雌孕激素联合补充治疗与脑卒中的预防

目的　探讨低剂量雌孕激素联合补充治疗对脑卒中的预防作用。方法　绝经过渡期及绝经后妇女84例随机设激素补充治疗组和对照组 ,采用酶免法测定治疗前后血脂和雌二醇 (E2 )水平。结果　治疗前后 E2、高密度脂蛋白 (HDL)增高 ,低密度脂蛋白 (L DL)、总胆固醇 (TC)降低 ,差异显著 (P<0 .0 5 ) ,甘油三酯 (TG)变化不明显。结论　低剂量雌激素对血脂谱产生有利影响 ,可降低脑卒中的发生     

Concordant and discordant effects on cardiovascular risks exerted by oestrogen and progestogen in women using oral contraception and hormone replacement therapy. ESHRE Capri Workshop Group

The major indications for the clinical use of oestrogen and progestogen are oral contraception (OC) in young women, and hormonal replacement therapy (HRT) in menopause. Over the past few years, epidemiological data have associated the use of these hormones to different cardiovascular conditions such as myocardial infarction, cerebrovascular disease and venous thromboembolism. This review summarizes the data discussed and the conclusions achieved by the ESHRE Capri Workshop Group, recently published in Human Reproduction.     

Hormonal contraception without estrogens

The long-term clinical effects of ethinyl estradiol and the impact on environmental safety of the alkylated estrogen components used in combined contraceptive pills remain the subject of debate. The development of improved methods for the use of progestogen-only contraception would represent a viable and desirable option. Several progestogen compounds are not alkylated, and these can be delivered through a variety of routes. Some of the progestogen-only methods are well established in clinical use. Estimates for both perfect and typical effectiveness are less than one pregnancy per 100 woman-years with oral, injectable, implantable and intrauterine methods. In practice, with the oral progestogen-only method, perfect and typical effectiveness range from three to five pregnancies per 100 woman-years. The main side effect with all progestogen-only methods is unpredictable vaginal bleeding during the first months of use, and this may lead to discontinuation. Nevertheless, continuation of use is more frequent if patients are well informed of this side effect before treatment begins. No cardiovascular- and cancer-related side effects have been proven.     

右旋柠烯对实验性乳腺增生症的影响

目的:观察右旋柠烯(d-limonene, DL)对大鼠乳腺增生及血雌激素和孕激素水平的影响.方法:苯甲酸雌二醇-黄体酮注射复制乳腺增生模型;HE染色观测乳腺组织学改变;放射免疫法检测血雌激素和孕激素水平.结果:右旋柠烯低、中、高剂量均能减少大鼠乳腺小叶数(9.20±2.32、6.90±1.20、6.10±1.37)、小叶腺泡数(8.20±1.75、6.10±2.23、5.10±1.52)和导管上皮层数(5.30±0.95、4.50±1.27、3.10±0.99),与模型组(分别为10.00±1.54、12.91±3.88和6.17±1.59)比较有显著性差异(P<0.01).右旋柠烯高、中剂量亦能降低血雌激素水平(28.35±2.16、25.17±1.25),提高孕激素水平(33.84±2.23、35.39±2.20),与模型组(分别为32.63±0.93, 31.77±1.48)比较差异显著(P<0.01),且对雌激素水平的影响有明显的量效关系.结论:右旋柠烯可抑制大鼠乳腺增生,降低血清雌激素水平、提高孕激素水平可能为其作用机制.     

乳腺癌C-erbB-2癌基因与雌激素和孕激素受体的关系及其意义

目的　探讨乳腺癌C -erbB - 2癌基因与雌激素和孕激素受体的关系及其意义。方法　采用免疫组化方法 (二步法 ) ,检测 83例乳腺癌组织中C -erbB - 2、ER、PR的表达。结果　C -erbB - 2、ER、PR在乳腺癌组织中表达阳性率为 5 7 83%、71 0 8%、6 6 2 7%。C -erbB - 2表达 :在ER、PR阴性组高于ER、PR阳性组 (P <0 0 5 ) ;在淋巴结转移组的乳腺癌高于淋巴结未转移组 (P <0 0 5 )。结论　C -erbB - 2与ER、PR联合检测 ,对于乳腺癌患者术后选择个性化化疗具有指导意义 ,也是衡量预后的重要指标。     

