assessed by Kupperman's index. RESULTS: Secretion of oestrogens was lower in postmenopausal women asthmatic women than in postmenopausal healthy women. HRT caused an increase in oestrogen concentration. The 24-h fluctuations of E1 and E2 in all studied groups before and after HRT did not differ significantly. A statistically significant decrease in the number of menopausal symptoms was found during the course of HRT. During the period of HRT, there was a reduction in the number of patients in whom it was necessary to use oral glucocorticoid therapy during exacerbation of asthma. CONCLUSION: A greater reduction in oestrogen secretion was found in postmenopausal asthmatic women than in postmenopausal healthy women. HRT resulted in normalization of serum oestrogen concentration in asthmatic women and diminishing psychosomatic symptoms of the menopause and symptoms of asthma.     

Risks and benefits of hormone replacement therapy

Menopause, the permanent cessation of menstruation, is due to ovarian failure, which may lead to oestrogen deficiency diseases, particularly osteoporosis, cardiovascular disease and cerebrovascular disease. Mortality and morbidity caused by these conditions can be modified by using hormone replacement therapy, but the benefits of this therapy must be weighed against the increased risk of breast cancer and the symptomatic side-effects the treatment may cause. The combination of transdermal oestrogen and natural progesterone offers the most favourable risk-to-benefit profile.     

雌激素替代治疗对绝经后妇女内皮功能的影响

目的观察雌激素替代治疗(ERT)对绝经后妇女内皮功能的影响。方法绝经组妇女32例每天口服结合雌二醇0.625mg,共两周;同期24名正常月经妇女为对照组。分别采集绝经组妇女服药前后和对照组妇女空腹静脉血标本测雌二醇(E2)、一氧化氮(NO)水平,并采用无创性高分辨超声法检测内皮依赖性血管舒张功能。结果绝经组ERT前血流介导的血管舒张(FMD)、NO及E2明显低于对照组(P<0.05),ERT后显著增加(P<0.05),而硝酸甘油介导的血管舒张(NMD)治疗前后差异无显著性意义;FMD与E2、NO相关(P<0.001),而NMD与NO、E2均无相关性(P>0.05)。结论女性绝经后存在显著的内皮依赖性血管舒张功能异常,进行雌激素替代治疗可明显改善甚至逆转上述变化,该作用可能是雌激素的心血管保护机制之一。     

替勃龙治疗绝经后更年期综合征临床效果观察

目的探讨替勃龙治疗妇女绝经后更年期综合征的疗效及副作用情况。方法对73例自然绝经后因身体不适就诊,确诊更年期综合征的妇女,其中自愿接受激素补充疗法48例（治疗组）;随机选择同期就诊,更年期症状明显,但拒绝接受激素替代治疗（HRT）的妇女25例（对照组）,经检查无子宫、卵巢的恶性病变,子宫内膜〈5mm;乳腺检查无异常后,治疗组予以替勃龙2．5mg／d口服治疗,疗程6月;对照组给谷维素60mg／d、维生素E50mg／d,口服连续6个月。观察治疗前后妇女更年期症状的变化;促卵泡生成素（FSH）、黄体生成素（LH）、雌二醇（E2）水平的变化;以及肝功能[丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）]、阴道出血、乳房胀痛变化的情况。结果应用替勃龙治疗3月后,更年期症状明显缓解,部分患者潮热、多汗消失。6月后检查：血FSH及LH水平下降,E2水平上升．与对照组比较及治疗前后比较均有显著性差异;肝功能无明显异常。患者治疗期间,1例在治疗2月后出现阴道流血,点滴状;2例在治疗1月后出现乳房胀痛,继续服药后症状消失;治疗结束后妇科B超示乳腺无异常、子宫内膜厚度〈5mm。结论替勃龙能有效改善绝经后妇女更年期症状,且副作用少,患者耐受性良好,值得临床进一步研究和探讨。     

Serum osteopontin levels in relation to bone mineral density and bone turnover markers in postmenopausal women

Osteopontin (OPN) is an extracellular matrix protein that is expressed in bone cells such as osteoblast and osteocytes and associated with bone turnover and bone mineral density (BMD) in postmenopausal women. Here, we aimed to investigate the relationship between circulating OPN levels and BMD in postmenopausal women in Southern China. A total of 362 postmenopausal women were consecutively recruited into this study from 2011–2013. Serum levels of OPN, receptor activator of nuclear factor kappa B (NF-κB) ligand (RANKL), and bone turnover markers were analyzed. BMD was measured by dual energy X-ray absorptiometry. Osteoporosis and osteopenia were diagnosed according to the World Health Organization criteria. Serum OPN levels were remarkably higher in the osteoporotic group than those in the osteopenic and normal groups (all p?r?=??0.25, p?=?0.004; r?=??0.66, p?r?=??0.28, p?=?0.001; respectively) and positively associated with type I procollagen amino-terminal propeptide (PINP), carboxy-terminal cross-linking telopeptide of type I collagen (CTX), and RANKL (r?=?0.20, p?=?0.020; r?=?0.17, p?=?0.036; r?=?0.19, p?=?0.028, respectively) in the osteoporotic group. In multiple regression analyses, lumbar spine BMD, PTH and RANKL were the predictors for serum OPN levels. In conclusion, OPN serum levels are negatively related to BMD and positively correlated with bone turnover levels in this group of Chinese postmenopausal women.     

