雌激素对绝经后妇女心血管高危因素的影响

目的：研究雌激素对绝经后妇女心血管高危因素的影响。方法：对绝经后妇女１７例随机分为Ａ、Ｂ两组，Ａ组９例服用炔雌醇００２５ｍｇ／ｄ，Ｂ组８例服用炔雌醇００５ｍｇ／ｄ，共３个月。于服药前后在相同条件下测量身高、体重、腰围、臀围和测定血压，血糖、胰岛素、总胆固醇、甘油三酯、高密度脂蛋白胆固醇。结果：两组的总胆固醇和低密度脂蛋白胆固醇均降低，Ｂ组高密度脂蛋白胆固醇升高。但甘油三酯水平也增加，两组空腹血糖、胰岛素水平均降低。结论：雌激素有助于绝经后妇女的糖、脂代谢，对心血管系统有保护作用。炔雌醇的剂量以００２５ｍｇ／ｄ为宜。     

绝经后妇女血糖变化及激素替代治疗对血糖的影响

目的：探讨绝经后妇女空腹血糖变化及低剂量激素替代治疗对空腹血糖（ＦＰＧ）的影响。方法：３３例绝经后妇女（ＰＭＷ）随机分为２组,试验组１７例,隔日口服结合型雌激素（ＣＥ）０．６２５ｍｇ与安宫黄体酮（ＭＰＡ）２ｍｇ交替应用;对照组１６例,口服ＣＥ０．６２５ｍｇ／日,每月连续服用２５天,后１０天加用ＭＰＡ４ｍｇ。两组均连续服用４周期,于用药前后分别测定ＦＰＧ及雌二醇（Ｅ２）水平、体重及血压,并与３４例绝经前妇女对比研究。结果：绝经后妇女ＦＰＧ较绝经前妇女明显升高;两组绝经后妇女治疗后ＦＰＧ显著下降,组间比较无差异（Ｐ＞０．０５）。两组用药后血压、体重均轻度下降,但无统计学意义（Ｐ＞０．０５）。结论：绝经后妇女ＦＰＧ水平与雌激素水平有关;低剂量激素替代治疗（ＨＲＴ）可有效降低ＦＰＧ,对体重、血压无副作用,能有效降低冠心病的危险因素     

妊娠期糖代谢变化及其与胎盘催乳素的关系

目的探讨正常妊娠过程中孕妇糖耐量、胰岛素释放、胰岛素敏感性变化及其与胎盘催乳素的关系。方法对９４例正常孕妇进行７５ｇ葡萄糖耐量试验,检测各时相血糖和胰岛素水平,计算胰岛素曲线下面积（ＩＡＵＣ）与血糖曲线下面积（ＧＡＵＣ）,并观察胰岛素敏感指数（ＩＡＩ）的变化,同时检验空腹人体胎盘催乳素（ＨＰＬ）。结果ＩＡＵＣ、ＧＡＵＣ、ＩＡＩ及ＨＰＬ均随孕期延长而升高,各孕期比较,差异有显著性（Ｐ＜０．０５）;多重相关分析显示,ＨＰＬ与ＧＡＵＣ、ＩＡＵＣ、ＩＡＩ均呈显著正相关关系。但在消除了ＩＡＵＣ和ＩＡＩ的影响后,ＨＰＬ与ＧＡＵＣ无相关关系。结论妊娠期表现高胰岛素血症及胰岛素敏感性下降,并与ＨＰＬ有关;ＨＰＬ是影响妊娠期糖代谢变化的因素之一。     

