性激素替代治疗的适应证和禁忌证

性激素替代治疗(hormonere placement therapy，HRT)的应用已经走过半个多世纪。自1998年美国进行的心脏与雌、孕激素替代治疗研究(HERS)发现HRT无益于冠心病的二级预防，至2002年美国妇女健康研究(WHI)做出对HRT否定大于肯定性的结论，世界范围内HRT的临床应用问题出现了一系列变化。通过回顾性分析，目前关于围     

绝经期性激素治疗与子宫内膜、泌尿生殖系统问题

1　绝经期性激素治疗与子宫内膜性激素补充治疗(HRT)用于绝经期综合征及其与绝经相关疾病的治疗时,如何得到最大受益而承担最小风险,且保护好子宫内膜是HRT的重要环节之一。1932年Geist与Spielman提出ERT可缓解更年期症状,70年代发现ERT可预防绝经后骨质疏松;90年代早期认可HRT能降低绝经后妇女心血管疾病的风险;此后又有HRT减少早老性痴呆发病的观点。直至2 0 0 2年,美国妇女健康研究(WHI)否定了HRT对心血管的防治作用。2 0 0 4年WHI的终点结论显示单纯雌激素补充治疗不增加心血管发病率,说明HRT中孕激素可能对抗了雌激素对心…     

绝经后妇女激素补充治疗后同型半胱氨酸及超声心动图改变的初步观察

目的　观察绝经后妇女激素补充治疗 (HRT)后血浆总同型半胱氨酸 [H(e) ]及超声心动图的改变。方法　将受试者分为 4组。Ⅰ组、Ⅱ组为自然绝经妇女 ,各 30例 ,其中Ⅰ组给予HRT(结合雌激素 0 6 2 5mg d ,安宫黄体酮 2mg d ,或者每月后 14d加安宫黄体酮 4mg d) 3个月 ;Ⅱ组不给予HRT ,为对照 ;Ⅲ组 2 0例 ,为已接受HRT1 5年的绝经后妇女 ;Ⅳ组 2 0例 ,为从未应用HRT的绝经后妇女。Ⅰ组、Ⅱ组受试者于接受HRT前及接受HRT 3个月后测定H(e) ;Ⅲ组、Ⅳ组受试者测定H(e) ,并行超声心动图检查。结果　Ⅰ组、Ⅱ组接受HRT 3个月前后H(e)无明显变化 ,Ⅰ组接受HRT前为(9 3± 2 5 ) μmol L ,Ⅱ组为 (9 4± 2 9) μmol L ;Ⅰ组接受HRT后H(e)为 (9 1± 2 8) μmol L ,Ⅱ组为(9 8± 3 6 ) μmol L。两组比较 ,差异无显著性 (P >0 0 5 )。Ⅲ组H(e)明显低于Ⅳ组 ,分别为 (8 0±1 3) μmol L及 (10 3± 3 2 ) μmol L。两组比较 ,差异有显著性 (P <0 0 5 )。Ⅲ组、Ⅳ组的超声心动图检查结果无明显改变。结论　短期应用HRT对H(e)无明显改善 ,长期应用HRT可降低H(e)水平。绝经后妇女应用HRT 1 5年 ,未见超声心动图有明显变化。     

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。     

激素补充治疗临床应用指南

20 0 3年 8月 ,中华医学会妇产科分会绝经学组来自全国 12个省、市的 31名专家在青岛召开了“HRT临床应用指南研讨会”。会上研讨了有关激素补充治疗 (HRT)临床应用的历史、现状及前景 ,一致通过“激素补充疗法临床应用指南”(简称HRT指南 )。之后 ,学组继续收集听取有关对HRT指南的意见 ,并在 2 0 0 3年 11月北京召开的“中国绝经相关问题高级研讨会”会上 ,再次广泛征求到会各位专家及全体代表的意见 ,进一步对HRT指南进行了补充和修改。现将《HRT临床应用指南》(2 0 0 3年 )在《实用妇产科杂志》全文刊登 ,希望广大妇产科及相关学科的有关临床、科研人员继续提出宝贵意见和建议 ,使HRT指南不断完善 ,以适应临床工作的发展     

性激素替代治疗在预防和治疗绝经后骨质疏松症中的应用

妇女健康研究(Women’s Health Initiative，WHI)近年研究结果证实激素替代治疗(HRT)在预防和治疗绝经后骨质疏松症(postmenopausal osteoporosis，PMOP)中的作用，随机对照实验数据表明，HRT可以增加骨皮质和骨小梁的骨密度(bone mineral density，BMD)以及全身骨矿含量(bone mineral content，BMC)，并存在剂量相关性。各项观察数据证实HRT在降低脊椎及股骨骨折上有积极影响，但HRT的副反应限制其在预防治疗骨质疏松症中的应用。     

