阴道pH值与血清雌二醇水平的相关性研究

目的 :探究妇女不同时期阴道 p H值与血清雌二醇 ( E2 )水平的相关性。方法 :2 85例已婚妇女 ,排除阴道炎症、阴道用药、性生活等影响因素 ,按月经周期、早孕、围绝经期及绝经期不同阶段分组 ,用精密 p H试纸测定阴道 p H值 ,同时应用磁性分离酶免疫法测定血清 E2 水平进行相关性分析。结果 :血清 E2 水平与阴道 p H值呈显著负相关 ( r=-0 .76 ,P<0 .0 5) ,阴道 p H值变化范围在 ( 7.6± 0 .3 )～ ( 3 .0± 0 .0 )之间。妇女阴道 p H值依次为妊娠期明显低于排卵期、排卵期低于卵泡期、卵泡期低于绝经期 ( P均 <0 .0 5)。结论 :阴道 p H值在一定范围内可反映血清 E2 水平 ,检测方便、快捷 ,价格低廉 ,可用于已婚妇女雌激素水平的判定、排卵期监测等     

Expression of estrogen receptor-alpha and -beta in anterior vaginal walls of genuine stress incontinent women.

Our objective was to study the expression of estrogen receptor (ER) isoforms, ER-alpha and ER-beta, in the anterior vaginal wall of menopausal and fertile women with genuine stress incontinence (SI) by immunohistochemistry and Western blot analysis. Eighteen menopausal women with SI who either were or were not taking estrogen/progestin replacement therapy and 14 fertile women with SI who either were or were not taking contraceptives were enrolled in the study. Biopsies from the suburethral anterior vaginal wall were obtained at tension-free vaginal tape (TVT) operation. Monoclonal antibody to ER-alpha and polyclonal antibody to ER-beta were used to stain frozen sections of vaginal tissue. The receptor expressions were scored based on percentage of positive cells. ER-alpha was detected in vaginal epithelial, stromal and smooth muscle cells. In menopausal SI women ER-alpha was detected significantly more frequently in the vaginal walls of estrogen/progestin-treated patients than in those who were untreated. Fertile SI women had significantly higher expression of ER-alpha than menopausal SI women. ER-alpha was not observed in vaginal blood vessels. ER-beta was detected in epithelial and vascular smooth muscle cells of the vagina. No significant difference in ER-beta expression was observed between different groups of patients. The expression of ER-alpha was not correlated with that of ER-beta. Both ER-alpha and -beta were detected, indicating a potential role for both types of estrogen receptor in the human vaginal wall. The expression of ER-alpha, but not of ER-beta, in menopausal SI women was regulated by estrogen/progestin replacement therapy. The presence of ER-beta in vaginal vascular smooth muscle cells raises the possibility of vascular effects of estrogen on the human vaginal wall.     

围绝经期的流行病学调查

1990年5～12月在北京东城区40～65岁妇女中进行了围绝经期流行病学调查。随机抽样得调查对象5000余名,应答率97.1％。共有5134名妇女进入分析,其中54.4％已绝经。绝经者中自然绝经占93.8％,手术绝经占5.4％。自然绝经平均年龄49岁。既往月经多,曾用甾体避孕药,肥胖及多次妊娠等与绝经晚有关;而吸烟及绝经前生活中发生重大事件可导致提早绝经。更年期症状不如西方妇女严重,与亚洲一些国家的研究结果接近,表明了种族和社会文化的不同对更年期症状的影响。产次、教育水平、绝经年龄、月经状况、哺乳、绝经时婚姻状态,以及生活中重大事件或环境变化等,均可以其特有方式影响更年期症状的轻重、出现早晚和持续时间。     

Testicular function in hyperthyroidism.

