应用低剂量激素治疗预防围绝经期妇女骨质疏松症的观察研究

Preventive effects of small dose estrogen and progesterone on prevention and treatment of perimenopausal osteoporosis

目的研究低剂量雌孕激素治疗预防绝经后骨质疏松症的疗效。方法将140例围绝经期和绝经后妇女随机分为4组,给药方案分别是:A组(35例):每日戊酸雌二醇(E2V)1mg+醋酸甲羟孕酮(MPA)2mg;B组(35例):每日结合雌激素(CEE)0.45mg+MPA2mg;C组(35例):每日替勃龙1.25mg;D组(35例):每日服用中成药坤泰胶囊,3次日,4粒次。共服药1年,每组均同时给予碳酸钙400mg并推荐服用维生素D200IU。于用药前后应用DEXA法测腰椎与髋骨的骨密度,同时B超监测子宫内膜厚度,患者每日记录阴道出血和乳房症状。结果三种HT方案均能有效维持BMD,效果优于中药,且未引起子宫内膜和乳腺增生,患者依从性与中药组相比无显著性差异。结论低剂量不间断HT可以安全有效地预防围绝经期及绝经后妇女的骨量丢失。

Objective To study the effect of small dose hormone therapy on prevention of postmenopausal osteoporosis. Methods One hundred and forty peri- and post- menopausal women were randomly divided into 4 groups ： group A（35 cases） received estradiol valerate （ E2 V） 1 mg ＋ medroxypregesterone acetate（MPA） 2 mg per day;group B（35 cases） received conjugated estrogen（CE） 0. 45 mg＋ MPA 2 mg per day; group C（35 cases） received livial 1.25 mg per day;group D（35 cases） received a kind of herbal drug-geng-nian-ning-xin. All subjects were given calcium carbonate 400 mg per day with the previeus prescription for one year and 200 IU vitamin D was recommended everyday. Before the drug administration and 12 months after the study, the bone mineral density（BMD） of lumbar verteba and hip bone was measured by dual-energy X-ray absorptiometry and the endometrium by B-ultrasound. Vaginal bleeding and breast tenderness were recorded by the subjects themselves. Results All subjects in group A, B and C maintained relatively higher BMD than those in group D hyperplasia of endometrium or breast. All women have similar compliance regardless of the group assignment. Conclusions Persistent small dose of estrogen and progesterin can prevent postmenopausal osteoporosis effectively and safely.