局部应用雌激素后下生殖泌尿道血流的改变及其安全性

Study of blood flow improvement of topical application of estrogen on low genitourinary tract and its safety

目的研究局部雌激素对绝经妇女下生殖泌尿道血流的改变及其安全性。方法采用彩色多普勒血流成像技术，观察下生殖泌尿道血流频谱，对2007年2月至2010年12月武汉大学中南医院门诊就诊的78例绝经妇女，在局部使用雌激素前及用药后1、3个月，分别测量阴道壁、尿道周血流的阻力指数（RI）及收缩期、舒张期比值（S／D）等多普勒血流指标，并观察下生殖泌尿道症状，如性生活、外阴阴道炎、尿频、夜尿等改善情况，以及用药的不良反应。结果用药前及用药后1、3个月，阴道壁动脉的R1分别为0．9±0．2、0．6±0．2和0．7±0．3，S／D分别为8．6±3．7、6．0±2．9和6．4±2．1。尿道周动脉的R1分别为0．9±0．2、0．6±0．2和0．6±0．2，S／D分别为6．6±1．9、3．5±0．7和3．4±0．5，用药后各指标与治疗前比较，差异均有统计学意义（均P〈0．01）。绝经妇女使用局部雌激素后，下生殖泌尿道的血管舒张，阻力降低。性生活满意度提高，外阴阴道炎、尿频、夜尿发病率明显降低，差异有统计学意义（P〈0．01）。结论绝经妇女使用局部雌激素后，促进了下生殖泌尿道的血液循环，从而减轻或消除萎缩性泌尿生殖道症状，提高性生活满意度。

Objective The study of blood flow improvement of local estrogen on the low genitourinary tract and its safety. Methods The color Doppler flow imaging technique was employed to observe the flow speetrum of genitourinary tract. During the period of February 2007 to December 2010, there were 78 cases of postmenopausal females on local estrogen. The Doppler parameters included vaginal wall, urethra resistance index （RI） and systolic/diastolic ratio and others. And the lower genital urinary tract symptoms, such as sexual satisfaction, vulvovaginitis, urinary frequency, nocturia and other improvements, as well as adverse drug reactions before treatment and after 1 month, 3 months were recorded and analyzed. Results The results before treatment and after 1 month, 3 months, vaginal wall artery RI were 0.9±0.2, 0.6±0.2 and 0.7 ±0.3; S/D 8.6±3.7, 6.0±2.9 and 6.4 ±2. 1; urethral artery RI 0. 7 ±0. 2, 0. 6 ±0. 2 and 0. 6 ±0. 2, S/D 6. 6 ±1.9, 3.5 ±O. 7 and 3.4 ±0. 5 respectively. When the pre- and post-treatment indices were compared, the differences were statistically significant （ P 〈 0. 01 ）. After using local estrogen in postmenopausal women, the resistance of lower genital urinary tract vasodilation decreased. Sexual satisfaction increased while the morbidities of vulvovaginitis, urinary frequency and nocturia decreased. The difference was statistically significant （ P 〈 0. 01 ）. Conclusion Postmenopausal females on topical estrogen may promote the blood circulation of lower genitourinary tract, red.