女性盆底疝患者的发病与绝经及雌激素水平的分析研究

目的探讨女性盆底疝患者的发病与绝经及雌激素水平的关系。方法将2013年1月至2016年1月首都医科大学附属北京朝阳医院收住的女性盆底疝患者以是否绝经分为两组,分别检测患者血清雌激素水平,并与正常对照组进行分析比较。结果绝经前及绝经后女性盆底疝患者雌激素水平均显著低于正常对照组,差异有统计学意义(P0.05)。结论雌激素水平明显下降是女性患盆底疝的危险因素,是女性绝经期后盆底疝发病率升高的重要原因之一。     

巨噬细胞在梗阻性肾病中研究进展

正梗阻性肾病(obstructive nephropathy, ON)是临床上常见的慢性肾脏病病因,成人以泌尿系结石多见,婴幼儿则以先天性泌尿系畸形多见[1],手术及时解除梗阻是挽救梗阻肾脏功能的主要方法。然而,许多研究表明患者肾功能在梗阻解除后仍不断进展,直至终末期肾病(end stage renal disease, ESRD)[2],因此,解除肾脏梗阻并不是梗阻性肾病治疗终点。     

女性胆囊结石患者血清脂联素和雌激素的相关性研究

目的探讨女性胆囊结石患者血清脂联素和雌激素的相关性及其与胆石形成的关系。方法62例女性胆囊结石症患者,33例为绝经前,29例为绝经后。选择60例年龄匹配的正常体检人群作为对照。胆囊结石经B超确诊。测量身高、体重,计算体重指数。葡萄糖氧化酶法测定血糖。全自动生化分析仪比浊法测定血脂。放射免疫法测定血清脂联素和雌激素。结果与对照组比较,绝经前和绝经后的胆囊结石患者,血清脂联素显著降低(P0.01),雌激素显著升高(P0.01)呈负相关。血清脂联素与HDL-C和ApoA1呈正相关。结论低脂联素水平可能是雌激素导致胆石症的一个诱发因素,且独立于肥胖和糖尿病之外。     

尿石症病因诊断及预防

泌尿系结石是最常见的泌尿外科疾病之一,据统计在我国一般人群中发病率达1%～10%,其中约25%的患者需住院治疗,在泌尿外科住院患者中居首位.结石治疗后易复发,10年复发率高达50%.而且目前泌尿系结石的发病率仍有继续升高的趋势.     

雌激素对去卵巢小鼠肿瘤坏死因子-α、白细胞介素6水平的影响

补充雌激素可预防绝经后女性多种疾病，如骨质疏松、冠心病、阿尔茨海默病等，说明雌激素（E2）缺乏是上述疾病产生的重要因素。而E2缺乏导致绝经女性相关疾病的具体机制仍未完全阐明。文献报道可能与E2下降，肿瘤坏死因子-α（TNF-α）、白细胞介素6（IL-6）水平异常升高有关。本     

雌激素与泌尿系结石发生的研究进展

正泌尿系结石在全球范围内患病率和复发率在不断增加,如果患者不作预防措施,每年结石复发率约为10%～23%,5年～10年复发率约为50%,20年复发率约为75%[1,2]。最近研究发现,泌尿系结石可以增加慢性肾脏病(chronic kidney disease,CKD)以及终末期肾脏病(end-stage renal disease,ESRD)的风险[3,4]。与此同时,心血管疾病,糖尿病和高血压的风险也随之增加[5,6]。因此,泌尿系结石的防治研究迫在眉睫。研究表明,无论地域及人种差异,泌尿系结石患病率在女性中显著低于男性[7]。我国最近流行病学调查显示,男性泌尿系结石患病率为6.5%,而女性为5.1%,二者之间存在显著性差异[8]。泌尿系结石在性别上的差异可能是由于雌激素在其     

泌尿系结石的预防和治疗展望

随着工业化进程带来环境及饮食结构的改变,泌尿系结石的发病率显著升高,泌尿系结石的防治工作也面临更大的挑战。结石病因学的研究进展提供了全面的结石危险因素分析,据此给予饮食、药物等干预措施,可以预防结石形成;ESWL、输尿管软镜、经皮肾镜取石技术等微创治疗技术的发展,将在泌尿系结石的治疗上呈现新的面貌并更加高效地予以治疗;手术机器人、纳米机器人等全新器械的出现,将开创泌尿系结石治疗的新天地。     

