结合雌激素联合方案连续应用防治绝经早期妇女骨量丢失的观察

目的　探讨两种剂量结合雌激素 (CEE)对绝经早期妇女骨丢失的影响及副作用。方法将 2 36例绝经妇女分为 3组 ,A组每日口服CEE 0 62 5mg+醋甲羟孕酮 (MPA) 2mg +钙剂 (Ca D) 1片(含元素钙 60 0mg) ;B组每日口服CEE 0 3mg +MPA 2mg +Ca D 1片 ;C组每日仅服Ca D 1片 ,连续用药 2年。于治疗前、治疗 1 2及 2 4个月测量第 2～ 4腰椎 (L2～ 4 )的骨密度 (BMD) ,记录每月阴道出血情况。结果　A组治疗前、治疗 1 2及 2 4个月 ,L2～ 4 BMD分别为 (1 0 62± 1 4 1 )、(1 0 86± 1 4 5)及 (1 1 0 1±1 34)mg/cm2 ,治疗前后比较 ,差异均有极显著性 (P <0 0 0 1 ) ;B组分别为 (1 0 81± 1 35)、(1 1 1 1± 1 68)及(1 0 90± 1 50 )mg/cm2 ,治疗 1 2个月时与治疗前比较 ,差异有显著性 (P <0 0 5) ,治疗 2 4个月时与治疗前比较 ,差异无显著性 (P >0 0 5) ;C组分别为 (1 0 70± 1 1 9)、(1 0 65± 1 34)及 (1 0 53± 1 30 )mg/cm2 ,治疗前后比较 ,差异均无显著性 (P >0 0 5)。治疗前后BMD的变化 ,A与C组、B与C组之间差异均有显著性 (P <0 0 0 1 ,<0 0 5) ;A与B组治疗 1 2个月时的BMD比较 ,差异无显著性 (P >0 0 5) ,2 4个月时比较 ,差异有极显著性 (P <0 0 1 )。各组子宫内膜均无不典型增生。A、B组出血率 ,治

Comparative study on two different dosages of conjugated equine estrogen continuously combined with medroxyprogesterone in prevention of postmenopausal osteoporosis

Objective To investigate the effects of two dosages of conjugated equine estrogen (CEE) in preventing bone loss in early postmenopausal women. Methods Two hundreds and thirty six early postmenopausal women were randomly given one of the following regimens for two years. Groups A(GA): CEE 0.625 mg+medroxyprogesterone (MPA domestic made) 2 mg+caltrate D (Ca D) 1 tablet daily; Group B (GB): CEE 0 3 mg+ MPA 2 mg+Ca D 1 tablet daily; Group C(GC): Ca D 1 tablet daily alone. The observation endpoints included: (1) bone mineral density (BMD) of lumbar 2 4 (L 2 4 ) measured by duel energy X ray absorptiometry (DEXA,Lunar DPX L) before and 1, 2 years after treatment; (2) vaginal bleeding recorded daily and endometrium thickness yearly by transvaginal ultrasonography. Endometrium biopsies were performed if its thickness greater than 5 mm. Results Two hundreds and thirteen (90%) cases completed 1 year study, 176 (75%) 2 year study. In GA L 2 4 BMD significantly increased both after 1 and 2 year treatment as compared with pretreatment value ( P <0 001).While in GB, L 2 4 BMD significantly elevated only after 1 year treatment, but did not reach significance during the end of 2 year therapy. In contrast, L 2 4 BMD decreased by 0 4% and 1 6% respectively after 1,2 year of GC although without significance. Compared among the three group, the increments of mean L 2 4 BMD after 1 year treatment in GA and GB were significantly different from, that in GC (+2 3%, +2 7% versus -0 4%, P <0 001, P <0 05 respectively). So were the values after 2 year treatment (+3 7%, +0 7% versus -1 6%, P <0 001, P <0 05 respectively). As compared the mean L 2 4 BMD between GA and GB, the difference reached significance only after 2 yaear ( P <0 01), but not after 1 year treatment ( P >0 05). The vaginal bleeding rate in GA during the first month and 1,2 year after treatment were higher than those in GB and GC (52% versus 16%, 9%; 43% versus 12%, 2 8%; 34% versus 8%,3 3%). Endometrium biopsies were carried in 153 cases (27 had endometrium thicker than 5 mm) in GA and GB. No atypical hyperplasia was found, but 2 cases showed simple hyperplasia in the GA. One case in GA developed superficial thromphlebitis during the 1 year treatment. Conclusion Both 0.625 mg and 0.3 mg daily of CEE continuously combined with domestic MPA are effective in preventing postmenopausal osteoporosis. The former has more stronger effect than the latter, but needs higher dose of MPA when combined continuously in order to decrease the vaginal bleeding rate and preventing endometrium hyperplasia.