围绝经期及绝经5年内和大于5年妇女对雌激素替代治疗的反应:腰椎及髋部骨密度变化

Reaction to hormone replacement therapy in women at peirmenopausal period and within and more than 5 years postmenopause:changes of bone mineral density at lumbar spine and hip

目的:探讨围绝经期及绝经5年内和>5年的妇女应用激素替代治疗对腰椎及髋部骨密度的变化的影响。方法:实验于2003-05/2004-05在沈阳医学院奉天医院完成。从妇科普查参检的围绝经及绝经后5年内及>5年的妇女中抽出90例骨质疏松妇女。参加实验的妇女均无心血管病史,无心、肝、肾、乳腺及生殖器肿瘤等器质性病变,且知情同意,受试前至少6个月未使用过性激素及影响骨代谢的药物。按不同绝经年限分为3组,均口服7-甲基异炔诺酮和钙剂治疗6个月。3组妇女比较治疗前后第2～4腰椎及髋部骨密度的变化情况。结果:按意向性处理分析,90例患者进入结果分析。①围绝经期妇女组治疗前及治疗后髋部骨密度分别为(0.631±0.098)和(0.842±0.076)g/cm2,腰椎骨密度分别为(0.806±0.128)和(0.898±0.106)g/cm2,治疗后骨密度的增加有统计学意义(t=3.032,P<0.01;t=2.319,P<0.05)。②绝经5年以上妇女组治疗前及治疗后髋部骨密度分别为(0.625±0.090)和(0.703±0.108)g/cm2,腰椎骨密度分别为(0.783±0.118)和(0.866±0.127)g/cm2,治疗后骨密度增加,差异有显著性意义(t=3.036,P<0.01;t=2.622,P<0.05)。③绝经5年之内妇女组治疗前及治疗后髋部骨密度分别为(0.627±0.082)和(0.656±0.095)g/cm2,腰椎骨密度分别为(0.798±0.106)和(0.812±0.103)g/cm2,在治疗后骨密度的增加无明显差别(分别t=1.266,1.622,P>0.05)。结论:激素替代疗法对围绝经期及绝经5年以上的骨质疏松妇女主要起治疗作用,对于绝经后5年内的妇女,仅减缓骨丢失。

AIM:To investigate the effect of hormone replacement therapy on the changes of bone mineral density at lumbar spine and hip in women at peirmenopausal period and within and more than 5 years postmenopause.METHODS:The experiment was carried out in Fengtian Hospital of Shenyang Medical College from May 2003 to May 2004.Ninety peirmenopausal and postmenopausal women with osteoporosis, who received general gynaecological examination, were selected.All the subjects had no history of cardiovascular disease,no organic lesions of heart,liver,kidney,mammary gland and genital tumor,they all took part in the study voluntarily,they had not taken any gonadal hormone or the drugs that could affect the bone metabolism within at least 6 months before the test.All the subjects were divided into 3 groups according to the postmenopausal years, they were treated with oral livial and Caltrate D for 6 months.The changes of bone mineral density at lumbar 2- 4 and hip before and after treatment were compared among the 3 groups.RESULTS:According to intention to treat analysis,all the 90 cases were involved in the analysis of results.① In the perimenopausal group,the bone mineral densities before and after treatment at hip were(0.631± 0.098) and(0.842± 0.076) g/cm2,respectively,and those at lumbar 2- 4 were(0.806± 0.128) and(0.898± 0.106) g/cm2,the bone mineral densities were significantly increased after treatment(t=3.032,P< 0.01;t=2.319,P< 0.05).② In the more than 5 years postmenopause group,the bone mineral densities before and after treatment at hip were(0.625± 0.090) and(0.703± 0.108)g/cm2,and those at lumbar 2- 4 were(0.783± 0.118) and(0.866± 0.127)g/cm2,the bone mineral densities were significantly increased after treatment(t=3.036,P< 0.01;t=2.622,P< 0.05).③ In the within 5 years postmenopause group,the bone mineral densities before and after treatment at hip were(0.627± 0.082) and (0.656± 0.095) g/cm2,and those at lumbar 2- 4 were(0.798± 0.106) and(0.812± 0.103)g/cm2,the bone mineral densities were insignificantly increased after treatment(t =1.266,1.622,P >0.05).CONCLUSION:The hormone replacement therapy has curative effects mainly on women at peirmenopausal period and more than 5 years postmenopause,and it can only relieve the loss of bone mass in women within 5 years postmenopause.