以生物电阻法检测的身体组成成分与女性骨量的关系

目的 探讨体内的体脂和非体脂对绝经前和绝经后妇女骨密度(BMD)的作用。方法 282例绝经前和205例绝经后妇女参加本研究,用双能X线骨密度仪测定腰椎和股骨颈BMD,用生物电阻法测定体脂和非体脂,同时测量身高、体重、腰围、臀围,并计算体重指数(BMI)和腰臀围比(WHR)。结果 体脂和非体脂与绝经前、绝经后妇女腰椎和股骨颈BMD均呈显著正相关(P＜0．01),多元逐步回归分析显示,在绝经前妇女中,非体脂和年龄是腰椎BMD的独立影响因素(R^2=0．077,P=0．000),非体脂、年龄和BMI是影响股骨颈BMD的决定因素(R^2=0．130,P=0．000),在绝经后妇女中,体脂和年龄是影响腰椎和股骨颈BMD的决定因素(R^2分别为0．153和0．184,P=0．000)。结论 体脂和非体脂对绝经前和绝经后妇女BMD的作用不同,非体脂是决定绝经前妇女骨量的重要因素,而体脂是影响绝经后妇女骨量的重要因素。     

Relationship between body composition and bone mineral density in healthy young and premenopausal Chinese women

This study investigated the relative contribution of fat mass and lean mass to bone mineral density (BMD) in young and premenopausal healthy Chinese women. The study was performed in 282 young and premenopausal healthy women with regular menstrual cycles. The BMD at lumbar spine (L2–L4), total hip and total body, together with fat mass and lean mass were assessed by dual-energy X-ray absorptiometry (DXA); body height, weight, waist and hip circumference were also measured, and body mass index (BMI) and waist-hip ratio were calculated. Fat mass was a major determinant for BMI, BMI and lean mass were positively related to L2–L4, total hip and total body bone density (P<0.001 for all), lean mass was the only independent factor contributing to BMD at L2–L4 (standardized coefficient =0.282, P<0.001), total hip (=0.336, P<0.001) and total body (=0.361, P<0.001) in multiple stepwise regression analysis. The correlation between BMI and BMD was improved after adjustment for fat mass, while decreased or even lost when lean mass was adjusted. These data suggested that in the Chinese population, lean mass is an important factor determining BMD in young and premenopausal women.     

Prevalence of Ischemia on Myocardial Perfusion Scintigraphy of Pre- and Postmenopausal Women

Background

In postmenopausal women, the presence of risk factors for coronary artery disease (CAD) increases. However, the difference in prevalence of ischemia between pre- and postmenopausal women with multiple risk factors for CAD has not been well established.

Objectives

To compare the prevalence of ischemia on Tc^99m-sestamibi myocardial perfusion scintigraphy (MPS) in pre-and postmenopausal women, and to evaluate whether menopause can be considered an independent risk predictor of ischemia in women with multiple risk factors for CAD.

Methods

This study retrospectively assessed 500 MPS of pre- and postmenopausal women with multiple risk factors for CAD. Statistical analysis was performed by using Fisher exact test and univariate and multivariate analysis, a p value ≤ 0.05 being considered significant.

Results

Postmenopausal women represented 55.9% of the sample; 83.3% were hypertensive; 28.9%, diabetic; 32.1%, smokers; 25%, obese; 61.2% had high cholesterol levels; and 34.3% had known CAD. Postmenopausal women were more often hypertensive, diabetic and dyslipidemic, and had lower functional capacity on exercise testing (p = < 0.005). The presence of ischemia on MPS did not significantly differ between the pre- and postmenopausal groups (p = 0.395). The only variable associated with ischemia on MPS was known CAD (p = 0.004).

Conclusion

The results suggest that, in women with multiple risk factors for CAD, menopause was not an independent predictor of ischemia on MPS. Those data support the idea that the investigation of ischemia via MPS in women with multiple risk factors for CAD should begin prior to menopause.     

Prognosis in pre-and postmenopausal patients with endometrial adenocarcinoma

The prognosis in 41 pre- and 143 postmenopausal patients with endometrial adenocarcinoma during two time periods were compared.A significantly shorter interval from 1st symptom to diagnosis was found in postmenopausal patients. The percent of patients diagnosed in stage I did not differ significantly between the two groups, but there was a significant, although small, excess of postmenopausal patients diagnosed in stages III–IV.A significantly more favourable survival in premenopausal patients was found and the same trend was observed when the effect of age, stage at diagnosis and operability were taken into consideration. The possibility that this could be related to hormonal and immunological factors is raised.A significantly better survival of patients diagnosed during the second period was observed and is attributed to improved planning and methods of treatment.     

