选择性雌激素受体调节剂

选择性雌激素受体调节剂是一类非甾体化合物,能与雌激素受体结合,但其类雌激素或抗激素作用依赖于组织特异性和机体激素环境。这些ＳＥＲＭｓ目前已被批准或正在临床接受评价用于治疗和预防与年龄相关的疾病,包括激素依性癌肿,骨质疏松和冠心病。雷洛昔芬是这类药物的代表,既能预防绝经后骨质疏松,提高绝经后妇女骨密度,又能降低血脂和乳癌的发生率,却不刺激子宫内膜。因此ＳＥＲＭｓ有可能成为新的激素替代治疗药物。     

适量补充雌激素可以纠正绝经后老年骨质疏松症

本文从探讨一种既保留雌激素对骨的保护作用，又可避免长期应用可能对某些器官和组织产生副作用的药物，用于绝经后妇女防治骨质疏松的药物即SERM倍受关注，此文从SERM的特征，分类及作用机理进行论述，旨在分析SERM治疗绝经后老年骨质疏松症的药理研究，雌激素仍是绝经后妇女激素补充治疗的首选药物，RAL则有待进一步探讨。     

适量补充雌激素可以纠正绝经后老年骨质疏松症

本文从探讨一种既保留雌激素对骨的保护作用,又可避免长期应用可能对某些器官和组织产生副作用的药物,用于绝经后妇女防治骨质疏松的药物即SERM倍受关注,此文从SERM的特征,分类及作用机理进行论述,旨在分析SERM治疗绝经后老年骨质疏松症的药理研究,雌激素仍是绝经后妇女激素补充治疗的首选药物,RAL则有待进一步探讨.     

选择性雌激素受体调节剂

选择性雌激素受体调节剂是一类非甾体化合物 ,能与雌激素受体结合 ,但其类雌激素或抗雌激素作用依赖于组织特异性和机体激素环境。这些 SERMs目前已被批准或正在临床接受评价用于治疗和预防与年龄相关的疾病 ,包括激素依赖性癌肿 ,骨质疏松和冠心病。雷洛昔芬是这类药物的代表 ,既能预防绝经后骨质疏松 ,提高绝经后妇女骨密度 ,又能降低血脂和乳癌的发生率 ,却不刺激子宫内膜。因此 SERMs有可能成为新的激素替代治疗药物。     

雌激素及受体与绝经后骨质疏松症关系的研究进展

绝经后女性,体内雌激素水平急剧下降,骨吸收大于骨形成,骨量迅速丢失,骨密度(bone mineral density,BMD)下降,发生骨质疏松(Osteoporosis,op).雌激素替代疗法在防治绝经后骨质疏松症中具有重要作用.为更深刻地认识和探讨雌激素及雌激素受体(ER)和骨质疏松的关系,就二者在防治绝经后骨质疏松症的可能作用机制的研究进展作一综述.     

选择性雌激素受体调节剂的研究进展及临床运用

妇女进入绝经期后,雌激素水平下降成为骨质疏松的首要病因,激素补充治疗虽可延缓骨质疏松,但可引起子宫内膜增生及增加乳腺癌的发生率。选择性雌激素受体调节剂(SERM s)的研制和使用给广大患者带来函新的福音,该类药在骨、心血管等需要雌激素保护的靶组织保留雌激素活性,而在乳     

