绝经后妇女阴式手术前后激素替代治疗观察

目的观察绝经后妇女阴式手术前后应用激素替代治疗(HRT)的临床效果和安全性。方法将2002年元月至2007年12月收住的绝经后妇女患有Ⅱ度、Ⅲ度子宫脱垂伴不同程度阴道前后壁脱垂及伴或不伴有张力性尿失禁而实行阴式手术治疗的患者随机分为实验组和对照组,每组48例。实验组在手术前后进行HRT,对照组给予安慰剂,观察各项临床指标。结果与对照组比较,阴道健康评分,阴道黏膜厚度、血清雌二醇(E2)明显增加,血清卵泡刺激素(FSH)降低,均有显著性差异(P<0.01)。手术时间、术中出血量明显降低,住院天数缩短,有显著性差异(P<0.01)。术后切口感染率明显降低,有显著性差异(P<0.05)。子宫内膜厚度及病理检查无明显变化(P>0.05)。用药后无明显不良反应。结论绝经后妇女阴式手术前后应用HRT并局部用药安全可行且临床疗效明显。     

激素替代治疗对绝经后子宫肌瘤患者的影响分析

目的 探究激素替代治疗对绝经后子宫肌瘤患者的影响.方法 86例绝经后子宫肌瘤患者,根据治疗方法分为对照组和实验组,每组43例.对照组采用谷维素治疗,实验组采用激素代替治疗.对比两组治疗前后性激素水平、子宫肌瘤体积、子宫内膜厚度以及生活质量评分.结果 治疗后,实验组患者卵泡刺激素(FSH)、雌二醇(E2)、孕酮(P)水平...     

对绝经后妇女激素替代治疗的认识

绝经是妇女生殖能力停止的时间,此时妇女的卵巢功能停止体内的性激素水平变化,同时身体发生许多生理变化。绝经是一个自然现象,但绝经后的低雌激素状况将会给这些妇女带来许多的生理和心理不适,包括围绝经时期的潮热、失眠、盗汗、情绪波动以及长期雌激素缺乏产生的退行性病变如心血管疾病、骨质疏松症和泌尿生殖道萎缩问题。妇女的平均绝经年龄为50岁。随着人类寿命的延长,妇女在绝经后要生活很长时间,几乎占生命的1／3时间,因此预防和治疗雌激素缺乏带来的健康问题是非常重要的。     

绝经早期妇女激素替代疗法对牙周病的影响

目的探讨绝经早期妇女,应用激素替代疗法,对牙周病的影响,为口腔牙周病的治疗和预防牙齿脱落提供参考依据。方法将2005年1月至2007年6月绝经早期妇女因口腔疾病就诊的患者150例,与妇科联合诊治随机分为两组,A组为应用激素替代治疗组,B组为观察组。结果 A组牙周炎治疗效果明显优于B组,牙齿脱落少于B组,且未发现有激素引起的子宫内膜、乳腺病变。结论对于绝经期妇女应用激素替代治疗不仅对妇女的心血管疾病具有预防作用,缓解更年期症状,同时对合并口腔病具有协同治疗作用,从而提高妇女生活质量。     

激素替代治疗对绝经后女性内分泌及脂代谢水平的影响

目的观察激素替代治疗对绝经后女性内分泌及脂代谢水平的影响。方法绝经后女性70例作为观察组,给予激素替代治疗。同期在该院行健康体检的绝经后女性70例作为对照组,不给予任何治疗,但保持观察。结果半年后,观察组血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清雌二醇(E2)、黄体生成素(LH)和尿促卵泡素(FSH)变化不大;对照组TC、TG、LDL-C、LH和FSH显著升高,HDL-C、E2降低,各项指标组间差异有统计学意义。结论激素替代治疗在短期内能有效抑制性激素水平的进一步异常,从而使脂代谢维持在基本稳定水平;长期治疗的有效性和安全性还需今后进一步观察。     