Testosterone and 17β-oestradiol secretion of the human ovary. I. Normal young women,and premenopausal women with endometrial hyperplasia

Testosterone and 17β-oestradiol were determined in blood obtained from the ovarian veins of 26 women, 16 of whom were young and regularly ovulating and menstruating, and 10 of whom were premenopausal with uterine bleedings and endometrial hyperplasia. The concentrations of these two hormones in the cubital veins of the premenopausal women were also determined. It was found that the concentrations of the two hormones were not significantly greater in the premenopausal women than in the control group of young normally ovulating and menstruating women in the periovulatory phase of the menstrual cycle, but that the ovarian secretion rates of both hormones, particularly of testosterone, were considerably greater in the premenopausal women. In these women the concentrations of both hormones were significantly lower in the cubital veins than in the ovarian veins. The conclusion is that the augmented oestrogenic effect on the endometrium and on other target organs of premenopausal women with endometrial hyperplasia may be due not only to an increased ovarian secretion rate of estradiol, but also and more specifically to an increased ovarian secretion rate of testosterone, and to the rapid conversion of this hormone into oestradiol in the periphery.     

Galectin-3在子宫内膜息肉中的表达及意义

目的 探讨子宫内膜息肉中Galectin-3的表达及Galectin-3与子宫内膜息肉发生的关系.方法 用免疫组织化学法检测Galectin-3在绝经前后子宫内膜息肉及正常子宫内膜中的表达.其中绝经前子宫内膜息肉51例,正常子宫内膜40例;绝经后子宫内膜息肉40例,正常内膜38例.结果 ①Galectin-3在绝经前子宫内膜息肉及正常内膜中均有表达,绝经前子宫内膜息肉中的表达高于正常内膜,差异有统计学意义(x2=37.640,P＜0.01).②Galectin-3在绝经后子宫内膜息肉及正常内膜中均有表达,绝经后内膜息肉中的表达高于正常内膜,差异有统计学意义(x2=30.664,P＜0.01).③Galectin3在绝经前、后内膜息肉中的表达差异无统计学意义(x2=1.894,P＞0.05).结论 ①Galectin-3在绝经前后内膜息肉中的高表达,提示Galectin-3可能与子宫内膜息肉的发生有关.②Galectin-3在绝经前后内膜息肉中的表达差异无统计学意义,表明绝经后内膜息肉更易恶变可能与Galectin-3无关.     

Association between Serum Osteocalcin Levels and Metabolic Syndrome according to the Menopausal Status of Korean Women

BackgroundOsteocalcin is known to regulate energy metabolism. Recently, metabolic syndrome (MetS) has been found to be associated with reduced levels of osteocalcin in men, as well as in postmenopausal women. The aim of this study was to investigate the association between serum osteocalcin and MetS in premenopausal women, compared with that in postmenopausal women.MethodsThis cross-sectional study was based on 5,896 participants who completed a health screening examination. They were classified according to their menopausal status. Each group was subdivided into non-MetS and MetS groups according to the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Serum osteocalcin levels were measured using the electrochemiluminescence immunoassay.ResultsSerum osteocalcin level was significantly lower in women with MetS than in those without MetS, after adjusting for confounders (14.12 ± 0.04 vs. 13.17 ± 0.13 [P = 0.004] in premenopausal women, and 20.34 ± 0.09 vs. 19.62 ± 0.21 [P < 0.001] in postmenopausal women), regardless of their menopausal status. Serum osteocalcin levels decreased correspondingly with an increasing number of MetS elements (P for trend < 0.001). Multiple regression analysis demonstrated that waist circumference (β = −0.085 [P < 0.001] and β = −0.137 [P < 0.001]) and hemoglobin A1c (β = −0.09 [P < 0.001] and β = −0.145 [P < 0.001]) were independent predictors of osteocalcin in premenopausal and postmenopausal women. Triglyceride levels were also independently associated with osteocalcin levels in premenopausal women (β = −0.004 [P < 0.013]). The odds ratio (OR) for MetS was significantly higher in the lowest quartile than in the highest quartile of serum osteocalcin levels after adjusting for age, alkaline phosphatase, uric acid, high sensitivity C-reactive protein, and body mass index in all women (OR, 2.00; 95% confidence interval [CI], 1.49–2.68) as well as in premenopausal (OR, 2.23; 95% CI, 1.39–3.58) and postmenopausal (OR, 2.01; 95% CI, 1.26–3.23) subgroups.ConclusionLower serum osteocalcin concentrations were significantly associated with MetS in both premenopausal and postmenopausal women and were therefore independent of menopausal status.     