年龄和雌激素对绝经后妇女骨转换生化指标的影响

目的调查骨转换生化指标的差异,并评估激素和年龄相关因素与绝经前和绝经后妇女生化指标的关系。方法选取在2016年1月至2018年1月期间在我院就诊的女性患者作为研究对象。根据问卷调查,共选出496名健康女性,其中绝经前244例,绝经后女性252例。根据试剂制造商提供的指南评估不同的骨标志物,并且采用化学发光免疫测定法进行激素测定,特别是雌二醇水平评估。结果与绝经前妇女相比,绝经后妇女血清钙水平和雌二醇水平显著降低,而绝经后妇女血清磷和碱性磷酸酶(ALP)水平显著升高(P0.05)。年龄与绝经后骨标志物(ALP和钙)显著相关(P 0.05),而绝经前组无显著相关性。绝经后妇女钙与雌二醇之间呈显著正相关,而ALP与雌二醇之间呈显著负相关。此外,在体质指数和年龄校正偏相关分析中,绝经后妇女雌二醇和骨标志物之间没有显著相关性。结论绝经后女性雌激素水平和骨代谢异常对骨质疏松症的预测有积极的意义。     

唑来膦酸对乳腺癌治疗相关骨流失保护作用的研究进展

乳腺癌是女性最为常见的恶性肿瘤之一。化疗及内分泌治疗显著改善了早期乳腺癌患者的预后,然而肿瘤治疗带来的骨流失问题值得关注。内分泌治疗通过降低雌激素水平发挥治疗作用;化疗可导致绝经前女性卵巢功能衰竭,同样使体内雌激素水平显著下降。而低雌激素水平减少骨生成、增加骨吸收,使骨质流失和骨质疏松症的发病率增加、骨折风险升高。第三代双膦酸盐唑来膦酸是一种特异性地作用于骨的二磷酸化合物,已被证实通过抑制破骨细胞活性和诱导破骨细胞凋亡来抑制骨吸收。本文将对唑来膦酸防治女性乳腺癌患者相关骨流失的临床研究进展进行综述。     

泌尿系结石诊治现状与展望

泌尿系结石是泌尿系统最常见的疾病之一,在我国一般人群中发病率高达1％～10％。其中约25％的患者需住院治疗,其比例居泌尿外科住院患者首位。而且结石治疗后易复发,5年复发率达40％～50％,10年复发率高达50％～60％。我国是世界上三大结石高发区之一,目前泌尿系结石的发病率仍有继续升高的趋势。     

Estrogen replacement therapy: implications for postmenopausal women with end-stage renal disease

Little information is available about either the potential beneficial or harmful effects of estrogen replacement therapy in postmenopausal women with end-stage renal disease. Although evidence supports a role for estrogen replacement therapy in postmenopausal women in the prevention of cardiovascular disease and bone loss, possible improvement in cognitive function, and the relief of menopausal symptoms, these conclusions may not be applicable to patients with end-stage renal disease, since these studies have generally excluded such women. This issue is of considerable importance since cardiovascular causes account for more than 50% of the all-cause mortality in patients with end-stage renal disease. However, estrogen replacement therapy may also have untoward effects in patients with the disease, including an increased risk of dialysis access thrombosis and potentially worsening coronary artery disease in postmenopausal patients. Furthermore, dosing of estrogens needs to be done carefully since renal excretion is important for the elimination of estrogen metabolites. Low dose or alternate day dosing in addition to monitoring estrogen levels may be warranted when prescribing estrogen replacement therapy to women with end-stage renal disease. In this review, it is our objective to analyze the evidence published in the literature so far and to weigh the risks and benefits of estrogen therapy in postmenopausal women with end-stage renal disease.     

Longitudinal changes in bone density in hyperparathyroidism.

Primary hyperparathyroidism (HPTH) is a known risk factor for cortical bone loss. The primary objective of this study was to examine the time course and location of changes in bone mass within the first year after parathyroidectomy (PAX). The secondary goal was to evaluate the efficacy of combined estrogen therapy and parathyroidectomy in postmenopausal women. Thirty-two subjects with primary HPTH participated in a prospective, longitudinal study for at least 1 yr. Twenty-seven subjects underwent PTX, while five received no therapy (control). Among the PTX patients, 21 were postmenopausal women, and 8 of these women also received estrogen. Subjects had serial measurements of parathyroid hormone levels, serum chemistries, and bone density at multiple sites. Among all PTX patients, lumbar spine, hip, and whole body bone mineral content increased significantly (3.8-6%; p < 0.005) at 12 mo, with most of the increments observed by 3 mo. In postmenopausal women, estrogen treatment resulted in higher increments in the femoral neck (8.6 +/- 2% vs 4.9 +/- 1.2%, respectively; p = 0.07) and the whole body (6 +/- 2% vs 2.4 +/- 1.6%, respectively; p = 0.07). In HPTH, early and generalized increments in bone mass follow PTX, and the combination of surgery with estrogen therapy may be superior to surgery without estrogen treatment. A randomized, controlled trial including PTX, estrogen, and a combination of the two is needed to determine the optimal therapy in postmenopausal women.     

