绝经早期低剂量激素治疗对乳腺的影响分析

目的:研究绝经早期低剂量激素治疗(HT)对乳腺的影响.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,由专人进行绝经期生存质量量表评分,受试者每日记录乳房胀痛情况.结果:绝经期生存质量量表中,激素组用药前评分为1.90±0.94分,用药后3月,6月,9月,12月评分较前均有显著性下降,分别为1.27±0.67分,1.08±0.62分,0.97±0.64分,0.69±0.50分;中药组用药后3月,6月,9月,12月评分也较用药前有显著性下降.激素组在用药3月,6月,9月,12月的乳房胀痛发生率分别为29.17%.14.63%,22.22%,9.09%,各时间点与中药组相比差异无统计学意义;在用药1～3月,激素组乳房胀痛程度为中度或重度的受试者占35.7%,显著多于中药组0%,其余各时间点两组在乳房胀痛程度上无统计学意义;激素组用药前乳腺小叶增生发生率为60%,用药后为91.4%,用药前后差异有统计学意义.结论:绝经早期低剂量HT和中药治疗1年均能有效提高生存质量,HT使乳腺小叶增生发生率增加,应用HT的过程中应加强乳房监测.     

绝经后激素治疗与认知及记忆功能

雌激素改善脑认知功能的作用早在20世纪70年代开始被人们认识,实验室和动物研究发现雌激素有神经保护功能且其机制复杂,许多研究显示绝经后激素治疗可降低与老年性痴呆有关的痴呆危险性并改善部分认知功能。近期研究发现激素治疗可通过增加脑萎缩这一机制增加大于65岁以上老年绝经后妇女认知障碍,激素治疗不能用于老年绝经后妇女认知功能的一级预防。     

激素替代治疗对绝经后妇女血清脂蛋白(a)的影响

目的 探讨戊酸雌二醇和倍美力对心血管疾病独立危险因子脂蛋白(a)[Lp(a)]的影响。方法 60例绝经后病例,按1:1随机分成两组,行连续序贯方案治疗,其中倍美力组30例口服结合雌激素0.625mg/d加醋酸甲孕酮4mg/d;戊酸雌二醇组30例口服戊酸雌二醇1mg/d加醋酸甲孕酮4mg/d。两组均连续治疗16周,于用药前、用药9周、16周取血测定血Lp(a),同时测血雌二醇水平。结果 两组用药后9周和16周Lp(a)均显著下降(P<0.01);两组间用药各时相Lp(a)水平差异无显著性(P>0.05)。两组用药前后E_2水平均显著升高(P<0.01),达正常月经周期早卵泡期水平。结论 激素替代治疗可使心血管疾病独立危险因子Lp(a)降低。     

小剂量激素治疗对绝经早期妇女生活质量和血液生化的影响

目的探讨小剂量激素对绝经早期妇女生活质量及血液生化的影响。方法中国医科大学附属二院妇产科于2002年3月至2004年9月选择绝经早期有明显围绝经期综合征症状的病人40例,每日口服小剂量激素及钙剂共6个月,比较用药前后临床症状及血液生化指标的变化。结果治疗前后比较除失眠症状一项为差异有显著性(P<0.05)外,其余差异均有非常显著性意义(P<0.01)。对血液生化的影响除HDLC升高和血小板轻微降低的作用外,均未见明显不利影响。结论小剂量激素治疗能明显提高绝经早期妇女的生活质量,对血液生化无明显不利影响。     

绝经激素治疗与认知

阿尔茨海默病的发病存在性别差异,其机制复杂。绝经激素治疗对认知的影响尚不确定。从整体健康效益而言,绝经女性窗口期应用激素治疗的受益远大于风险,没有理由仅因未确定的风险而否定绝经激素治疗。     

绝经激素治疗与认知

阿尔茨海默病的发病存在性别差异,其机制复杂。绝经激素治疗对认知的影响尚不确定。从整体健康效益而言,绝经女性窗口期应用激素治疗的受益远大于风险,没有理由仅因未确定的风险而否定绝经激素治疗。     