Testicular function was assessed in nine men aged 17 to 35 years and seven men aged 36 to 46 years with Graves' disease. Levels of total testosterone, estradiol, sex hormone binding globulin, luteinizing hormone, and follicle stimulating hormone, and gonadotropin responses to gonadotropin releasing hormone were significantly greater than these levels and responses in age-matched controls. Although the percentage of free testosterone was lower than control values in the hyperthyroid men, calculated levels of free testosterone were not different from normal. Lower than normal percentages of free estradiol values resulted in higher than normal calculated free estradiol levels. As a result, the free testosterone/free estradiol ratio in the men with Graves' disease was lower than normal. Although mean sperm densities in the hyperthyroid men were not different from control values, the percent forward progressive motility of sperm from these men was significantly lower than control values. The hormonal and seminal abnormalities corrected when the patients became euthyroid after radioiodine therapy. The results of this study indicate that hyperthyroid men may have abnormalities in their hypothalamic-pituitary-testicular axes.     

Pharmacokinetics of estrogen and progesterone in chronic kidney disease

Estradiol, estrone, and estrone sulfate are the primary circulating estrogens in women; the relative amounts depend on the menopausal status of the women. Administration of oral estradiol or conjugated equine estrogens (CEE) results in a high ratio of estrone to estradiol, whereas use of nonoral routes (dermal, vaginal, or parenteral) results in approximately equal plasma concentrations of estradiol and estrone. Although estradiol and estrone are predominately eliminated by metabolism, and little is excreted unchanged in the urine, evidence indicates that chronic kidney disease (CKD) alters the pharmacokinetics of estradiol. Free and total estradiol plasma concentrations are higher in women with end-stage renal disease (ESRD) after an oral estradiol dose, but no change occurs in estrone concentrations. Neither estradiol nor estrone is removed in the dialysate. These studies suggest that women with CKD should receive a least a 50% reduction in oral estradiol doses. No information is available on the pharmacokinetics of any of the progestins in CKD. In the future, knowledge of the concentration effect relationship for the treatment of symptoms of menopause, as well as prevention of osteoporosis, will benefit all postmenopausal women who choose to use hormone replacement therapy.     

切除卵巢对雌、雄激素及尿钙的影响

为了解卵巢所分泌的雄激素是否亦增加尿钙量的排出。对２１例绝经前、后切除卵巢患者手术前后用放射免疫法测定雌、雄激素水平，并观察尿钙排泄的变化。结果：绝经前切除双侧卵巢１３例，术后雌二醇（Ｅ２）水平明显降低，雄激素（Ｔ）水平也略有下降，尿钙排泄明显增加。绝经后切除双侧卵巢７例，术后睾酮（１）水平明显降低，尿钙与肌酐比值（Ｃａ／Ｃｒ）显著升高。表明雌激素减少明显增加了尿钙的排出量。绝经后的卵巢仍分泌一定量的雄激素，它在妇女骨质疏松中亦同时起一定的作用。     

High endogenous estradiol is associated with increased venous distensibility and clinical evidence of varicose veins in menopausal women

OBJECTIVE: The purpose of this study was to determine if there is an association between elevated sex hormones (ie, serum estradiol, sex hormone binding globulin [SHBG], testosterone) and increased venous distension and clinical evidence of varicose veins in menopausal women. METHODS: Participants were 104 healthy volunteer menopausal women, aged 48 to 65 years, who were not undergoing hormonal treatment. Of these 104, 14 were excluded from analyses because their estradiol levels were compatible with a premenopausal condition (4), because they had missing values for insulin concentration (5), and because they did not show up at venous vessel examination (5). Patients underwent a physical examination to determine the presence of varicose veins; a venous strain-gauge plethysmographic examination to compute instrumental measures of venous distensibility; and laboratory analyses of blood so serum testosterone, estradiol, SHBG, glucose, and insulin could be measured. There were also prevalence ratios and odds ratios used to test the presence of an association between biochemical and instrumental variables. RESULTS: Serum levels of estradiol in the upper tertile of the frequency distribution were significantly associated with clinical evidence of varicose veins (prevalence odds ratios 3.6; 95% CI 1.1-11.6) and with increased lower limb venous distensibility (prevalence odds ratios 4.4; 95% CI 1.2-15.5). No association was found for SHBG and testosterone. CONCLUSIONS: Our finding that high serum levels of estradiol are associated with clinical evidence of varicose veins and instrumental measurements indicating increased venous distensibility in menopausal women suggests that endogenous estrogens may play a role in the development of this very common venous vessel abnormalities.     