胎儿生长迟缓孕妇淋巴细胞姐妹染色单体的互换频率

目的：了解胎儿生长迟缓（ＩＵＧＲ）孕妇外周血及新生儿脐血姐妹染色单体互换（ＳＣＥ）频率的变化。方法：应用姐妹染色单体互换技术，对１４例单纯性ＩＵＧＲ孕妇（ＩＵＧＲ组）及９０例正常孕妇（对照组）的外周血及其所分娩新生儿脐血ＳＣＥ频率进行测定。结果：ＩＵＧＲ组外周血及脐血ＳＣＥ频率分别为１０．５３±２．６９，７．２５±１．３４；对照组外周血及脐血ＳＣＥ频率分别为７．５８±０．３２，５．０５±０．２９；两组比较，差异有极显著性（Ｐ均＜０．０１）。ＩＵＧＲ组外周血及脐血ＳＣＥ频率全部异常。结论：ＩＵＧＲ与遗传物质损伤有关，ＳＣＥ频率有可能作为一项诊断ＩＵＧＲ的新指标。     

绝经后妇女低剂量激素替代治疗的有效性与安全性的临床研究

目的：探讨绝经后妇女低剂量激素替代治疗的有效性与安全性。方法：４４例绝经后妇女随机分为两组,试验组２２例,隔日口服结合型雌激素（ＣＥ）０．６２５ｍｇ与安宫黄体酮（ＭＰＡ）２ｍｇ交替应用;对照组２２例,口服ＣＥ０．６２５ｍｇ／ｄ,每月连续服用２５天,后１０天加用ＭＰＡ４ｍｇ。两组均连续服用４周期。结果：实验组１例退出,对照组２例退出。两组比较治疗效果无差异（Ｐ＞０．０５）,治疗后绝经期症状均明显改善（Ｐ＜０．００１）;两组血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白（ＬＤＬ）均明显下降,两组ＨＤＬ无显著变化（Ｐ＞０．０５）;两组尿钙／肌酐（Ｃａ／Ｃｒ）值均明显下降;试验组副反应明显低于对照组;阴道出血试验组２例（９．１％）,对照组１４例（６３．６％,Ｐ＜０．００１）;乳房胀痛试验组１例（４．５％）,对照组７例（３１．８％,Ｐ＜０．００１）。两组用药后无血压升高、乳腺增生及子宫内膜增生。结论：绝经后妇女低剂量激素替代治疗具有用量小、副反应少、有效、安全、经济、依从性高等优点。     

输卵管结扎术后盆腔静脉瘀血综合征患者腹腔液中内皮素-1和心钠素的变化

目的：测定妇女腹腔液内皮素－１（ＥＴ－１）和心钠素（ＡＮＰ）浓度，探讨其在结扎术后盆腔静脉瘀血综合征（ＰＶＣＳＳ）发病中的作用。方法：应用放射免疫技术对２１例ＰＶＣＳＳ患者（ＰＶＣＳＳ组）腹腔液及血浆中ＥＴ－１和ＡＮＰ浓度、腹腔液量和巨噬细胞密度进行测定，并与１２例绝育术后正常妇女（ＮＷＳ组）、１１例正常妇女（ＮＷ组）进行比较。结果：ＰＶＣＳＳ组腹腔液ＥＴ－１浓度、ＥＴ－１／ＡＮＰ比值、巨噬细胞密度均低于ＮＷＳ组和ＮＷ组（Ｐ＜０．００５，Ｐ＜０．００１，Ｐ＜０．００１），且均与疾病严重性评分呈负相关（Ｐ＜０．０５），但腹腔液量多于ＮＷＳ组和ＮＷ组（Ｐ＜０．００１）；各组巨噬细胞密度均与ＥＴ－１浓度呈正相关（Ｐ＜０．０５）；各组血浆ＥＴ－１和ＡＮＰ浓度间差异无显著性（Ｐ＞０．０５）。结论：妇女腹腔液含有一定浓度ＥＴ－１，腹腔液ＥＴ－１浓度和ＥＴ－１／ＡＮＰ比值降低，与ＰＶＣＳＳ发病有关。     