雌激素与女性认知功能关系的研究进展

随着女性平均预期寿命的延长及阿尔茨海默病(alzheimer disease,AD)的发病率明显上升,雌激素与女性认知功能的关系研究成为当今学术界研究的热点之一。细胞培养和动物实验数据已经证实,雌激素能通过多种途径保护认知功能相关区域的神经细胞,进而提高认知功能。但是学者们对雌激素水平和女性认知功能的相关性问题,及激素补充治疗(HRT)对围绝经期及绝经后女性认知功能是否有保护作用仍有争议。多数研究表明雌激素水平和女性认知功能是相关的,但是不同的人群,不同时期,不同的认知测试可能会有不同结果。激素补充治疗能否提高女性认知功能取决于研究人群、治疗时机、药物种类及个体化用药等。     

绝经后激素相关治疗与认知功能改变

对绝经后应用激素补充治疗(HRT)的认识,及HRT对老年妇女认知功能的影响,在近十几年中发生了很大变化。在20世纪90年代初期,大多数人认为,HRT可以改善绝经后妇女的认知功能,预防和治疗阿尔茨海默病(Alzheimer’s disease,AD)。但最近的研究表明,对上述观点还存在争议。本文综合有关文献,对绝经后应用激素相关治疗与认知功能改变的关系,作一综述。     

激素替代治疗对绝经后妇女体内脂肪分布的影响

女性随着绝经、年龄的增长 ,体重和体内脂肪分布将发生变化。本研究通过对绝经后经激素替代治疗 (ＨＲＴ)的妇女体内脂肪含量的测定 ,探讨ＨＲＴ对绝经后妇女体内脂肪分布的影响。一、资料与方法1 研究对象 :选择 1998年 8月～ 1999年 10月在我院更年期门诊就诊的绝经后妇女 44例 ,绝经 1～ 4年。雌二醇(Ｅ2 ) <2 0ｎｇ/Ｌ ,卵泡刺激素 (ＦＳＨ) >40ＩＵ/Ｌ ,有完整子宫 ,无糖尿病等代谢性疾病史 ,无性激素治疗史。将 44例随机分为ＨＲＴ组和对照组 ,ＨＲＴ组的年龄、绝经时间、身高分别为(5 2 6± 4 7)岁、(2 5 7± 8 3)个月和 (15 9 0±…     

激素补充治疗与安慰剂治疗6个月的心血管效应：与绝经年限相关的差异

为评估妇女健康研究（WHI）之后个体化激素替代治疗（HRT）的效果，观察按绝经年限分组的妇女使用HRT和安慰剂对心血管和神经内分泌的影响。     

中草药对子宫内膜异位症患者术后生存质量影响的Meta分析

目的:系统评价中草药对子宫内膜异位症(EMs)患者术后生存质量的影响。方法:计算机检索Medline、EMBASE、The Cochrane Library、CNKI、中国生物医学文献数据库(CBM)、万方数据库。由2名研究者按照纳入与排除标准独立筛选文献、提取资料和评价文献质量后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入7篇文献,共计644例患者。Meta分析结果显示,依据世界卫生组织生存质量简化量表(WHOQOL-BREF)评分,中草药干预能够改善患者术后的总体生存质量[SMD=0.19,95%CI(0.11,0.28),P0.000 1]。此外,依据研究中的量表EHP-30/5评分,中草药可能提高了EMs患者术后生存质量。结论:研究结果显示中草药可改善EMs患者术后总体生存质量,然而研究中所用量表不是EMs的专用量表,且由于目前相关研究的质量和数量尚不足,还不能提供足够证据说明中草药的干预效果,尚需更高质量研究以增强论证强度。     

Long-Term Outcomes on Quality of Life in Women Submitted to Laparoscopic Treatment for Bowel Endometriosis

