不同剂量雌激素在绝经后骨质疏松症治疗中的作用

目的　研究不同剂量雌激素对绝经后骨质疏松症的治疗作用。方法　 6 9例绝经 <4年的妇女被随机分为 3组 (每组 2 3例 ) ,A组给予倍美力 0 .6 2 5mg +安宫黄体酮 2mg +钙尔奇D片 1g/d ;B组给予倍美力 0 .3mg +安宫黄体酮 2mg +钙尔奇D片 1g/d ;C组给予安慰剂 +钙尔奇D片 1g/d ;连续用药 2年。在用药前、用药后 6、12、2 4个月分别检测骨密度、骨代谢生化指标、骨细胞调节因子、子宫内膜增厚及乳房情况。结果　A组和B组在用药后一年骨密度有明显提高 ,而C组在一年后骨密度呈下降趋势。治疗组中均未发现子宫内膜的异常增生。骨代谢生化指标及血清IL 6水平在用药 6个月时就有显著下降。结论　在绝经早期的妇女中 ,小剂量雌激素加钙剂能防治骨质疏松症的发生 ,增加HRT(性激素替代疗法 )的安全性 ,降低子宫内膜过度增厚和阴道出血的发生率。此种雌激素加钙剂防治骨质疏松症的联合治疗方案值得推广。

Different Dose Hormone-Replacement Therapy in Treatment of Postmenopausal Osteoporosis

Purpose To study the effects of prevention and treatment in postmenopausal osteoporosis with different dose hormone replacement therapy. Methods Sixty-nine postmenopausal women were divided into three groups(n=23 per group):Group A to receive daily oral conjugated estrogen(Premarin 0.625 mg) in combination with medroxyprogesterone acetate and calcium carbonate(1 g/d);group B to receive daily oral conjugated estrogen(Premarin 0.3 mg)in combination with medroxyprogesterone acetate and calcium carbonate(1 g/d);group C to receive placebo and calcium carbonate(1 g/d) for two years.We observed bone mineral density,biochemical markers and LI?6.We also followed up endometrium thickness and breast.Examinations were scheduled to be performed pre-therapy and after 6,12,18,24 months of therapy. Results Bone mineral density of group A and B increased significantly one year after treatment.Bone mineral density of group C decreased in one year.No endometrial hyperplasia was observed in any of the three groups.The biochemical markers decreased at 6 months and remained low thereafter.We also observed a similar decrease in serum levels of IL?6. Conclusions Lower-dose HRT are effective in long-term prevention of postmenopausal osteoporosis,and prevents endometrium hyperplasia and decrease the vaginal bleeding rate.