阴道超声检查绝经后子宫内膜评分法的价值

目的：设计阴道超声检查（ＴＶＳ）评分法,对绝经后妇女子宫内膜进行检测,并探讨该评分法筛选诊断性刮宫术的意义。方法：根据绝经后子宫内膜的ＴＶＳ影像表现（形态、回声、厚度及有无宫腔积液）进行评分,每例妇女在ＴＶＳ后行诊断性刮宫并行病理检查。根据临床症状将２２６例绝经后妇女分为Ａ、Ｂ、Ｃ三组。结果：Ａ组ＴＶＳ评分０～５分,子宫内膜癌（ＥＣ）阳性率２１．０％,良性病变阳性率５０．８％;Ｂ组ＴＶＳ评分０～５分,ＥＣ阳性率８．０％,良性病变阳性率６０％;Ｃ组ＴＶＳ评分０～４分,良性病变阳性率５０％,未发现无ＥＣ者。ＴＶＳ评分与病理检查结果呈明显相关性,ＴＶＳ评分越高,有病变者发生率越高。结论：ＴＶＳ是诊断绝经后妇女子宫内膜是否正常的有效方法,ＴＶＳ评分法可作为绝经后妇女筛选诊断性刮宫手段,如ＰＭＢ妇女ＴＶＳ≥２分或ＰＭＤ妇女ＴＶＳ≥４分,则应行诊断性刮宫。     

继发性高促性腺激素性闭经妇女的骨代谢状况

目的：探讨继发性高促性腺激素性闭经妇女的骨代谢状况。方法：对１２例继发性高促性腺激素性闭经妇女，１２例同龄正常妇女及８例自然绝经妇女的空腹２小时尿钙与肌酐比值（Ｃａ／Ｃｒ）、尿羟脯氨酸与肌酐比值（ＯＨＰｒ／Ｃｒ）、血碱性磷酸酶（ＡＫＰ）、血骨钙素（ＢＧＰ）、血降钙素（ＣＴ）、血白细胞介素Ⅵ（ＩＬ－６）及血雌二醇（Ｅ２）水平进行测定与比较。结果：继发性高促性腺激素性闭经组与正常对照组相比，＜Ｅ２血ＣＴ水平显著降低（Ｐ＜００１），尿Ｃａ／Ｃｒ、尿ＯＨＰｒ／Ｃｒ比值及血ＡＫＰ、血ＢＧＰ、血ＩＬ－６水平均明显增高（Ｐ＜００１）。继发性高促性腺激素性闭经组与自然绝经组相比，尿Ｃａ／Ｃｒ比值及血ＢＧＰ水平明显低于自然绝经组（Ｐ＜００５），血Ｅ２水平，尿ＯＨＰｒ／Ｃｒ比值、血ＡＫＰ、血ＣＴ及血ＩＬ－６水平无明显统计学差异（Ｐ＞００５）。结论：继发性高促性腺激素性闭经妇女与同龄正常妇女相比，骨代谢呈高转换负钙平衡状态，此状态的出现与其ＣＴ分泌减少、ＩＬ－６产生增多有关     

放置IUD后宫腔微生物及子宫内膜病理学研究

研究ＩＵＤ与盆腔感染及子宫内膜恶变或其他病理改变的关系,探讨 ＩＵＤ长期使用的安全性。方法：将 ８８例分为 Ａ、Ｂ、Ｃ、Ｄ ４组,Ａ组 ２０例使用带尾丝活性 ＩＵＤ;Ｂ组２４例使用惰性 ＩＵＤ;Ｃ组 ２４例为正常对照组;Ｄ组 ２０例为盆腔感染组。所有病例取宫腔冲洗液进行需氧菌、厌养菌、解脲支原体、沙眼衣原体等培养,并取子宫内膜进行病理学检查,结果：Ａ、Ｂ组主要表现为正常增生期、分泌期或月经期子宫内膜,部分是单纯性或腺囊性增生,与Ｃ组、Ｄ组差异无显著性（Ｐ＞０．０５）,４组均未见不典型增生及恶变。Ａ、Ｂ、Ｃ３组子宫内膜均无慢性炎症改变,Ｄ组８例存在慢性子宫内膜炎改变,与Ａ、Ｂ、Ｃ组差异有显著性（Ｐ＜０．０５）。Ａ、Ｂ、Ｃ组淋巴细胞、浆细胞、中性白细胞、纤维细胞计数差异无显著性（Ｐ＞０．０５）,Ｄ组淋巴细胞、浆细胞、中性白细胞计数较以上３组明显增加（Ｐ＜０．０５）,间质细胞及纤维细胞计数与以上３组差异无显著性（Ｐ＞０．０５）。Ａ、Ｂ、Ｃ组宫腔微生物检出率分别为３０．０％,２９．２％,２０．８％,与Ｄ组（７０．０％）差异有显著性（Ｐ＜０．０５）。结论：使用ＩＵＤ５－１４年未增加子宫内膜癌、癌前病变及慢性子宫内膜炎发生率。Ｉ     