雌激素水平与绝经女性并发骨质疏松症的相关性研究

目的:探讨雌激素水平与绝经女性并发骨质疏松症的关系。方法:选择2010年2月～2011年2月在北华大学第一临床医院诊治的绝经后骨质疏松患者30例,年龄49～69岁,平均57.8岁,绝经后2～23年,平均13.2年。骨密度测量结果符合世界卫生组织制定的骨质疏松诊断标准。选择30例未伴发骨质疏松的绝经后妇女为对照组。选择DEXA(Lunar,US)骨密度仪对两组妇女行骨密度测量,并取清晨空腹静脉血检测血清雌二醇(E2),肿瘤坏死因子-α(TNF-α)及白介素-6(IL-6)水平。比较两组妇女骨密度(BMD)、E2、TNF-α及IL-6水平,并对E2水平与BMD、TNF-α及IL-6水平行相关分析。结果:①观察组患者骨密度及血清E2均值分别为(0.53±0.08)g/cm2和(25.58±7.85)ng/L,明显低于对照组(P<0.05)。观察组患者血清TNF-α及IL-6平均为(5.63±4.10)ng/L和(109.86±46.34)ng/L,明显高于对照组(P<0.05)。②观察组及对照组血清E2水平均与骨密度呈明显正相关(P<0.05),血清E2水平与血清TNF-α及IL-6水平呈明显负相关(P<0.05)。结论:雌激素水平与绝经后女性骨密度呈负相关,雌激素能通过多种途径影响骨组织代谢,绝经后女性体内雌激素水平明显下降,能够导致骨质疏松,应该采取积极的预防和治疗措施。     

选择性雌激素受体调节剂的现状与展望

选择性雌激素受体调节剂(SERM)代表了一组抗雌激素药物,在特异的靶组织如:骨、脂类及脂蛋白中发挥激动作用,而在子宫内膜及乳腺表现为拮抗作用。因此,从理论上讲,这类药物在维持骨密度、降低骨质疏松性骨折及冠心病发生危险的同时,又能降低子宫内膜癌及乳腺癌发生的危险。雷洛昔芬短期治疗的资料显示,它具有保护骨质及减轻脂质致动脉粥样硬化的作用。这类药物能否降低乳腺癌与子宫内膜癌发生的危险,还需要进一步的研究证实。     

选择性雌激素受体调节剂雷洛昔芬的临床研究进展

选择性雌激素受体调节剂雷洛昔芬(raloxifene)在骨和心血管系统表现雌激素样作用，在乳腺和子宫表现抗雌激素样作用，并能预防乳腺癌的发生，目前临床上用于预防和治疗绝经后骨质疏松。结合近年文献，综述雷洛昔芬对绝经妇女的骨、心血管、乳腺、子宫方面的研究进展。     

绝经后骨质疏松用雌激素治疗多久

河南焦作读者王某来信说：我的老伴已过“知天命”之年．患有绝经后骨质疏松症．医生建议长期补充雌激素．以防止病情加重及预防骨折发生．我们不清楚这种“长期”是多长时间．而且担心长期服用雌激素会产生副作用．想请专家告知这一方面的相关知识。     

绝经后妇女的骨代谢及钙摄入对骨折风险的影响

绝经后妇女一方面由于骨转化速率加快,矿化不足,骨矿含量降低;另一方面由于需要矿化的骨基质增加,导致机体对钙的需求量增加。同时,由于雌激素水平降低,导致肠道对钙的吸收能力及肾脏对钙的重吸收能力降低,导致钙吸收降低而排泄增加。因此,保证充足钙摄入对维持绝经后妇女骨骼结构具有重要意义。目前各国制定的钙参考摄入量不同。我国2000年制定的50岁以上妇女的适宜摄入量为元素钙1000 mg/d。增加饮食来源钙摄入是最佳的预防骨质疏松的方法。钙剂补充对增加绝经后妇女骨密度具有一定的有利作用,但对骨折风险的影响尚缺乏一致性的结论,对心血管疾病的影响尚不明确。目前的证据表明：联合补充钙剂与维生素D不增加心血管疾病的风险。     

