激素替代治疗对绝经后妇女乳腺密度的影响——附150例分析

Effect of hormone replacement therapy on mammographic density in postmenopausal women——an alasysis of 150 cases

目的：探讨激素替代治疗（hormone replacement therapy,HRT）对绝经后妇女乳腺密度的影响。方法：150例绝经后妇女分为替勃龙组（A组,56例）、联合应用结合雌激素和甲羟孕酮组（B组,44例）和尼尔雌醇和甲羟孕酮序贯用药组（C组,50例）3组。其中A组予替勃龙2.5mg,每日1次睡前口服;B组予结合雌激素0.625mg和甲羟孕酮2.5mg,每日1次睡前口服。C组予尼尔雌醇2mg,每月1号和15号各1次睡前口服,每隔4次加用甲羟孕酮10mg,每日1次睡前口服,连用10日。3组疗程均为1年。观察患者治疗前、后的围绝经期症状、乳腺致密度的改变情况,以及比较3组治疗期间乳房胀痛的发生情况。结果：3种HRT治疗方案均能减轻围绝经期症状。治疗期间,3组乳房胀痛发生率比较差异均有统计学意义（P〈0.05-0.01）,以B组最高,C组次之,A组最低。A组治疗前、后乳腺致密度评分比较差异无统计学意义（P〉0.05）;B组和C组治疗后的乳腺致密度评分均比治疗增高（P〈0.05-0.01）;3组治疗后的乳腺致密度评分比较差异有统计学意义（P〈0.05）,其中以B组最高,C组次之,A组最低。结论：HRT对绝经后妇女乳腺致密度有一定影响,采用替勃龙对乳腺致密度的影响较小。

Objective： To investigate the effect of postmenopausal hormone replacement therapy （HRT） on mammographic density in postmenopausal women. Methods： 150 women after menopause were divided into three groups. Tibolone （2.5 mg） were taken before retiring everyday in group A （ n = 56）. Conjugated estrogen hormone （0. 625 mg） and medroxyprogesterone （ MPA, 2. 5 mg） were taken before retiring everyday in group B （n =44）. Estriol （2 mg） were taken before retiring on the 1^st and 15^th day every month in group C （n=50） , and MPA （ 10 mg） were taken for 10 days every four times after taking estriol in group C. All the course of treatment keep on 1 year. The postmenopausal symptom, mammographic density were analyzed before and after the treatment. The incidence of mastalgia were compared during the treatment in three groups. Results： In each group, menopausal symptoms could be relieved. The incidence of mastalgia was significantly increased in group B and C （P 〈0. 05-0. 01）, especially in group B. After the treatment, there were no changes in mammographic density in group A （ P 〉 0. 05 ） and significantly increased in group B and C （ P 〈 0. 05 - 0. 01 ）, especially in group B. Compared with the score of mammographic density before therapy, there was significantly difference in three groups after therapy. Conclusion： HRT can affect the mammographic density in postmenopausal women. The effect of mammographic density is reduced with tibolone therapy.