新型铜Flaxigard宫内节育器与TCu380A宫内节育？…

目的 了解新型铜Ｆｌａｘｉｇａｒｄ ＩＵＣ（Ｃｕ Ｆｉｘ ＩＵＤ）的避孕效果，以ＴＣｕ３８０Ａ ＩＵＤ为对照组进行临床实验。方法 采用前瞻性、随机分配原则，共接收２００例受试者。结果 １２个月内两组无一例发生妊娠，脱落率为每百妇女１０．２和１．０，有明显统计学意义（Ｐ〈０．０５）。累积使用率为每百妇女８８．８和９７．０，两组无统计学意义（Ｐ〉０．０５）。２４个月时累积使用率两组分别为每百妇女２．０     

The effect of estrogens on carbohydrate metabolism: glucose, insulin, and growth hormone studies on one hundred and seventy-one women ingesting Premarin, mestranol, and ethinyl estradiol for six months

To understand the effect of estrogens on blood glucose, plasma insulin, and plasma growth hormone levels, 171 women from Jackson Memorial Hospital, Florida were tested with a 3-hour 100 Gm oral glucose tolerance test and then treated for 6 months with 1.25 mg of Premarin, .08 mg mestranol, or either .05 mg or .5 mg of ethinyl estradiol. A second glucose tolerance test was done, and the results were compared on the basis of menstrual status, pretreatment glucose status, and the type and dose of estrogen taken. There was a significant increase in the weight of the women in all 4 groups. There were few significant changes in the group glucose values, the individual glucose tolerance curves, or the group plasma insulin levels. The glucose tolerance curves deteriorated slightly in postmenopausal women and improved slightly in premenopausal women. There was a significant rise in the fasting glucose level for the Premarin group and a significant 2 hour decrease for the mestranol group. The mean fasting ambulatory growth hormone levels rose significantly in the mestranol group. It appears that estrogen preparations investigated did not consistently or significantly alter carbohydrate metabolism. It seems that metabolism alterations reported are due to progestogens alone or from a synergistic effect of estrogen and progestogen.     

Low-dose hormone therapy and carbohydrate metabolism

OBJECTIVE: To evaluate the influence by two low doses of oral continuous-combined formulations of 17 beta-estradiol (E(2)) and norethisterone acetate (NETA) on carbohydrate metabolism in healthy postmenopausal women. DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: Volunteers at a university hospital. SUBJECT: One hundred twenty healthy postmenopausal women. INTERVENTION(S): One hundred twenty women were randomized to three treatment arms: (1) E(2) 1 mg/NETA 0.25 mg group (n = 40); (2) E(2) 1 mg/NETA 0.5 mg group (n = 40); (3) placebo group (n = 40). A total of 102 women completed 12 months of treatment. An oral glucose tolerance test (OGTT) was performed at baseline and at 3, 6, and 12 months. MAIN OUTCOME MEASURE(S): Fasting glucose, fasting insulin, total area under the curve (AUC) and insulin/glucose index during OGTT. RESULT(S): Fasting levels of glucose and insulin declined significantly in the E(2)/NETA 0.5 mg group. At OGTT, the total AUC for insulin declined in both active arms. The curve for glucose increased significantly in the E(2)/NETA 0.25 mg group. A lower insulin/glucose index was observed during OGTT in both active regimens when compared with placebo. In the active treatment groups, a significant reduction of fasting glucose and/or fasting insulin was encountered in women with higher basal fasting levels (fasting glucose >4.2 mmol/L or log-fasting insulin >0.87). CONCLUSION(S): Oral low-dose E(2) 1 mg/NETA 0.5 mg regimen did not impair carbohydrate metabolism, but seemed to improve insulin sensitivity in healthy postmenopausal women.     