芬吗通在冻融周期子宫内膜发育不良患者中的应用

目的探讨子宫内膜发育不良患者在冻融胚胎移植(FET)周期中行芬吗通激素替代方案时血清雌二醇(E_2)水平、内膜厚度与胚胎种植结局的关系,并分析不同17β雌二醇剂量和用药方式对血清E_2水平、内膜厚度和种植结局的影响。方法回顾性分析子宫内膜发育不良患者(曾行戊酸雌二醇激素替代方案因内膜厚度未达标而取消周期)行芬吗通激素替代方案的41个FET周期,根据临床结局分为着床组与未着床组,分析胚胎种植结局与血清E_2水平和内膜厚度的关系。并根据不同雌激素剂量和用药方式分为三组:A组仅口服雌激素6 mg,B组口服雌激素4 mg+阴道给药2 mg,C组口服雌激素6mg+阴道给药2 mg。三组两两比较其血清E2水平、内膜厚度和妊娠结局是否有差别。结果胚胎着床组与未着床组比较,两组患者的年龄、不育年限、移植胚胎数、优质胚胎数、基础E_2水平、移植日E_2水平、注射黄体酮第3日(D3)E_2水平、用药第7天内膜厚度和移植日内膜厚度均无统计学差异(P>0.05)。着床组的内膜增厚值明显大于未着床组,且差异有统计学意义(P<0.05)。B、C组分别与A组相比,移植日E_2水平、注射黄体酮D3日E_2水平和内膜增厚值均明显增加,且差异有统计学意义(P<0.05)。而C组与B组相比,除内膜增厚值明显增加且差异有统计学意义外(P<0.05),其余指标差异均无统计学意义(P>0.05)。结论在FET周期中,芬吗通激素替代方案适合用于子宫内膜发育不良患者,其血清E2水平、子宫内膜厚度、胚胎种植率和临床妊娠率均可达到满意效果。内膜增厚值是影响FET结局的重要因素之一。雌激素用药剂量与方式以口服17β雌二醇4 mg+阴道给药2 mg比较适宜内膜生长及胚胎种植。     

Pelvic connective tissue resilience decreases with vaginal delivery,menopause and uterine prolapse

BACKGROUND: The late onset of pelvic visceral prolapse and incontinence after childbirth injury could be explained by menopause-associated connective tissue weakening. Uterosacral ligament resilience (UsR) was assessed to determine whether it influenced uterine or pelvic floor mobility, or varied with age, vaginal delivery, menopause or histological variations in the ligament. METHODS: UsR was measured by tensiometry in ligaments from 85 hysterectomy specimens, and was correlated with the presence of symptomatic uterocervical prolapse, prehysterectomy uterine and anorectal mobility, patient age, history of vaginal delivery and menopause. Forty-five of these ligaments were examined for ligament thickness, muscle to collagen ratio, and oestrogen and progesterone receptor density. The results were correlated with UsR. RESULTS: UsR was significantly reduced (P = 0.02) in symptomatic uterovaginal prolapse, but there was no correlation with either uterocervical or anorectal descent in women without symptomatic prolapse. There was a significant decrease in UsR with vaginal delivery (P = 0.003), menopause (P = 0.009) and older age (P = 0.005). The uterosacral ligament was significantly thinner and contained fewer oestrogen and progesterone receptors after menopause, but this did not affect UsR. CONCLUSION: Where pelvic floor muscles are weakened, decreases in pelvic connective tissue resilience related to the menopause may facilitate progression to symptomatic pelvic visceral prolapse.     