阿托伐他汀联合降钙素对绝经期女性骨质疏松患者骨代谢指标的影响

目的探讨阿托伐他汀联合降钙素对绝经期女性骨质疏松患者骨代谢指标的影响。方法选取2017年2月-2018年2月来温州市中西医结合医院就医的绝经期骨质疏松症患者126例随机分为研究组和对照组各63例,对照组采用降钙素、钙尔奇D3片及骨化三醇胶丸进行治疗,研究组在对照组基础上采用阿托伐他汀进行治疗,以此观察两组患者治疗后骨密度、骨代谢指标以及并发症的发生率。结果治疗前两组腰椎L2-4、FN及Ward三角区BMD动态水平差异无统计学意义(P>0. 05);治疗后两组腰椎L2-4、FN及Ward三角区BMD动态水平均高于治疗前,且研究组高于对照组,差异均有统计学意义(P<0. 05)。治疗前两组AKP、OC、TP1NP以及PTH的水平差异无统计学意义(P>0. 05);治疗后两组AKP、OC、TP1NP以及PTH的水平低于治疗前,且研究组低于对照组,差异均有统计学意义(P<0. 05)。治疗后研究组不良反应发生率4. 8%低于对照组的15. 9%,差异有统计学意义(P<0. 05)。结论采用阿托伐他汀与降钙素联合治疗绝经期OP女性患者能有效对其骨吸收进行抑制,对骨形成具有一定的促进作用,从而达到临床治疗目的。     

浅谈绝经后骨质疏松症的临床特点、预防及护理

女性绝经后卵巢功能减退,雌激素分泌减少,骨骼中钙丢失加速,常引起骨质疏松症,表现为渐进性的腰背四肢关节酸痛、乏力、走路不稳,易于骨折而导致肺炎、心血管疾病等并发症,严重影响着绝经后女性的健康和生活质量.对绝经后女性实施正确的骨质疏松症防治和护理措施,可预防骨质疏松症的发生,提高绝经后骨质疏松症患者生活质量.     

蔬菜类食物对绝经期妇女骨质疏松预防作用的研究

传统观念认为,预防骨质疏松,补钙是最重要的营养措施,但西方营养学家长期研究得出结论:蔬菜疗法对预防骨质疏松症的效果更为显著.本研究旨在了解绝经期妇女骨健康状况,分析各类蔬菜对绝经期妇女骨质疏松发生的影响. 1.对象与方法: (1)研究对象:采用整群抽样的方法在哈尔滨市354个社区中随机抽取电力小区作为研究群,再从小区内随机抽取373名年龄50～65岁、自然停经≥1年的调查对象,最终符合入选标准的共281名.     

Melting bones: The social construction of postmenopausal osteoporosis in Turkey

The increased medicalization of different life stages, including menopause, is a subject studied mostly in the Western context. Examining medicalization in the non-Western world advances discussions of body, identity and health. In this paper, I analyze the discourses around postmenopausal osteoporosis in Turkey, focusing on the different constructions of risk in the medical and popular literature. The empirical basis of the paper draws on ethnographic research done in Istanbul, Turkey between June 2006 and March 2007. The research includes participant observation in gynecology clinics, interviews with clinicians and menopausal women and archival research on the representations of menopause in the Turkish media between 1999 and 2006. Referred to as kemik erimesi (melting of the bones) in colloquial Turkish, osteoporosis has been an essential component in the medicalization of menopause in Turkey. I argue that postmenopausal osteoporosis is defined as a combination of embodied risk, which is related to the definition of menopause as a risky period, and lifestyle risk, demonstrated in discussions around "traditional" vs. "modern" clothing and healthcare habits. The Turkish example emphasizes the importance of local conditions in defining medical risk and complicates the embodied vs. lifestyle risk categories.     

低剂量雌孕激素联合治疗对绝经后妇女绝经相关指标及生活质量的影响

目的:探讨激素替代治疗(HRT)对更年期综合征妇女绝经相关指标及生活质量的影响。方法:将2005年1月～2011年9月绝经后期妇女60例分为治疗组及对照组各30例,两组均给予饮食及体育锻炼治疗;治疗组口服倍美力0.625 mg/d,28天为1周期,每周期第19～28天加用安宫黄体酮4 mg/d,共3个周期。观察两组患者临床症状缓解情况、各项激素及生化指标的变化情况。结果:治疗组治疗后的临床症状明显改善,雌二醇(E2)、孕激素(P)明显升高,卵泡刺激素(FSH)、黄体生成素(LH)、碱性磷酸酶(AKP)、总胆固醇(TC)及甘油三酯(TG)均明显降低,与治疗前及对照组治疗后比较,差异均有统计学意义(P<0.01,P<0.05)。结论:低剂量雌孕激素联合治疗能显著改善绝经后妇女的激素相关指标水平及临床症状,提高患者的生活质量,值得临床应用推广。     