Insulin sensitivity during postmenopausal hormone replacement with transdermal estradiol and intrauterine levonorgestrel.

BACKGROUND: The study was devised to measure the effect of intrauterinely delivered levonorgestrel and transdermal estradiol on insulin sensitivity in postmenopausal women and compare this effect with that induced by transdermal estradiol alone. METHODS: An open, prospective, comparative study of healthy postmenopausal women without earlier use of hormone replacement therapy. The estrogen therapy group consisted of eight hysterectomized women, who used a transdermal patch delivering a daily dose of 50 microg of estradiol continuously for 6 months. The estrogen-progestin therapy group consisted of 13 women with an intact uterus, who received a simultaneous combination of a transdermal patch and a levonorgestrel (20 microg/day) intrauterine system for the same length of time. Fasting plasma concentrations of glucose, insulin and C-peptide and an insulin tolerance test were used to measure glucose metabolism and insulin sensitivity. RESULTS: Neither therapy changed the fasting plasma levels of glucose, insulin or C-peptide. Transdermal estrogen improved insulin sensitivity by 22%, as measured by an insulin tolerance test, while a small increase of 3.6% was observed using the combination therapy. CONCLUSIONS: Transdermal estradiol improves insulin sensitivity in healthy postmenopausal women. Combining intrauterine levonorgestrel to transdermal estradiol reverses this effect. This combination does not, however, seem to induce insulin resistance.     

Triphasic oral contraception: metabolic effects in normal women and those with previous gestational diabetes

The effect of a low-dose triphasic oral contraceptive (ethinyl estradiol and levonorgestrel) on glucose tolerance, plasma insulin and glucagon responses to glucose, fasting plasma cortisol, triglycerides, free fatty acids, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very--low-density lipoprotein cholesterol was investigated in 16 women with previous gestational diabetes and in 19 normal women. Investigations were performed prior to the hormonal intake and after treatment for 2 and 6 months. Before treatment, the women with previous gestational diabetes had significantly elevated fasting glucose (p less than 0.05) and impaired glucose tolerance (p less than 0.05) when compared to those of the healthy control subjects. The glucose, insulin, and glucagon responses to oral glucose remained unchanged during the treatment period. Plasma cortisol increased in both groups (p less than 0.05) whereas plasma triglycerides increased in the control subjects only (p less than 0.05). Plasma free fatty acids, lipoproteins, and high-density lipoprotein cholesterol/total cholesterol ratio remained unchanged in both groups. The results suggest that a low-dose triphasic oral contraceptive (ethinyl estradiol and levonorgestrel) is suitable as contraception even in women with a previous deterioration of glucose tolerance during pregnancy.     

Carbohydrate metabolic studies in women using a levonorgestrel/ethinyl estradiol containing triphasic oral contraceptive for eighteen months.

Carbohydrate metabolism was evaluated in 17 women before and after 18 months of triphasic oral contraceptive use. The triphasic oral contraceptive contained levonorgestrel and ethinyl estradiol. An oral glucose tolerance test was utilized and both plasma glucose and insulin levels were measured. There were no significant changes in the glucose levels. The fasting insulin level was raised at the 18-month test, whereas the other insulin values were similar. These results demonstrate that the new triphasic oral contraceptive preparations produce minimal carbohydrate metabolic changes.     