绝经后长期低剂量激素替代治疗的临床观察

目的　观察绝经后长期低剂量激素替代治疗 (HRT)的有效性与安全性。方法　HRT48例 ,自然绝经组 2 2例 ,手术绝经组 2 6例。年龄 39～ 6 1岁 ,用药 2～ 6年。自然绝经组用倍美力 (CEE) 0 3mg/d× 2 2天 ,后 7天加安宫黄体酮 (MPA) 4mg/d。无子宫者不加MPA。服药前后抽血测E2 、FSH、血脂、骨密度检查 ,治疗前后自我对照 ,骨密度设正常对照组。结果　绝经症状均在用药3周内缓解。无子宫内膜增生过长、乳房病变发生 ;HRT后E2 明显上升 (P <0 0 1) ;FSH明显下降(P <0 0 0 1)。总胆固醇 (TC)、载脂蛋白B(APOB)HRT前后无明显变化 (P >0 0 5 ) ;甘油三酯 (TG)、高密度胆固醇 (HDL C)、载脂蛋白A1(APOA1) ,HRT后均上升 (P分别 <0 0 5 ,<0 0 1)。骨密度(BMD)L2～ 4 及股骨颈HRT后与对照组比 (P <0 0 0 1)。结论　长期服用低剂量HRT对绝经后妇女能改善临床症状 ,保护心血管及保持骨健康。     

激素替代治疗对绝经后妇女血清E2,阴道上皮及子宫内膜的影响

通过监测113例组经后激素替代治疗（HRT）妇女血清E2、V分、子宫内膜厚度及内膜细胞形态的变化，探讨不同药物、剂量及HRT时间对E2、阴道上皮及子宫内膜的影响。结果：爱斯经凝胶组E2最高，戊酸雌二醇次之，利维爱最低，前两者V分、内膜厚度、增殖期及萎缩型比例相近，而后者V分、内膜厚度明显低于前两者（P＜0．001）。”爱斯妥凝胶、戊酸雌二醇两种剂量间E2差异显著（P＜0.001，0．05），戊酸雌二醇、利维爱两种剂量间V分差异显著（P＜0．01，0．05），三种药物两种剂量间内膜厚度及细胞学均无显著性差异。随着HRT时间延长，E2、V分、内膜厚度及增殖期型比例逐渐降低，萎缩型、混合型比例升高，HRT≤2年与≥5年间内膜厚度、增殖期及萎缩型比例有显著性差异，但应用三种药物不同时间组间的内膜细胞学表现并非完全一致。     

A cost-utility analysis of low-dose hormone replacement therapy in postmenopausal women with an intact uterus

ABSTRACT

Objective: The objective of this study was to evaluate the cost utility of one year's treatment with a low-dose conjugated estrogen/medroxyprogesterone acetate (CE/MPA low dose) preparation (Premique Low Dose [Wyeth Pharmaceuticals, Maidenhead, UK]), compared with a higher-dose preparation (Premique; CE/MPA [Wyeth Pharmaceuticals, Maidenhead, UK]), in postmenopausal women with an intact uterus. The evaluation captured the resource implications associated with the difference in treatment discontinuation and adverse event driven consultations in patients receiving either the low- or higher-dose preparation. This economic evaluation was conducted from the perspective of the NHS.

Research design and methods: A health economic model was developed to calculate the incremental cost per quality-adjusted life year (QALY) gained from treatment with a lower-dose CE/MPA combination, compared with a higher-dose CE/MPA preparation. Cohorts of 100 patients were assumed to receive either CE/MPA low dose or CE/MPA for one year. A probabilistic sensitivity analysis was used to explore whether the base case model was robust to the assumptions employed. Neither costs nor consequences were discounted because of the one-year timeframe.

Results: In the base case, CE/MPA low dose dominates, i.e. it showed a greater health gain at a reduced cost, in both mild and severe symptom populations. These results were repeated in the sensitivity analysis, with the cost-effectiveness planes for both mild and severe symptom pop-ulations showing a greater utility at a reduced cost.

Conclusions: CE/MPA low dose has been demonstrated to be a cost-effective treatment of estrogen-deficiency symptoms in postmenopausal women with an intact uterus. It has great potential for increasing the number of patients benefiting from relief of menopausal symptoms while also reducing the resource utilisation associated with managing the adverse effects associated with higher-dose HRT.     