Developing profiles of postmenopausal women being prescribed estrogen therapy to prevent osteoporosis

Postmenopausal women with estrogen deficiency are at high risk for osteoporosis. Estrogen therapy has been shown to be effective in preventing postmenopausal bone loss and maintaining bone mineral density. The increasing number of women at risk for osteoporosis and the high cost of treating this condition emphasizes the importance of preventing osteoporosis. This study was designed to identify trends and predictors of estrogen use for osteoporosis prevention among postmenopausal women. A retrospective, cross-sectional study was conducted using Behavioral Risk Factor Surveillance System data (1997–1999). Women 35 years and older who had passed menopause or were currently going through menopause were identified from the states including the BRFSS module that asked questions about estrogen use. Results showed an increasing prevalence in estrogen use from 1997 to 1999 for osteoporosis prevention. In 1999, almost a third of the postmenopausal women surveyed used estrogen to prevent osteoporosis. Prevalence was higher among women 45–64 years of age, whites, and those with higher education levels. Physician counseling on the benefits and risks of estrogen therapy was the strongest predictor of estrogen use for prevention of osteoporosis. Insurance coverage and compliance with other preventive behaviors such as mammograms and Pap smears were also strongly associated with greater estrogen use. However, women who were at risk for acute drinking, not married, overweight or obese, and diabetic were all less likely to receive estrogen therapy for osteoporosis prevention. The relationships demonstrated between estrogen use and demographic characteristics, lifestyle behaviors and health care access and utilization factors underline the importance of targeting specific groups of women for promoting its protective effect against osteoporosis.     

大豆异黄酮对更年期妇女膳食干预

目的：通过人体膳食干预试验，从临床上观察确定大豆异黄酮对更年期围绝经期妇女骨质疏松的作用。方法：试验对象80例随机分为大豆异黄酮组和安慰组，试验对象按时按量服用24周并进行追踪观察。结果：大豆异黄酮组桡骨和胫骨骨密度明显增加，有统计学意义。而安慰剂对照组桡骨和胫骨骨密度不但没有增加，而且稍有下降。结论：通过此次研究证实大豆异黄酮可以作为雌激素替代物促进成骨细胞生长，使骨密度得到增加，可以防治更年期围绝经期妇女骨质疏松。     

Serum lipids in postmenopausal or perimenopausal women using estrogen alone, estrogen with levonorgestrel, or estrogen with norethisterone, compared with nonusers: results from a cross-sectional study in two Norwegian counties 1985-1988

The aim of this study was to compare, in a population setting of postmenopausal or perimenopausal women aged 40 to 54, the levels of serum lipids in women using different hormone replacement therapy (HRT) regimens with women using no sex hormones. There was no unequivocal tendency of a more healthy lifestyle among those using HRT than among nonusers. Any type of regimen was associated with a lower mean level of total and calculated low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol was 0.08 mmoI/L (5.2%) higher in those using estrogen alone, 0.07 mmoI/L (4.5%) higher in users of HRT with norethisterone, and 0.07 mmol/L (4.5%) lower in users of HRT with levonorgestrel, compared with nonusers. The ratio of total-to-HDL cholesterol was lower by 0.37 (6.1%) in those using estrogen alone, by 0.65 (12.3%) in those using HRT with norethisterone, and by 0.24 (5.3%) in those using estrogen with levonorgestrel. There was no association between body mass index and HDL-cholesterol among women who used HRT with norethisterone, whereas an inverse relationship was present in those using estrogen alone and in nonusers (P [interaction] < 0.05).