The effect of adjuvant therapy with or without tamoxifen on the endocrine function of patients with breast cancer

The ovarian and pituitary functions of 64 operable breast cancer patients undergoing adjuvant therapy with cytotoxic chemotherapy and/or tamoxifen were investigated. The post menopausal patients, divided into 3 treatment groups, one with tamoxifen alone, one with tamoxifen and chemotherapy and the other with chemotherapy alone had serum estradiol 17-β (E2) and progesterone levels lower than the evaluable limits. Although there was no significant difference in the level of estrone sulfate (E1-S) between these three groups, the level of lutainizing hormone (LH) and follicle stimulating hormone (FSH) in the patients treated with tamoxifen alone and tamoxifen and chemotherapy were significantly lower than those treated with chemotherapy alone. The decrease in gonadotropin levels induced by tamoxifen treatment was reversible as it appeared after the initiation of tamoxifen and recovered after its cessation. In the premenopausal patients, a group treated with tamoxifen and chemotherapy had significantly higher E1-S, E2 and progesterone levels and significantly lower gonadotropin levels than a group treated with chemotherapy alone or one treated with a cyclophosphamide regimen. These increases in the levels of estrogen and progesterone were also reversible, and induced by tamoxifen. Thus, adjuvant endocrinochemotherapy causes profound alteration in the hypothalamo-pituitary-ovarian axis and therefore, monitoring a variety of hormonal levels is thought to be necessary for assessing the consequences of adjuvant therapy in breast cancer patients, especially in premenopausal patients using tamoxifen.     

Effect of hormone replacement therapy on CD4+ and CD8+ numbers, CD4+/CD8+ ratio, and immunoglobulin levels in hemodialysis patients

Uremia induces a suppression of the immune status. A large clinical literature suggests that estradiol (E2) plays a critical role in immune function. A large proportion of women hemodialysis patients faced early menopause and inadequate estrogen levels. The aim of the present study is to evaluate the effect of hormone replacement therapy on immune function in terms of CD4+ numbers (inducer/helper T cells), CD8+ numbers (cytotoxic/suppressor T cells), CD4+ / CD8+ ratio, and IgG, IgM, IgA levels in woman hemodialysis patients. In our study, 15 female hemodialysis patients (median age 32.6 range 24-45) were treated with triphasic estrogen/progesterone preparation (estradiol 2 mg for 10 days, and afterwards estradiol 2 mg+norethisterone 1 mg for another 10 days, and at the end estradiol 1 mg for 6 days) for 6 months. CD4+ numbers, CD8+ numbers, and IgG, IgA, and IgM levels were determined before and after HRT. The "paired-samples T" test was used for statistical analysis of pretreatment and posttreatment values. A significant increase was observed for CD4+ numbers (582 +/- 435 versus 637 +/- 445, p = 0.04) and CD4+/CD8+ ratio (1.4 +/- 0.16 to 2.4 +/- 0.3, p < 0.01) after hormone replacement therapy (HRT). Serum immunoglobulin levels were not changed significantly. In conclusion, in postmenopausal hemodialysis patients, HRT significantly increased CD4+ numbers and CD4+ / CD8+ ratio, but no effect was observed in IgM, IgG, and IgA levels. Long-term clinical effects of HRT on immune system should be investigated in dialysis patients with further studies.     

The effect of adjuvant therapy with or without tamoxifen on the endocrine function of patients with breast cancer

The ovarian and pituitary functions of 64 operable breast cancer patients undergoing adjuvant therapy with cytotoxic chemotherapy and/or tamoxifen were investigated. The post menopausal patients, divided into 3 treatment groups, one with tamoxifen alone, one with tamoxifen and chemotherapy and the other with chemotherapy alone had serum estradiol 17-beta (E2) and progesterone levels lower than the evaluable limits. Although there was no significant difference in the level of estrone sulfate (E1-S) between these three groups, the level of lutainizing hormone (LH) and follicle stimulating hormone (FSH) in the patients treated with tamoxifen alone and tamoxifen and chemotherapy were significantly lower than those treated with chemotherapy alone. The decrease in gonadotropin levels induced by tamoxifen treatment was reversible as it appeared after the initiation of tamoxifen and recovered after its cessation. In the premenopausal patients, a group treated with tamoxifen and chemotherapy had significantly higher E1-S, E2 and progesterone levels and significantly lower gonadotropin levels than a group treated with chemotherapy alone or one treated with a cyclophosphamide regimen. These increases in the levels of estrogen and progesterone were also reversible, and induced by tamoxifen. Thus, adjuvant endocrinochemotherapy causes profound alteration in the hypothalamo-pituitary-ovarian axis and therefore, monitoring a variety of hormonal levels is thought to be necessary for assessing the consequences of adjuvant therapy in breast cancer patients, especially in premenopausal patients using tamoxifen.     

