戊酸雌二醇/醋酸环丙孕酮片治疗围绝经期症状的效果研究

Estradiol valerate/cyproterone acetate improves menopausal syndrome in perimenopausal women

目的探讨戊酸雌二醇/醋酸环丙孕酮片在改善围绝经期女性更年期症状的效果。方法对2012年1月1日至2012年10月30日,在上海交通大学医学院附属第六人民医院更年期专病门诊就诊的围绝经期女性,在排除雌激素应用禁忌症后,使用戊酸雌二醇/醋酸环丙孕酮片治疗围绝经期症状,每日1片,连续服用21 d停药,于停药出血后第5天开始第二周期服药,共3个月经周期。比较治疗前及治疗3个周期后患者更年期症状的改善情况。采用改良kupperman评分表评估更年期症状的改善程度、采用MRS评分法评估更年期症状对更年期生活质量的影响。结果 135例围绝经期接受戊酸雌二醇/醋酸环丙孕酮片的HRT方案妇女中有101例坚持治疗,依从性为74.8%,其中纳入研究的34例均能按医嘱定期服药、随访者,另有33例因各种原因未定期随访但坚持HRT。34例纳入研究患者的平均年龄47.3±3.76岁。经过3个周期戊酸雌二醇/醋酸环丙孕酮片治疗后,kuppeman总分由治疗前18.5±3.2降至11.9±5.2(P<0.01),感觉异常,眩晕、头痛心悸及泌尿生殖道症状外其余症状评分均显著改善。MRS评分由治疗前10.9±4.2降至6.7±3.5(P<0.01)。结论戊酸雌二醇/醋酸环丙孕酮片能显著改善围绝经期症状,未发现严重不良反应;患者依从性良好,值得临床进一步推广。

Objective To evaluate the clinical efficacy of climen （estradiol valerate 2 mg / cyproterone acetate 1 mg ） for menopausal symptoms in perimenopausal women. Methods One hundred and thirty five perimenopausal women received climen treatment between January 2012 and October 2012 in Sixth People＇s Hospital, Shanghai Jiaotong University. Modified Kupperman scale was applied to evaluate the improvement of menopausal symptoms and MRS scale was used to evaluate the effect of menopausal symptoms on the quality of life. Results One hundred and one out of 135 patients kept the treatment protocol with a compliance rate of 74.8 %, among whom 34 patients were followed up regularly and enrolled in the study. The average age of 34 patients was 47.3 ± 3.76. The total Kuppeman score decreased from 18.5 ± 3.2 （pre-treatment） to 11.9 ± 5.2 （post-treatment） （P 〈 0. 01 ）and the symptom scores were improved significantly except paresthesia, vertigo, headache, palpitation and urogenital tract symptoms. The total MRS score decreased from 10.9 ± 4.2 （pre-treatment）to 6.7 ± 3.5 （post-treatment） （P 〈0.01 ）. Conclusion Climen can improve menopausal syndrome in perimenopausal women with satisfactory compliance rate and without severe adverse reaction.