激素替代疗法联合福善美及单用福善美治疗围绝经期妇女骨质疏松症和骨量减少的效果评价

Therapeutic evaluation of hormone replacement therapy with combination of Fosamax and alone use of Fosamax in osteoporosis and steopenia of perimenopausal women

目的 探讨激素替代疗法（HRT）联合福善美及单用福善美治疗围绝经期妇女骨质疏松症和骨量减少的疗效及安全性.方法 将2010年12月至2014年6月到我院门诊接受诊疗的113例围绝经期妇女骨质疏松症患者按照治疗方法分为对照组（55例）与观察组（58例）.对照组单用福善美,观察组在此基础上联合HRT法.比较两组治疗疗效、治疗前后腰椎及髋骨骨矿物质含量密度（BMD）水平、治疗前后胫骨超声传导速度（SOS）、治疗前后性激素水平、治疗前后子宫内膜厚度及不良反应.结果 （1）观察组经治疗总有效率为93.10％显著高于对照组78.18％（x2=3.829,P=0.034）;（2）两组治疗前后腰椎BMD、髋骨BMD、胫骨SOS、血促卵泡素（FSH）及雌二醇（E2）比较差异均有统计学意义（P均＜0.05）且观察组治疗后腰椎BMD、髋骨BMD、胫骨SOS、FSH及E2与对照组治疗后比较差异均有统计学意义（t值分别为3.389、5.012、3.997、5.829、3.902,P值分别为0.035、0.028、0.033、、0.024、0.038）;（3）观察组患者治疗过程中不良反应发生率与对照组比较差异有统计学意义（6.90％与16.36％;x2=8.273,P=0.012）.结论 HRT联合福善美与单用福善美治疗围绝经期妇女骨质疏松症和骨量减少的疗效比较效果显著,不良反应发生率低,具有推广价值.

Objective To explore the efficacy and safety of hormone replacement therapy with combination of Fosamax and simple use of Fosamax in osteoporosis and steopenia of perimenopausal women.Methods One hundred and thirteen perimenopausal women with osteoporosis accepted treatment in Outpatient Clinic of Panyu Convalescent Hospital of Guangzhou from December 2010 to June 2014 were chosen and divided into the control group （n=55） and the observation group （n=58） according to therapeutic method.The control group was treated with Fosamax alone while the observation group was treated with HRT basing on the simple use of Fosamax.The therapeutic effect,lumbar and hip bone mineral density（BMD） level,tibial ultrasound velocity （SOS） and T values of tibia,gonadal hormone concentrations,endometrial thickness and adverse reaction of the two groups before and after the therapy were compared.Results （1） The total effective rate of the observation group after the treatment was 93.10%,significantly higher than tbat of the control group （78.18%,x2=3.829,P=0.034）.（2） Before and after treatment in two groups,there were statistically significant differences in terms of lumbar spine BMD,hip BMD,SOS of tibia,blood follicle stimulating prime （FSH） and estradiol（E2） （P〈0.05）,and there were statistically significant differences between the two groups after the treatment in terms of lumbar spine BMD,hip B MD,SOS of tibia,FSH and E2 （t =3.389,5.012,3.997,5.829,3.902;P=0.035,0.028,0.033,0.024,0.038）.（3） There was statistically significant differences in term of the incidence of adverse reactions between the observation group and the control group （6.90% vs.16.36%;x2=8.273,P=0.012）.Conclusion Compared with alone use of Fosamax,the therapeutic effect of hormone replacement therapy with combination of Fosamax and in osteoporosis and steopenia of perimenopausal women is more significant with low occurrence rate of adverse reaction.It is worth popularization.