Mammographic densities and circulating hormones: a cross-sectional study in premenopausal women

Progestogens appear to influence breast density more than estrogens in postmenopausal women taking hormone replacement therapy (HRT), but little is known about the effect of circulating hormones on mammographic density among premenopausal women. This cross-sectional study explores the relationship of body weight and sex steroids with breast density. Luteal serum samples were analyzed for progesterone, estrone, estradiol, and sex hormone-binding globulin (SHBG). Mammograms were assessed for density using a computer-assisted method. We performed mediation tests using multiple linear regression models. Significant associations of SHBG and estradiol with percentage density disappeared after adjustment for body weight and other covariates, whereas the relationship between progesterone and breast density remained borderline significant. The mediation tests indicated that progesterone has a direct and an indirect effect on mammographic density. Our finding that progesterone shows a stronger association with percentage of mammographic density than estrogen agrees with clinical reports describing denser mammographic patterns among women taking HRT, although these women differ in menopausal status.     

Fractional CO₂ vaginal laser for the genitourinary syndrome of menopause in breast cancer survivors

Adjuvant chemotherapy and endocrine therapy can induce early iatrogenic menopause or worsen pre-existing menopausal symptoms in breast cancer survivors (BCS). The second most frequent menopausal symptom after hot flushes is the genitourinary syndrome (GSM). Since hormone replacement therapy is contraindicated in BCS, vaginal laser might represent a new nonhormonal option for GSM. This study aims at evaluating the effectiveness of the fractional CO₂ vaginal laser for GSM in BCS compared with healthy women. This is a retrospective study on 135 postmenopausal women (45 BCS and 90 healthy women) who underwent fractional CO₂ laser for GSM. Objective (VHI and VVHI) and subjective outcomes (VAS for dyspareunia and vaginal dryness and a pain questionnaire) were evaluated at baseline visit and at every follow-up visit. Subjective and objective parameters improved significantly in both groups after laser therapy. The improvement was progressive and long-lasting up to 12 months after the end of the treatment. No severe adverse events were observed during the treatment. Fractional CO₂ vaginal laser induces a significant and long-lasting improvement on GSM symptoms in BCS. However, this improvement is slower than in healthy women undergoing the same treatment. Laser therapy turns out to be safe and well-tolerated.     

The age at natural menopause and the frequency of climacteric symptoms in Chinese women

IntroductionNaturalmenopauseisconsistentlydefinedasthelastmenstrualperiod.Itisobservedretrospectivelyas12consecutivemonthsofa-menorrheawithuterusandatleastoneovaryintactandwithoutanidentifiablecausefora-menorrheaL1j.Itwasconservativelyestimatedthattherewereabout113.4miIlionwomenatagesof45andaboveinChinaby199OL2j.Ear-lynaturalmenopauseisapotentialbiologicmarkerofhealthandaging.TheageatmenopauseinindividualsmaybeobtainedbyperiodicaIlyaskingwomenaboutthepresenceofmenstrualcyclesL'j.oritmaybed…     

Decreased circulating levels of estrogen alter vaginal and clitoral blood flow and structure in the rabbit.