激素替代治疗5年安全性分析

目的　探讨激素替代治疗 (HRT)的安全性。方法　 1994年 1月至 2 0 0 1年 8月应用激素替代治疗已满 5年的 74例绝经期妇女 ,分别用倍美力与利维爱治疗。每半年进行妇科、乳腺的B超检查 ,每年进行血生化系列检查。结果　倍美力组用药前甘油三脂 (TG)与用药后比较明显上升 (P <0 0 1) ,高密度脂蛋白胆固醇 (HDL C)上升 (P <0 0 5 ) ,低密度脂蛋白胆固醇 (LDL C)下降 (P <0 0 5 )。利维爱组用药前后比较 ,TG明显降低 (P<0 0 1) ,LDL C下降 (P <0 0 5 )。两组子宫出血例数以绝经初期及应用HRT 3年内最多 ,用药后子宫内膜厚度无明显增加 (P >0 0 5 ) ,子宫体积渐缩小。乳腺增生程度呈减轻趋势 ,但存在个体差异。结论　定期对接受HRT的妇女进行检查及评价 ,使HRT的应用更为安全有效。     

重新认识绝经妇女长期性激素补充治疗的利弊

绝经妇女应用性激素补充治疗 (HRT)已有半个世纪的历史了 ,它的发展及人们对其受益与风险的认识 ,经历了曲折的道路。早年应用雌激素 ,仅限于治疗绝经期综合征。 2 0世纪 70年代 ,开始应用单一雌激素治疗围绝经期症状 ,但因子宫内膜癌发病数的增加 ,而使雌激素的临床应用陷入低潮。 2 0世纪 80年代 ,有关研究规定 ,有完整子宫的妇女在应用单一雌激素时必须加用孕激素 ,以及雌、孕激素的剂量、日程 (每日方案 )及配伍方案 ,并规定了补充雌激素的目标浓度。随后的研究发现 ,雌激素的作用广泛 ,HRT还可预防老年退化性疾病 ,首先是保护骨骼系…     

第16届FIGO会议纪要(1)——绝经与激素替代治疗

2000年9月3～8日在美国华盛顿召开了第16届国际妇产科协会(FIGO)年会,共有近200篇报道涉及绝经和激素替代治疗(hormone replacement therapy,HRT)问题,讨论了各国HRT的一般情况和面临问题,探讨了HRT机制及临床应用多个层画的课题,反映了目前妇女卫生保健和疾病治疗领域的新发展。现就此专题介绍如下: 一、HRT的现状 由于经济发展水平的不平衡、文化传统的不同和相关知识普及程度的差异,世界各国围绝经期和绝经后妇女保健、HRT应用状况有很大差距。欧美等发达国家应用HRT非常普遍,     

性激素替代治疗与绝经期妇女的心血管疾病

多年来，大量的流行病学调查研究显示，绝经妇女的雌激素替代治疗或是雌孕激素替代治疗(hormone replacement therapy，HRT)可以降低绝经期女性发生冠心病(coronary heart disease，CHD)的风险。一系列的试验研究也显示，雌激素对心血管具有保护作用。然而，近年来，随机临床试验(randomized clinical trial，RCT)则发现，HRT并不具有预防CHD的作用，雌孕激素联合的替代治疗甚至增加了绝经期妇女发生CHD的风险。如何分析和认识这些研究结果，并指导临床医疗实践，已成为一线临床医师所面临的首要问题。     

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND: Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS: Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS: The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Reproductive and menstrual factors and risk of peritoneal and ovarian endometriosis

OBJECTIVE: Between 1987 and 1989 data were collected to evaluate risk factors for pelvic endometriosis. DESIGN: A case-control study was conducted on 241 cases with laparoscopically or laparotomically confirmed peritoneal or ovarian endometriosis consecutively admitted to three teaching hospitals in Northern Italy. The control group consisted of 437 women admitted to hospitals for acute conditions covering similar catchment areas. RESULTS: Compared with nulliparous women, the risk of endometriosis decreased with increasing number of births: the point estimates were 0.4 and 0.3, respectively, for those with one and two or more births (X2(1) trend = 50.3, P less than 0.001). No relation emerged with age at first birth and spontaneous miscarriages. Relative to women whose menarche occurred at age 11 or younger, the risk of endometriosis was slightly lower in those who experienced later menarche, but the trend in risk was not significant. Women with irregular menstrual cycles showed a lower frequency of the disease (relative risk, 0.3; 95% confidence interval, 0.2 to 0.5). The role of various factors was largely similar for different disease locations (ovary, peritoneum, and both) and indication for diagnostic surgery (sterility, pelvic pain, and other reasons). CONCLUSIONS: This study found that parity and irregular/long menses lower the risk of endometriosis. These findings were similar in different subgroups of disease location and indication for surgery, giving strong evidence of the consistency of the general results.