A clinical trial on the effects of a combination of elcatonin (Carbocalcitonin) and conjugated estrogens on vertebral bone mass in early postmenopausal women

Summary The study was carried out to determine the effect of a combination regimen of a small dose of calcitonin added to conjugated estrogens with medroxyprogesterone acetate on vertebral bone mass in early postmenopausal women. Comparisons were made with groups of women on calcitonin alone, on conjugated estrogens with medroxyprogesterone acetate alone, or on no treatment. The study was carried out over a 2-year period. The results of the study suggest that the combined regimen of calcitonin and estrogens increased vertebral bone mass in early postmenopausal women to a greater extent than calcitonin alone or estrogen alone. Increases in vertebral bone mass of 11.2% after 1 year and 9.2% after 2 years were demonstrated using the combined regimen. Both estrogens alone and calcitonin alone were, however, very effective in preventing rapid bone loss in the postmenopausal women studied.     

New therapies for osteoporosis: Zoledronic acid, bazedoxifene, and denosumab

Intravenous (IV) zoledronic acid, a new once-yearly bisphosphonate therapy, is approved by the US Food and Drug Administration for treatment of postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and osteoporosis in men. IV zoledronic acid significantly reduced the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women and decreased risk of clinical fracture and clinical vertebral fracture in men and women with hip fracture. Two promising new therapies are in late clinical development. Denosumab is a monoclonal receptor activator of nuclear factor-κB ligand (RANKL) antibody given by subcutaneous injection every 6 months that has been shown to significantly reduce risk of vertebral-, nonvertebral-, and hip fracture in postmenopausal women. Bazedoxifene, an estrogen agonist/antagonist, has significantly reduced the risk of vertebral fracture in postmenopausal women; a post hoc analysis showed reduction in risk of nonvertebral fracture in high-risk women.     

Evidence that type I osteoporosis results from enhanced responsiveness of bone to estrogen deficiency

Type I osteoporosis occurs within 20 years after menopause and is associated with excessive cancellous bone loss and fractures of the vertebrae and distal radius. We have suggested that it may be caused by estrogen deficiency plus some additional factor predisposing to excessive bone loss. One such factor might be a greater degree of sex steroid deficiency, a possibility that could not be previously excluded because assays of sufficient sensitivity have only recently become available. Thus, we studied 36 women with vertebral fractures due to typical high turnover type I postmenopausal osteoporosis and 36 normal postmenopausal women using new ultrasensitive assays with detection limits of 1 pg/ml for estradiol, 5 pg/ml for estrone and 5 ng/dl for testosterone to test if type I osteoporosis results from enhanced responsiveness of bone to estrogen deficiency. Mean levels of serum sex steroids were identical in both groups, but bone turnover was increased by up to 55% in the women with type I osteoporosis. Moreover, compared with controls, the osteoporotic women had a 51% higher (P<0.01) serum osteoprotegerin level, which was likely a compensatory response to the increased bone turnover. In the osteoporotic women, 1-year treatment with transdermal estrogen in 14 women reduced total deoxypyridinoline, an index of bone resorption, by 58% as compared with placebo treatment in 17 women (P<0.001). Thus, as compared to controls, postmenopausal osteoporotic women had comparable sex steroid levels but higher bone turnover levels that were responsive to estrogen therapy. This is consistent with the hypothesis that the greater bone loss in type I osteoporosis is the result of impaired responsiveness of bone to low postmenopausal levels of sex steroids.     

Effect of hormonal replacement therapy in postmenopausal women with chronic irritative voiding symptoms

Hormonal replacement therapy was carried out on 24 postmenopausal women who had chronic irritative lower urinary tract symptoms without definable causes. They all underwent bacteriological, endoscopic and urodynamic evaluations, and were diagnosed as having no abnormalities. Depot estradiol (4 mg i.m.) was administered for 2 months at 2-weekly intervals. Two patients discontinued the study because of genital bleeding. After the treatment subjective symptoms, including urinary frequency, urgency, urge incontinence, sense of incomplete emptying and lower abdominal discomfort, were relieved in more than 80% of the patients. Diurnal frequency and nocturia had significantly decreased. Urodynamic assessment revealed that volume at first sensation and maximum cystometric capacity were increased by estrogen therapy. It appeared that estrogen therapy improved the hypersensitivity of the lower urinary tract and relieved chronic voiding symptoms in postmenopausal women.     