Aging and menopause related decline in circulating levels of estrogen has been shown to adversely affect female sexual arousal function. Our aim was to study the effects of circulating levels of estrogen on the hemodynamic mechanism of vaginal and clitoral engorgement and on the structure of the vaginal and clitoral cavernosal tissue in the rabbit. New Zealand White female rabbits (3.5-4 kg) were randomly divided into three groups with five rabbits in each group: control; bilateral oophorectomy; bilateral oophorectomy undergoing subcutaneous injection of estrogen (40 microg/kg/day). After 6 weeks, the serum levels of 17 beta-estradiol were measured and systemic blood pressure was monitored. Vaginal and clitoral cavernosal blood flows were measured with laser Doppler flowmeter before and after pelvic nerve stimulation. Cross sections of the clitoris and vagina were processed for histologic examination and histomorphometric image analysis. Serum level of 17 beta-estradiol (pg/ml; mean+/-s.d.) revealed a significant decrease in the oophorectomy group (25.4+/-5.1) compared with the control (38.5+/-7.6) and estrogen replacement (115.9+/-57.3) groups (P<0.05). Nerve stimulation-induced peak vaginal and clitoral intracavernosal blood flows in the oophorectomy group (28.9+/-16.3 and 6.1+/-1.4, respectively) were significantly less than those recorded in the control (48.9+/-6.5 and 11.0+/-2.4, respectively) or estrogen replacement (48.7+/-12.2 and 10.1+/-2.8, respectively) group (P<0.05). In histology, marked thinning of the vaginal epithelial layers, decreased vaginal submucosal microvasculature, and diffuse clitoral cavernosal fibrosis were evident in the oophorectomy group but not in the estrogen supplement and control groups. In histomorphometry, the percentage of clitoral cavernosal smooth muscle in the oophorectomy group (49.6+/-6.2) was significantly decreased compared with the control (56.8+/-2.6) and estrogen replacement (58+/-3.0) groups (P<0.05). Our studies show that decline in circulating levels of estrogen impairs the hemodynamic mechanism of vaginal and clitoral engorgement and leads to histopathologic changes in the vagina and clitoral cavernosal tissue. These observations suggest that decreased circulating levels of estrogen, a physiologic change in the menopausal state, may play a role in the development of female sexual arousal dysfunction.     

北京市中老年女性月经及身体成分与骨密度的相关性研究

目的调查北京市中老年女性年龄、月经和身体成分特征,分析其与骨密度的关系以及对骨密度的影响。方法招募45～80岁女性384名,调查受试者月经状况,包括初潮年龄、绝经年龄和绝经年限;测试受试者腰椎、左股骨颈、左髋以及全身骨密度,并测试全身脂肪和肌肉含量,由此计算脂肪含量指数(fat mass index,FMI)、肌肉含量指数(lean mass index,LMI)和四肢骨骼质量指数(appendicular skeletal muscle mass index,ASMI)。采用Pearson相关和多元逐步回归模型分析各因素与骨密度的关系。结果相关性结果显示,年龄、绝经年限、初潮年龄与骨密度呈显著负相关,绝经年龄、LMI、FMI和ASMI与骨密度呈显著正相关。多元逐步回归分析结果显示,绝经年限与各部位骨密度均呈显著负相关,ASMI与各部位骨密度均呈显著正相关,FMI仅与全髋和全身骨密度具有显著相关性,初潮年龄和绝经年龄仅与腰椎和全身骨密度具有显著相关性。结论绝经年限是中老年女性骨密度的独立危险因素,而ASMI则为独立保护因素,绝经年龄、初潮年龄以及FMI对中老年女性骨密度的影响存在部位差异性。     

Safety and efficacy of hormonal therapy in menopausal kidney-allograft recipients