Comparative trial of the effects on glucose tolerance and lipoprotein metabolism of two new oral contraceptives containing gestoden and desogestrel

The effects of two new low-dose oral contraceptives (triphasic ethinyl estradiol/gestoden and monophasic ethinyl estradiol/desogestrel) on glucose tolerance, plasma insulin response to glucose, fasting plasma cortisol, triglycerides (TG), total cholesterol (C), HDL-C, LDL-C, VLDL-C and sex hormone binding globulin (SHBG) were investigated in two groups of healthy women (n = 10). Investigations were performed prior to hormone ingestion and after treatment for 2 and 6 months. In both groups, fasting plasma levels of glucose and insulin as well as the areas below the glucose concentration curves were unchanged during treatment, whereas the insulin response to oral glucose was equally increased (p less than 0.05). Intake of both compounds was followed by similar increases in the levels of HDL-C (p less than 0.05) and in the HDL-C/total-C (p less than 0.05). A transient decrease in the levels of LDL-C was observed in both groups after two months. During intake of the gestoden-containing compound increases in VLDL-C and TG levels were registered after six months (p less than 0.05). Plasma levels of SHBG increased similarly in both groups (p less than 0.01). The study indicates, that intake of both hormonal compounds is free from adverse effects on glucose tolerance and lipoprotein metabolism known to be of clinical significance. No differences in the metabolic effects were found between the two compounds.     

Oral contraception, mechanical contraception, and carbohydrate and lipid metabolism: a two-year study.

The carbohydrate and lipid metabolism of 100 women using an oral contraceptive (0.5 mg norgestrel + 0.05 mg ethinyl estradiol) and of 96 women using mechanical contraceptives was monitored over a 2-year period. The women had been screened for factors known to adversely affect carbohydrate and lipid metabolism. Two-hour oral glucose tolerance tests were performed at 6-month intervals during the study; serum insulin was determined at the same intervals in half the women. Triglycerides, total cholesterol, free fatty acids, and body weight were also measured. The study showed no significant differences in lipid metabolism nor in weight gain between women using oral or mechanical contraceptives. After 6 months the fasting glucose of women using oral contraceptives was significantly decreased; at 120 minutes, glucose and insulin levels were significantly increased in comparison to women using mechanical contraceptives. A greater percentage of oral contraceptive users had borderline-abnormal oral glucose tolerance tests but the abnormalities did not persist in the same individuals during the study. The incidence of a pathological oral glucose tolerance with oral contraceptives was 1%.     

Glucose and insulin levels after six months of treatment with a triphasic oral contraceptive containing ethinyl estradiol and norethindrone

A prospective study of carbohydrate metabolism was done on 33 women who used a triphasic oral contraceptive (OC) containing ethinyl estradiol and norethindrone for six months. A three-hour oral glucose tolerance test was administered before and after the OC usage, and both the blood glucose and insulin levels were determined. A significant decrease in the fasting glucose level was found with treatment. All other glucose values and insulin levels were unchanged.     

Effect of hormone replacement therapy on insulin secretion and insulin sensitivity in postmenopausal diabetic women.

The aim of the present study was to evaluate the effect of three different combinations of hormone replacement therapy (HRT) on insulin secretion, peripheral insulin sensitivity, serum lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous glucose tolerance test (IVGTT). Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods: estradiol valerate plus cyproterone acetate (Climen); transdermal 17 beta-estradiol (System TTS 50) plus dydrogesterone (Duphaston) 10 mg daily for 10 days a month; oral 17 beta-estradiol plus dydrogesterone (Femoston) for 14 days a month. A group of nine women with normal glucose tolerance (according to World Health Organization criteria during a 75-g oral glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after Climen: FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 50% after Systen TTS 50 + Duphaston; fasting hyperinsulinemia was normalized and total antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01). Femoston led to an increase in insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects. Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while dydrogesterone in combination with a transdermal estrogen should be recommended in cases with leading insulin resistance.