分析绝经后骨质疏松症应用阿仑膦酸钠与激素替代疗法的治疗效果

目的 分析绝经后骨质疏松症应用阿仑膦酸钠与激素替代疗法治疗的临床效果.方法 70例绝经后骨质疏松症患者作为研究对象,依据随机数字表法分为对照组与观察组,每组35例.对照组患者口服替勃龙治疗,观察组患者口服阿仑膦酸钠治疗.比较两组患者骨密度、临床疗效与雌二醇(E2)、促卵泡生成素(FSH)水平.结果 治疗前,对照组患者的...     

Effect of hormone replacement therapy on cardiovascular disease: current opinion

Cardiovascular disease (CVD) is increasingly being recognised as having a profound effect on women, especially after menopause. Lack of oestrogen has been targeted as one of the reasons for increased incidence of CVD in postmenopausal women. Oestrogen has been found to have favourable effects on lipid profile, tone of vascular smooth muscle cells and fibrinogen levels. Several observational studies have supported these experimental findings, consistently demonstrating reduced cardiovascular risks in users of hormone replacement therapy (HRT). However, evidence from recent clinical trials has challenged this widespread belief. Heart and Estrogen/Progesterone Replacement Study II, Estrogen Replacement and Atherosclerosis trial and more recently, Women’s Health Initiative, have shown that HRT has no role in primary and secondary prevention of CVD and most authorities currently do not advocate HRT for the prevention of CVD.     

Lipid-modifying effects of rosuvastatin in postmenopausal women with hypercholesterolemia who are receiving hormone replacement therapy*

SUMMARY

Objective: To evaluate the efficacy and safety of rosuvastatin in postmenopausal women with hypercholesterolemia who are receiving hormone replacement therapy (HRT) in a randomized, double-blind, placebo-controlled trial.

Methods: After a 6-week dietary lead-in period, 135 postmenopausal women who had been taking a stable HRT regimen for at least 3 months were randomized to receive rosuvastatin 5?mg, 10?mg or placebo for 12 weeks. Fasting levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TG) were assessed at weeks 0, 2, 6, 10, and 12; apolipoprotein (Apo) B and Apo A-I were measured at weeks 0 and 12.

Results: Rosuvastatin 5?mg and 10?mg significantly reduced LDL-C by 38% (SE = 2.1) and 49% (SE = 2.1), respectively, compared with placebo (1% [SE = 2.1]; p < 0.001). TC, TG, Apo B, and all lipid ratios examined (LDL-C/HDL-C, TC/HDL-C, non-HDL-C/HDL-C, and Apo B/Apo A-I) were also reduced significantly by both rosuvastatin doses (?p < 0.001). HDL-C levels increased significantly in the rosuvastatin groups (11% and 8% for 5?mg and 10?mg, respectively, vs. –0.5% for placebo; p < 0.001), as did Apo A-I levels (?p < 0.05). The combination of rosuvastatin plus HRT was well tolerated with no apparent differences among treatments in the numbers or types of adverse events reported.

Conclusions: Rosuvastatin 5?mg or 10?mg once daily is a well-tolerated and highly efficacious lipid-lowering therapy in postmenopausal women receiving HRT.     

Current breast cancer risks of hormone replacement therapy in postmenopausal women

The controversies surrounding hormone replacement therapy have left many women confused and afraid. Providers have been faced with long-standing assumptions challenged by an abundance of new data in the past few years, with little guidance on how to interpret these findings. The objective of this paper is to provide a framework for understanding breast cancer risk associated with postmenopausal hormone replacement therapy, with a particular focus on how observational studies and randomised trials provide complementary information. This framework considers the data on risks of various hormonal preparations, the profiles of women at risk, and ends with an expert opinion in this context.     