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。     

Short- and long-term prognosis of blood pressure and kidney disease in women with a past history of preeclampsia

Little research has been conducted into the long-term effects of preeclampsia, despite its frequent occurrence. The aim of this review is to examine the association between preeclampsia and the development of hypertension and kidney diseases later in life. To achieve this aim, we evaluated three retrospective studies conducted in our department. In the first study, 52 women who suffered from preeclampsia during their first pregnancy were followed for 2 years after delivery for any long-term effects upon blood pressure. In the second study, we evaluated HOMA-R, pulse wave velocity and augmentation index in groups of 48 postmenopausal women with a past history of preeclampsia and 204 postmenopausal women without a past history of preeclampsia. In the third study, we examined the association between a past history of preeclampsia and chronic kidney disease based on biopsy in 127 postmenopausal women. From the first study, although there were no significant differences in age, blood pressure at the onset of preeclampsia, the levels of proteinuria and the birth weight of the child between women who remained hypertensive and those who became normotensive, body mass index was significantly larger in women who remained hypertensive compared to those who were normotensive. In the second study, we found that women with a past history of preeclampsia exhibited insulin resistance combined with reduced vascular elasticity. In the third study, of 32 patients with a past history of preeclampsia, 12 patients exhibited focal segmental glomerulosclerosis, 10 exhibited IgA nephropathy and 10 exhibited nephrosclerosis. In contrast, of the women without a past history of preeclampsia, 26 patients exhibited IgA nephropathy, 20 exhibited a minimal change in nephritic syndrome, 6 exhibited nephrosclerosis, 6 exhibited membranous nephropathy, 5 exhibited lupus nephritis, 5 exhibited diabetic nephropathy, and 27 exhibited various nephropathies. None of the women without a past history of preeclampsia exhibited focal segmental glomerulosclerosis. Taken together with previous results, these findings suggest that hypertension and chronic kidney disease in postmenopausal women are closely associated with a past history of preeclampsia.     

The Decrease in Serum Bone-Specific Alkaline Phosphatase Predicts Bone Mineral Density Response to Hormone Replacement Therapy in Early Postmenopausal Women

Hormone replacement therapy (HRT) prevents bone loss in postmenopausal women. Up to 20% of women demonstrate no increase in bone mineral density (BMD) on HRT. We examined whether early changes in serum bone alkaline phosphatase (B-ALP) predict long-term BMD changes in postmenopausal women on HRT. Ninety women within 1 year of menopause were randomly assigned to continuous or sequential estrogen/progestin (beta estradiol/norethisterone acetate) if naturally postmenopausal, or beta estradiol if within 1 month of surgical menopause. Spine, femoral neck BMD (DXA), and B-ALP were determined over 2 years. The mean percent BMD changes were 3.8%, 2.9%, 1.6% in the spine and 2.4%, 4.0%, 1.1% in the femoral neck in sequential, continuous, and estrogen alone treatment groups, respectively, significantly different from zero except for femoral neck BMD change in the estrogen alone group. HRT was associated with spine and femoral neck BMD loss in 17.4% and 25.3% of women, respectively. In estrogen/progestin-treated women, baseline B-ALP correlated with spine BMD change (r = 0.42, P < 0.01). At 3 months, B-ALP dropped significantly in the estrogen/progestin-groups with a maximal decrease at 12 months, but no change from baseline in the estrogen alone group. Using quartile analysis, women with the greatest drop in B-ALP (≥50%) at 6 months demonstrated the greatest gain in spine BMD at 2 years. A 40% decrease at 6 months in B-ALP had a 56% sensitivity, 83% specificity, 95% positive predictive value for spine BMD gain at 2 years. The decrease in B-ALP can be used to monitor BMD response to HRT. Received: 6 January 1999 / Accepted: 13 August 1999     

倍美力对绝经后妇女纤溶活性的影响

为了探讨激素替代治疗（ＨＲＴ）的心血管保护机制，观察了倍美力对绝经后妇女纤溶活性的影响。４８例绝经后妇女分为３组：安慰剂组１０例；单用倍美力组（Ｅ组）１７例；倍美力、孕激素合用组（Ｅ＋Ｐ组）２１例，并以２０例绝经前妇女作为对照。采用发色底物法测定了ＨＲＴ治疗前及治疗３个月后血浆组织纤溶酶原激活剂（ｔＰＡ）及其抑制因子（ＰＡＩ）活性。结果：绝经后妇女治疗前ＰＡＩ活性明显高于对照组（Ｐ＜０．０１）。安慰剂组治疗前后ｔＰＡ及ＰＡＩ均无显著性变化（Ｐ＞０．０５）。Ｅ及Ｅ＋Ｐ组治疗３个月后ＰＡＩ活性明显减低，ｔＰＡ活性明显升高（Ｐ＜０．０１），两组比较，治疗前后ｔＰＡ及ＰＡＩ活性均无显著性差异。认为ＨＲＴ可通过改善绝经后妇女纤溶活性保护心血管。