围绝经期妇女激素替代治疗的临床研究

Clinical study on HRT of the perimenopause women

目的 了解西安地区围绝经期妇女的心理状况及可接受激素替代治疗 (HRT)的程度 ,探讨HRT是否象在西方和国内其他地区妇女中一样 ,能保持或减少绝经后妇女骨密度的降低 ,改善血脂代谢。方法 采用前瞻性对照研究 ,实验组 3 0例病人采用激素补充疗法 ,3 0例未采用干预治疗的围绝经期妇女为对照组。首先进行心理问卷调查并进行评估 ,然后观察用药前后Kupperman评分、血脂、BMD、子宫内膜的变化。结果 心理咨询结果显示 ,实验组要求行HRT治疗者之文化程度及经济状况均优于对照组 ,但对HRT及围绝经期保健知识了解的程度均低。用药前后评分显示 ,实验组用药 1 2月后症状完全缓解率达 90 % ,而对照组中 6 6 %患者症状无改善。实验组用药后BMD保持不变 ,对照组明显下降 (P <0 0 5 )。实验组用药后TC、TG无变化 ,HDL水平上升 (P <0 0 0 1 ) ,LDL下降 (P <0 0 0 1 ) ,对照组无变化。两组子宫内膜均无明显变化。结论 ①西安地区相应群体对HRT缺乏认识和了解 ,相关部门普及围绝经期保健工作的力度不够 ,需政府、社会和家庭的支持。②西安地区围绝经期妇女适宜HRT ,其可保持BMD ,改善血脂 ,保护心血管 ,提高该群体妇女的生活质量。

Objective To explore the psychological conditions and attitude about HRT of the Xi'an perimenopause women whether HRT could improve the situation of lipid metabolism,and control the decreasing of bone density of the perimenopause women just like those who live in the other region of China or westen country. Methods A controlled prospective trial of 60 perimenopause women were divided into 2 groups:Experimental group(30 cases) and control group (30 cases).Firstly, they were asked to full a questionnaire. The experimental group were given HRT.The Kupperman scores,TC,BMD and responses of endometrium would be observed during the intervention. Results The psychological consulting indicated that the educational degree and the economic condition of expiremental group were better than that of the control group,but all patients knew little about health caring of perimenopause.The score showed that 90% of the expiremental group mitigated completely after 12 months HRT.66% of the control group didn't get better.The BMD of expiremental group had no changes,control group's BMD obviously decreased ( P <0 001),TC,TG of expiremental group had no changes,HDL level increased ( P <0 001), LDL level decreased ( P <0 001).These parameters of the control group didn't change.No response of endometrium of both groups.Conclusion ①Xi'an perimenopause women had merely knowledges of HRT,it needs support of government,society,family and related organizations to carry out health caring for perimenopause;②The HRT is suitable to the perimenopause women to maintain BMD,improve the TC situation,prevent vascular disease and eventually improve the life of them.