Depression and its link to other symptoms in menopausal transition

Background: Menopausal transition may occur between 45 and 55 years old and take 3–9 years. During this transition, the hormonal changes may contribute to the physical and psychological complaints in women. One of the psychological complaints is a sign of depression. However, not all of the women will experience those complaints.Objective: To assess the relationship between depression in menopause transition and other menopausal symptoms and factors contribute to depression among Indonesian people.Methods: Cross-sectional study on 133 female subjects between 45 and 55 years old. Depression measured using Beck Depression Inventory-II (BDI-II), and menopausal symptoms were collected using Menopause Rating Scale (MRS). The comparison and relation were assessed for every aspect regarding depression and menopausal symptoms.Results: Out of 133 subjects, depression was found in 17 subjects (12.8%). Somato-vegetative symptoms were complained by 50.4% and urogenital symptoms by 75.9% subjects. There was significant correlation between depression and somato-vegetative (p = 0.008) as well as urogenital complaints among women who underwent menopause transition (p = 0.016). These findings were consistent with previous studies.Conclusion: Depression on menopausal transition significantly correlated with somato-vegetative and urogenital symptoms among women. Future investigations should be conducted with a cohort design to observe mood alterations during the menopause transition.     

广东地区妇女乳腺癌预测模型的研究

目的建立广东地区妇女乳腺癌预测模型,筛选高危人群,为乳腺癌的早期干预提供线索。方法在门诊患者和正常体检的妇女中,采用简单随机的方法选取35～60岁乳腺癌病例284例,以1：2成组配对原则在相应年龄段内选取非乳腺癌妇女673例,进行回顾性病例对照研究。分析数据时,首先将数据按绝经前后分层;以是否为乳腺癌患者为结果变量,其余变量为自变量,分别通过logistic单因素、多因素回归分析筛选出绝经前、后乳腺癌的危险因素,并以此建立绝经前、后妇女乳腺癌预测模型;用判别分析法分别对绝经前、后预测模型的预测能力进行判别。结果绝经前妇女患乳腺癌的主要危险因素包括服用避孕药史、亲属中有乳腺癌患者、有不良情绪、有不良事件、劳动强度大、无乳腺组织活检史、很少参加运动等。绝经前妇女患乳腺癌的预测模型为：1／{1＋exp[-（-4．314＋1．333服用避孕药＋1．167亲属中有乳腺癌患者＋0．404有不良情绪＋0．613有不良事件＋0．754劳动强度大-0．716有乳腺组织活检史-0．839经常运动）]}。此模型有统计学意义（x^2=165．83,P=0．000）,并且其预测不发生乳腺癌的正确率为74．2％,预测发生乳腺癌的正确率为58．4％。绝经后妇女患乳腺癌的主要危险因素包括亲属中有乳腺癌患者、文化程度低、情绪调节能力差等。绝经后妇女患乳腺癌的预测模型为：1／{1＋exp[-（1.211＋2．269亲属中有乳腺癌患者-1．617文化程度高-0．635情绪调节能力强）]}。此模型有统计学意义（x^2=116．32,P=0．000）,并且其预测发生乳腺癌的正确率为78．9％,不发生乳腺癌的正确率为55．2％。结论绝经前、后妇女患乳腺癌的影响因素不完全相同。绝经后妇女乳腺癌预测模型对预测发生乳腺癌有一定的参考价值;绝经前妇女乳腺癌预测模型对预测不?     

戈舍瑞林联合来曲唑治疗晚期绝经前乳腺癌的临床疗效研究

目的探讨戈舍瑞林联合来曲唑治疗晚期绝经前乳腺癌的疗效和毒副作用。方法选择中国医学科学院肿瘤医院2004年5月—2009年5月,采用戈舍瑞林联合来曲唑治疗绝经前激素受体阳性的转移性乳腺癌52例,戈舍瑞林3.6 mg,皮下注射,1次/4周;来曲唑2.5 mg,口服,1次/d。其中,一线治疗者为36例,二线治疗者为16例。中位治疗时间为11(2～61)个月,中位随访时间31(3～66)个月。结果完全缓解(CR)2例(3.8%),部分缓解(PR)9例(17.3%),稳定(SD)29例(55.8%),进展(PD)12例(23.1%)。客观缓解率为21.1%,临床获益率为71.1%,中位疾病无进展时间(PFS)为10(2～61)个月,中位总生存时间(OS)为40(3～66)个月。无内脏转移患者PFS长于有内脏转移者(P=0.034)。毒副作用发生率为34.6%,均为Ⅰ～Ⅱ度的反应。结论戈舍瑞林联合来曲唑是一种有效且安全地治疗绝经前转移性乳腺癌的方案。