手术绝经后妇女结合雌激素替代治疗的临床观察

Clinic Evaluation of Conjugated Estrogen for Postoperative Menopausal Women

目的：探讨手术绝经后妇女用结合雌激素替代治疗的必要性。方法：选取２年内行子宫加双卵巢切除者２０例（双侧组），行子宫加单侧卵巢切除者 ２１例（单侧组）。口服结合雌激素 ０． ６２５ ｍｇ／ｄ，每月连续服用 ２８ ｄ，共服用 ６个月。观察治疗前后Ｋｕｐｐｅｒｍａｎ评分、血ＦＳＨ、ＬＨ、Ｅ２骨密度（ＢＭＤ）及骨生化指标的变化。结果：两组治疗后更年期症状明显改善（Ｐ＜０．００１）；两组术后血ＦＳＨ、ＬＨ升高，双侧组较单侧组高（Ｐ＜０．０１，Ｐ＜０．０５）；Ｅ２下降，双侧组较单侧组低（Ｐ＜０．０５）。治疗前、后两组ＦＳＨ、ＬＨ、Ｅ２有明显差异（Ｐ＜０．０１—Ｐ＜０．００１）。两组治疗前骨密度（ＢＭＤ）变化有差异（Ｐ＜０．０５），治疗后两组ＢＭＤ无明显变化（Ｐ＞０．０５）；血ＡＬＰ治疗前、后无明显变化（Ｐ＞０．０５）；尿钙／肌酐、尿羟脯氨酸／肌肝均有下降（Ｐ＜０．０５）。结论：手术绝经后妇女用雌激素替代治疗能有效地改善更年期症状，减缓骨吸收速度，减少骨质丢失，防治骨质疏松。

Objective: The aim of this study is to discuss the importance of hormone replace therapy for postoperative menopausal women. Methods: 20 women undergoing hysterectomy and bilateral oophorectomy (bilateral group) and 21 women undergoing hysterectomy and one - side oophorectomy (one - side group) within two years were included. Conjugated estrogen at an oral dose of 0. 625/day was assigned to each participant for 6 months. The results were evaluated by comparing Kupperman Score, serum FSH, LH. E2, bone mass density (BMD) of pre and post medication. Results: The climacteric symptoms alleviated significantly (P < 0. 001) in both groups after medication. Before intervention, either group had high levels of serum FSH, LH and a low level of E2, while the bilateral group presenting a significantly more obvious change when compared with the one - side group. After six months medication, the serum FSH, LH levels were significantly lowered, while the serum E2 elevated (P < 0. 01 - P < 0. 001 ). The BMD changed significantly compared with pre - intervention in both groups and its level remains une3dlin3e. There was no significantly difference in the value of serum ALP. The values of urinary calcium/creatinine ratio and urinary hydroxproline /creatinine lowered (P < 0. 01 ). Conclusion: Hormone replacement therapy may effectively alleviate climacteric symptoms, slowdown bone resorption and reduce bone loss,therefore may prevent osteoposis in postoperative menopausal women.