低剂量雌激素替代疗法对围绝经期综合征患者激素水平及骨密度的影响

Influence of low-dose estrogen replacement therapy on hormone levels and bone mineral density of patients with peri-menopausal symptoms

目的 观察低剂量雌激素替代疗法对围绝经期综合征患者临床症状、激素水平及骨密度的影响。方法 根据患者是否愿意接受雌激素替代疗法将105例围绝经期综合征患者分为试验组52例和对照组53例,对照组不接受任何药物治疗,试验组口服替勃龙,2.5 mg/次,1次/d,连续治疗6个月。结果 试验组治疗后Kupperman各项评分均下降,卵泡刺激素（FSH）、黄体生成素（LH）水平下降,雌二醇（E2）水平升高,L1~4骨密度及股骨颈骨密度显著增加（P〈0.05或P〈0.01）。试验组未出现需要停药的不良反应,但子宫内膜厚度显著增加。结论 低剂量雌激素替代疗法可有效改善围绝经期综合征患者临床症状,调节激素水平,增加骨密度值,但可能会增加患者子宫内膜厚度,临床应用时应采用最低有效剂量,确保安全性。

Objective To observe the influence of low-dose estrogen replacement therapy on hormone levels and bone mineral density of patients with peri-menopausal symptoms. Methods A total of 105 patients with peri-menopausal symptoms were assigned into two groups. The study group （n = 52 ） was treated with oral administration of tibolone, 2.5 mg per time, once per day for 6 months, and the control group （ n = 53 ） did not received estrogen replacement therapy. Results The Kupperman score of patients in the study group were significantly higher after treatment compared with treatment before （P 〈 0.05 or P 〈 0.01 ）, the level of follicle stimulating hormone （FSH） and luteinizing hormone（LH） were decreased （ P 〈 0.05 or P 〈 0.01 ）, while level of estradiol（ E2 ） was increased in study group after treatment （P 〈 0.05）. The bone mineral density at lumbar spine 1-4 and neck of femur were higher after treatment compared with those before treatment （ P 〈 0.05 or P 〈 0.01 ）. There was no adverse reaction in this study, and patients in study group received an increase in thickness of endometrium after treatment （P 〈 0.01 ）. Conclusion Application of low-dose estro- gen replacement therapy can regulate hormone levels and increase the bone mineral density of patients with peri-menopausal symptoms. The minimum effective dose should be carefully administrated as low-dose estrogen replacement therapy may cause increase of endometrial thickness.