Study ObjectiveTo evaluate the long-term effects of laparoscopic surgery on quality of life in women with bowel endometriosis.DesignObservational prospective cohort study (Canadian Task Force classification II).SettingCentral Hospital of Santa Casa, Sao Paulo, Brazil.PatientsForty-five patients answered a short-form, 36-item, quality-of-life questionnaire (SF-36) at 3 different times.InterventionsBetween June 2007 and September 2008, patients underwent laparoscopic surgery to treat deep infiltrative endometriosis, with colorectal resection.Measurements and Main ResultsForty-five patients with bowel endometriosis were followed up from 2007 to 2012. Before surgery, all patients exhibited signs suggestive of bowel endometriosis at magnetic resonance imaging and transrectal ultrasound. The patients underwent laparoscopic surgery for resection of the endometriosis lesions, including colorectal resection. The patients completed the questionnaire before surgery (T0), at 12 (T12) and 48 (T48) months after surgery. The 8 items of the SF-36 questionnaire at the different time points of application were compared. For each domain attribute, a score of 0 to 100 was assigned, where 0 signified the worst quality of life, and 100 the best. Statistical analysis was performed using analysis of variance. If differences were detected, multiple comparisons were performed using the Tukey test. Analysis of each domain revealed improved quality of life when comparing the period before surgery with 12 and 48 months after surgery. There was a significant increase (p < .001) in the scores in all of the SF-36 domains when comparing T0 vs T12 and T0 vs T48, with higher average scores at T48 corresponding to the domains of physical functioning, role physical, and social functioning (scores of 85.56, 75.69, and 73.61, respectively).ConclusionLaparoscopic treatment of bowel endometriosis improved the long-term quality of life of patients.     

Sexual Function and Quality of Life for Women with Mild‐to‐Moderate Stress Urinary Incontinence

Introduction: Sexual function is affected by stress urinary incontinence with or without pelvic organ prolapse. The aim of the study was to describe the sexual function of women with mild‐to‐moderate stress urinary incontinence, with or without pelvic organ prolapse (up to stage 2) and examine correlations with symptoms and quality of life. This investigation was part of a large, randomized, clinical trial of women with stress urinary incontinence who participated in an exercise intervention. Methods: Women included in the study suffered from stress urinary incontinence as measured by a pad test and were interested in an exercise intervention. All participants underwent assessment for prolapse staging. Instruments included: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12), Incontinence Quality of Life Questionnaire (I‐QOL), and a health and urinary leakage questionnaire. Results: One hundred and eighty‐seven ambulatory women, aged 20 to 65 years, had a mean sexual function score of 36.9 (standard deviation [SD] 5.9). No significant correlation was found between the sexual function scores and quantity of urinary leakage. A significant correlation existed between the sexual function and I‐QOL scores (P < .001). An additional finding was that women with urgency symptoms were older (P= .04) and had significantly lower sexual function scores (mean 35.7; SD 6.4) than those who did not report urgency (mean 38.7; SD 4.6; P < .001). Discussion: Women with mild‐to‐moderate stress urinary incontinence, without or with lower stages of pelvic organ prolapse, demonstrated good sexual function, which correlated with physical and psychosocial factors. Health professionals need to perform multifaceted intake assessments on women with urinary leakage to customize their health promotion regimen.     

Depression, Anxiety, and Quality of Life in Patients with Epithelial Ovarian Cancer

Objective. The aims of this study were to evaluate psychological distress and quality of life (QOL) in patients with epithelial ovarian cancer (EOC) and to examine the relationship between these problems and health and demographic variables.Methods. Of 344 consecutive patients identified, 246 completed questionnaires. Four dimensions of QOL were assessed including physical, functional, emotional, and social/family well-being, as well as concerns specific to ovarian cancer patients. Depression was measured with the Center for Epidemiologic Studies-Depression (CES-D) scale and anxiety was measured by the State Anxiety Subscale of the Spielberger State–Trait Anxiety Inventory. Performance status was evaluated by the Zubrod score.Results. Sixty-five patients (26%) had early stage disease; 181 (74%) had advanced disease. One hundred twenty-one patients (49%) were under active treatment, while 124 (51%) were seen for posttherapy surveillance. Forty-eight (21%) met CES-D cutoff criteria for a clinical evaluation for depression, and 29% scored above the 75th percentile for anxiety. Performance status was related to depression, anxiety, and QOL problems, except in the domain of social well-being.Conclusions. Clinically significant depression and anxiety may be more prevalent in patients with EOC than previously reported. Future studies of screening for and treating psychological distress are being designed to improve QOL in these women.