雌、孕激素对HOX基因的调节作用

同源框基因（homeobox genes）是一类控制胚胎发育和细胞分化的调节基因。近年来,雌、孕激素及其受体显示对HOX基因表达具有调节作用。     

Effects of estradiol and progestogens on human breast cells: Regulation of sex steroid receptors

ObjectivesTo examine the effects of 17β-estradiol (E₂) and progestogens, used in hormone therapy, on estrogen receptors (ER), progesterone receptors (PR), and human breast tumor cell growth.Materials and methodsMCF-7 cells were incubated in pure E₂ (1 nM and 10 nM) as well as in E₂ in conjunction with 10 nM progestogens, including progesterone (P4), medroxyprogesterone acetate (MPA), norethisterone acetate (NET), and cyproterone acetate (CPA). Cell proliferation, apoptosis, expression of caspase-3, and both ER and PR isoforms were evaluated.ResultsCaspase-3 was significantly diminished in cultures with only E₂, whereas ERα significantly increased. A significant increase of caspase-3 in addition to the entire abolishment of E₂-induced augmentation of ERα was observed in 1 nM E₂ plus MPA and 10 nM E₂ plus NET, whereas PR isoform B (PRB) was significantly increased. The ratios of apoptosis: proliferation significantly increased in 1 nM E₂ plus progestogens (except P4) and 10 nM E₂ plus NET. The changes of the PRA/PRB ratio were inversely related to the changes of the apoptosis to proliferation ratio. Significant increase of ERβ and PRB was noted in the E₂ plus MPA or NET, in addition to a significant increase of ERα and decrease of PRA in the E₂ plus CPA, as well as an increase of ERα and decrease of PRA and PRB in the E₂ plus P4.ConclusionsThe combination of E₂ and various progestogens resulted in diverging effects on ERs and PRs expressions, which induced different effects on MCF-7 cell growth. Compared with P4, aberrant hormone and biological activity of synthetic progestin, by way of altered receptor expression, may be an important factor in affecting breast cell growth.     

LNG-IUS 12: a 19.5 levonorgestrel-releasing intrauterine system for prevention of pregnancy for up to five years

Introduction: Globally, intrauterine devices (IUDs) are the second most commonly used form of reversible contraception because of their high efficacy, safety, convenience and cost effectiveness. The levonorgestrel releasing intrauterine system with daily average release of 20 mcg (LNG-IUS 20) is the popular choice because of its favorable bleeding patterns and many noncontraceptive benefits. A three year (LNG-IUS 8) became available three years ago. More recently, the LNG-IUS 12 was added. This new IUD shares a smaller frame, narrow inserter and lower rate of amenorrhea with the LNG-IUS 8, but it offers the five years of contraceptive protection of the LNG-IUS 20.

Areas covered: This article provides information on the contraceptive efficacy, safety and tolerability of this new IUS based on approximately 60,000 cycles of use. Where available, the impacts of subject age, parity and body mass index (BMI) on study outcomes are reported.

Expert opinion: This new LNG-IUS 12 with mid-dose hormone levels, smaller frame and longer effective life fills a niche that may better meet the needs of women who might appreciate the narrow insertion tube and/or the lower rates of amenorrhea. Cost will ultimately help determine success.     

超排卵治疗过程中卵泡液促性腺激素、雌二醇和胰岛素样生长因子水平检测

目的: 检测超排卵治疗过程中卵泡液内某些激素以及生长因子的水平,探讨它们与受精后胚胎发育潜能的关系.方法:接受辅助生殖技术治疗的患者,根据胚胎发育状况及治疗结局分为妊娠组、正常未孕组和胚胎质量较差组,超促排卵后在超声引导下经阴道穿刺获得卵泡液,用放射免疫法测定卵泡液中促卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、生长激素(GH)以及胰岛素样生长因子1(IGF-1)的水平,比较其与不同胚胎发育状况及治疗结局之间的关系.结果:妊娠组及胚胎发育正常但未妊娠组E2水平明显高于胚胎质量较差组(P＜0.05);妊娠组IGF-1水平明显高于胚胎质量较差组(P＜0.05),正常未孕组居于2者之间,但差异无统计学意义;FSH、LH、P及GH水平在以上3组中差异无统计学意义.结论:超促排卵时卵泡液中E2及IGF-1可能与卵子受精后胚胎发育的潜能有关,测定其水平有助于评估辅助生殖技术治疗后的结局.