AIM: A higher risk of premature menopause and osteoporosis has been observed in female kidney-allograft recipients, providing particular indications for hormonal therapy. We have summarized our 10-year-experience with hormonal therapy in menopausal kidney transplant recipients. MATERIALS AND METHODS: From 1995 to 2004, hormonal therapy was administered to 54 kidney transplant recipients. At onset of therapy the ages of the women ranged from 31 to 52 years, and the period from transplantation from 3 months to 13 years. The mean time on therapy was 4.2 years. All patients received transdermal estradiol (E(2)) in combination with oral progestin. RESULTS: Total regression of climacteric symptoms was reported in 75% of patients. After 3 months of the therapy follicle stimulating hormone (FSH) and E(2) levels normalized: FSH from 129 +/- 30.1 IU/L to 38.3 +/- 26.1 IU/L and E(2) from 18.5 +/- 5.8 pg/mL to 98.6 +/- 33.2 pg/mL. No significant change was noted in serum creatinine. Eleven patients developed abnormal uterine bleeding but none had premalignant or malignant lesions of the uterus on endometrial curettage. No incidence of breast cancer was noted during mean treatment period of 5.2 years. Seventeen patients discontinued therapy for medical indications: one for profound thrombophlebitis and 16 for significant deterioration of liver function. Twelve women made their own decision to discontinue therapy. CONCLUSION: Hormonal replacement therapy was effective with no negative impact either on graft function or sex organs among kidney transplant recipients. Liver parameter monitoring seemed to be essential for safe continuation of treatment.     

经皮用雌二醇凝胶预防绝经早期骨丢失用量的探索

探索经皮用雌激素凝胶对中国妇女预防绝经早期骨丢失的用量 ,进行 2年开放随机前瞻性研究。采用周期性联合应用雌孕激素 ,雌激素为经皮用雌二醇 (E2 )凝胶 ,孕激素为口服微粉化孕酮 (microprogesterone,MP)和醋甲羟孕酮 (MPA)。 60名妇女 ,身体健康 ,绝经 1～ 5年 ,随机进入 4组 :G1 :E2 1 .5 mg/ d+ MP1 0 0 mg/ d;G2 :E2 1 .5mg/ d+ MPA 2 mg/ d;G3 :E2 0 .75 mg/ d+ MP 1 0 0 mg/ d;G4:E2 0 .75 mg/ d+ MPA 2mg/ d。每日睡前应用 ,每月连用 2 5 d。用 SPA法测前臂骨密度 (CBMD) ;QCT法测腰椎松质骨骨密度 (TBMD) ;DEXA法测腰椎 (L 2 -4 )与髋部骨密度。分别在用药 0、 6、1 2、 1 8和 2 4个月时测量骨密度、骨代谢生化指标、评分绝经症状及骨质疏松症状及记录阴道出血。结果 :5 9名 (98% )完成 1年 ;5 6名 (93 % )完成 2年。用药 6个月时 4组症状平均缓解约 80 % ;2年时腰椎 TBMD平均升高 4.3 %～ 7.5 % ;L 2 -4升高 2 .7%～4.5 % ;股骨颈升高 2 .0 %～ 4.2 %。E2 1 .5 mg(G1 + G2 )与 E2 0 .75 mg(G3 + G4)比较 ,对骨密度的改善无显著性差异 (P=0 .0 7～ 0 .93 )。不规则阴道出血率 G2最高 (41 .3 % )、G3最低 (1 0 .2 % )。结论 :每日经皮用 0 .75 mg E2 凝胶可有效缓解绝经相关症状 ,预防绝经早期     

The effect of ovariectomy on spine bone mineral density in rhesus monkeys

As part of a study on the effects of hormones on uterine biology and estrogen metabolism, 12 normal female rhesus (Macaca mulatta) monkeys were ovariectomized, and treated intermittently with estradiol and progesterone. In order to determine whether there were changes in bone density as a result of ovariectomy despite the hormone therapy, spine bone mineral density (BMD) was measured by dual-photon absorptiometry. The mean +/- SE time from ovariectomy was 26 +/- 3 months, the mean estrogen treatment time was 3.5 +/- 0.4 months and the mean time from last hormonal treatment was 4.1 +/- 0.6 months. In these 12 monkeys aged 7.7 +/- 0.2 years, the mean spine BMD, 0.825 +/- 0.008 g/cm2, was significantly less, p = 0.0011, than the spine BMD, 0.863 +/- 0.007 g/cm2, in 12 intact female rhesus of similar age, 7.6 +/- 0.1 years and weight. Ovariectomy in female rhesus monkeys results in a relatively rapid diminution of spine BMD which is not prevented by intermittent hormonal replacement. This species may be an excellent model for studies of human osteoporosis.