Positive impact of hormone replacement therapy on the fibrinolytic system: a long-term randomized controlled study in healthy postmenopausal women

Summary.  Background : The mechanisms by which postmenopausal hormone replacement therapy (HRT) may influence risk of cardiovascular disease are still unclear. Impaired fibrinolytic function is associated with an enhanced risk of cardiovascular disease and therefore the effect of HRT on fibrinolysis may be of importance. Objectives : To investigate the prolonged effect of HRT on the fibrinolytic system and to determine whether two common polymorphisms in the plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (t-PA) genes modulate this effect. Methods : Healthy postmenopausal women ( n  = 248) were randomized to HRT ( n  = 122) or no substitution ( n  = 126) 5 years prior to investigation. Results : Significantly higher values of t-PA activity and lower values of PAI-1 activity and PAI-1 antigen were found in the HRT group compared with the control group. This effect was independent of smoking and without influence from the two common polymorphisms PAI-1 −675(4G/5G) and t-PA intron8ins311. Furthermore, no difference between opposed estrogen (with norethisterone acetate as the gestagen component) and unopposed estrogen therapy was found. Both an intention-to-treat and a per-protocol analysis were performed and similar results were obtained. Conclusions : Long-term treatment with HRT in healthy postmenopausal women was found to be associated with a beneficial fibrinolytic profile. This effect was found independent of smoking status, opposed and unopposed estrogen therapy had equal effect, and no influence of the two common polymorphisms PAI-1–675(4G/5G) and t-PA intron8ins311 was found. This effect of HRT on fibrinolytic capacity may be one of the beneficial effects of HRT in relation to cardiovascular diseases.     

Comparison of the effects of new and conventional hormone replacement therapies on left ventricular diastolic function in healthy postmenopausal women: a Doppler and ultrasonic backscatter study

We aimed to compare the effects of new treatment modalities to conventional hormone replacement therapy (HRT) on left ventricular (LV) diastolic function, by means of conventional and tissue Doppler echocardiography and the myocardial integrated backscatter (IBS) in postmenopausal women. One hundred and fifty healthy postmenopausal women were included in this study. Subjects were assigned to one of the five groups receiving 1 year of treatment (estrogen, estrogen plus progesterone, raloxifene, tibolone or placebo). E and A wave velocity, E/A ratio, isovolumic relaxation time (IVRT), deceleration time (DT), peak early (Em) diastolic mitral annular velocity, E/Em ratio, the cyclic variation of integrated backscatter (CVIBS) and the mean value of the IBS signal (MIBS) were determined before and 12 months after therapy. E (76 ± 10 vs. 98 ± 8 cm/s, P = 0.0001 and 78 ± 10 vs. 90 ± 12 cm/s, P = 0.02, respectively), Em (14.3 ± 2.4 vs. 16.4 ± 2.5 cm/s, P = 0.001 and 15.1 ± 3.4 vs. 16.2 ± 3.5 cm/s, P = 0.01, respectively), and E/A ratio (1.15 ± 0.3 vs. 1.42 ± 0.4, P = 0.0001 and 1.0 ± 0.2 vs. 1.22 ± 0.2, P = 0.01, respectively) were increased significantly compared to pretreatment in both estrogen and raloxifene groups while DT, A, E/Em, and IVRT were significantly decreased. A significant increase in CVIBS and decrease in MIBS were detected 12 months after estrogen and raloxifene administration while no significant changes were observed in other groups. Changes in the MIBS and CVIBS were found to be independently associated with the observed changes in the diastolic function indexes during therapy. Both estrogen and raloxifene regimens may improve LV diastolic functions in healthy postmenopausal women. This improvement may be a result of direct cardiac effects on LV myocardium.     

Post-surgical hormone replacement therapy: information needs of women

• ? This study examines the feelings and thoughts of women who have received hormone replacement therapy (HRT) after a surgically induced menopause.
• ? The paper outlines the patients' need for easily accessible information about HRT from professionals. Sometimes the information is not completely clear because of anxiety or misinterpretation. Women are also concerned about side-effects.
• ? Women feel that they can cope better if they understand why certain treatments are carried out, and if they have an informed choice about their method of treatment.

     

雷洛昔芬治疗绝经后骨质疏松临床观察

目的观察选择性雌激素受体拮抗剂雷洛昔芬治疗绝经后骨质疏松症的疗效。方法 66例绝经后骨质疏松症患者被随机分为观察组与对照组 (各 3 3例 ) ,前者服雷洛昔芬 60mg/日 ,后者服安慰剂 ,治疗并观察 6个月。治疗前后做常规化验检查 ,并行经阴道B超测量子宫内膜厚度及诊断性刮宫了解内膜情况。结果观察组腰椎、股骨颈及大粗隆、Ward’s的骨密度均升高 ,总有效率 60 .6% ,明显高于对照组的 2 1.2 % (P <0 .0 1) ;未见子宫内膜增生、内膜异常及阴道点状出血等。结论雷洛昔芬能明显提高绝经后骨质疏松症患者的骨密度 ,且不良反应轻微 ,无明显子宫内膜刺激等副作用