两种绝经激素治疗方案改善绝经后妇女绝经症状和生活质量的效果分析

Comparison of two menopausal hormonal therapies in improving life quality of postmenopausal women

目的探讨替勃龙和雌二醇屈螺酮替代治疗方案改善绝经后妇女绝经症状和生活质量的效果和安全性。方法选取2012年1月—2013年5月就诊于上海交通大学附属第六人民院妇产科更年期门诊的56例绝经后妇女,分别接受替勃龙(36例,替勃龙组)和雌二醇屈螺酮(20例,雌二醇屈螺酮组)治疗,连续用药3个月。采用改良Kupperman评分量表(KMI)评价绝经症状和严重程度,采用绝经评定量表(MRS)评价绝经后生活质量。比较两组患者治疗前和治疗后3个月两种量表的评分,以及不良反应的发生情况。结果替勃龙组和雌二醇屈螺酮组患者治疗后KMI评分总分和MRS生活质量评分总分均显著低于同组治疗前(P值均<0.01)。替勃龙组治疗后的性生活质量下降评分和雌二醇屈螺酮组治疗后的皮肤蚁走感、性生活质量下降、情绪低落、焦虑、性生活问题、膀胱不适、阴道干涩评分与同组治疗前的差异均无统计学意义(P值均>0.05),两组治疗后的其他症状评分均显著低于同组治疗前(P值分别<0.01、0.05)。雌二醇屈螺酮组治疗前后皮肤蚁走感、情绪低落、焦虑、性生活问题的评分差值均显著低于替勃龙组(P值均<0.05),两组间治疗前后其余各症状评分差值、KMI评分总分差值、MRS生活质量评分总分差值的差异均无统计学意义(P值均>0.05)。替勃龙组患者非预期阴道出血发生率显著低于雌二醇屈螺酮组(P<0.05),体重增加发生率显著高于雌二醇屈螺酮组(P<0.05),两组间乳房胀痛发生率的差异无统计学意义(P>0.05)。结论应用替勃龙和雌二醇屈螺酮进行绝经激素治疗,均能够有效改善患者的绝经后相关症状,提高其生活质量。在改善泌尿生殖道症状和精神神经症状方面,替勃龙的疗效优于雌二醇屈螺酮;在药物安全性方面,两种药物的不良事件发生率均较低,但表现不一。

Objective To investigate the efficacy and safety of tibolone and estradiol drospirenone in improving the life quality of postmenopausal women. Methods Fifty-six postmenopausal outpatients were treated by tibolone （tibolone group, n = 36） or estradiol drospirenone （estradiol group, n = 20） in our hospital between January 2012 and May 2013. The medicines were given for three consecutive months. The modified Kupperman scale （KMI） and menopause rating scale （MRS） were used to evaluate menopausal symptom and quality of menopause life, respectively. The scores of KMI and MRS and the incidence of adverse events were compared between the two groups. Results The scores of KMI and MRS after treatment were significantly lower than those before treatment in both groups （all P〈0.01）. No significant differences were found in the scores of sexual problems in the tibolone group before and after treatment （P〈0.05） neither were skin crawing feeling, sexual problems, low spirits, anxiety, urinary bladder complaints, or vaginal dryness in the estradiol group （all P〉 0.05）. The scores of other symptoms after treatment were significantly lower than those before treatment in both groups （P〈0.01, P〈0.05）. The differences of skin crawing feeling, low spirits, anxiety, and scores of sexual problems before and after treatment in the estradiol group were significantly lower than those in the tibolone group （all P〈0.05）. However, there were no significant differences in the differences of other symptom scores, total KMI score or MRS score in quality of life between two groups （all P〈0.05）. The incidence of unexpected vaginalbleeding in the tibolone group was significantly lower than that in the estradiol group （P〈0.05）, while the incidence of body weight gain in the tibolone group was significantly higher than that in the estradiol group （P〈0.05）. No significant difference was found in the incidence of breast gas pains between two groups （P〉0.05）. Conclusion Both tibolone and estradiol drospirenone used for peri-menopausal hormonal therapy can effectively improve postmenopausal symptoms and quality of life. However, tibolone is superior to estradioi drospirenone in relieving urogenital tract symptoms and mental and nervous symptoms. Various adverse events occur after administration of the two drugs, but the incidence of adverse events is very low.