绝经妇女的血脂变化与心血管疾病的探讨

目的绝经妇女的血脂变化与心血管疾病发生相关性及预防措施。方法以绝经后健康妇女139例为观察对象,以生活水平,生活习惯,饮食习惯相似的125例绝经前健康妇女作为对照,以同一份血清用全自动生化分析仪做总胆固醇（CH）,甘油三酯（TG）、低密度脂蛋白血胆固醇（LDL-C）,高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A1（APOA1）、脂蛋a[Lp（a）]6项检查。结果两组CH、TG、HDL-C、LDL-C、APOA1．LP（a）6项指标比较有显著差异。结论绝经后妇女血清CH、TG、HDL—C、LDL—C、LP（a）较绝经前明显升高,而HDL—C、APOA,明显下降;血脂代谢紊乱是绝经后雌激素水平下降所致。医生应该认识到激素替代治疗仍旧是绝经妇女预防疾病,保持生活质量的主要手段。     

短期激素替代治疗围绝经期综合征的临床观察

目的探讨短期激素替代治疗围绝经期综合征的临床效果。方法将70例患者按照随机数字分组法均分为实验组和对照组,实验组采用激素替代治疗,对照组采用谷维素治疗,比较两组的临床效果。结果实验组患者Kupperman评分较对照组下降更明显（P〈0.05）;两组患者治疗后血清雌二醇水平均明显增加,促卵泡激素和促黄体生成素水平均明显下降,但是实验组患者变化幅度更明显（P〈0.05）;两组患者治疗后子宫内膜厚度均增加（P〈0.05）,实验组患者增加幅度更大（P〈0.05）。结论小剂量激素替代治疗围绝经期综合征的疗效显著,但需要正确把握适应证和禁忌证。     

Do Finnish women using hormone replacement therapy need more information about risks

Objective In 1998, the Women’s Health Initiative (WHI) in 2002 and the Million Women Study (MWS) in 2003 have shown a need for re-evaluation of the benefits and adverse reactions of hormone replacement therapy (HRT). Consequently the authorities in Europe and USA have issued new recommendations against the use of HRT. The aim of this study was to examine women’s perceptions of HRT since the publication of the Women’s Health Initiative study and the Million Women Study, and the kind of sources women use to obtain information about HRT. Method The data was collected with questionnaire survey in the autumn 2003 among 315 women using HRT. Results One third of the respondents (35%) had experienced fears concerning HRT use, and more than half (52%) reported that the debate in the media had markedly influenced them; they have experienced fears or worries, considered discontinuation or discussed with the physician. Whereas the most common source of information concerning the benefits of HRT was the physician (74%), the most common source of information concerning the risks of HRT was the media (78%). Conclusion This study shows that women using HRT should get more information about the risks from health care professionals. Physicians and pharmacists have an opportunity to alleviate fears and to help women to critically evaluate the information they get from the media. Such discussions are also important to women who have been using HRT for years.     

Effects of long-term, low-dose sex hormone replacement therapy on hippocampus and cognition of postmenopausal women of different apoE genotypes

Aim： To study the effects of long-term, low-dose sex hormone replacement therapy （HRT） on the volume and biochemical changes of the hippocampus in postmenopausal women carrying apolipoprotein E （apoE） gene ε3 or ε4. Methods： Eightythree postmenopausal women who had used a low dose of HRT for over 4 years were selected as the HRT group, and 99 postmenopausal women with matched age and education were enrolled as the control group. ApoE alleles were analyzed by PCR. Magnetic resonance imaging was performed to determine the volume of the brain hippocampus. Proton magnetic resonance spectroscopy was used to detect the biochemical changes in the anterior cingulate cortex and hippocampus in apoE ε4 and ε3 carriers. Six common cognitive tests were used to make an overall evaluation of cognitive function. Results： Analysis with the apoE ε4 carriers showed that the volume of the hippocampus of the control group were significantly lower than those of the HRT group, The biochemical analysis showed that there was an increase of N-acetylaspartate （NAA）/total creatine （tCr） and a decrease of myoinositol （mI）/tCr in the hippocampus of apoE ε4 carriers in the HRT group, compared with the control group. For the apoE ε3 carders, the least squares means （LSMEAN） of the HRT group was higher than that of the control group. Conclusion： This study showed that long-term, low dose HRT might be beneficial for reducing the risk of AD development in vulnerable postmenopausal women. Meanwhile, HRT could increase the LSMEAN of apoE ε3 carriers.