激素替代治疗对宫颈鳞癌术后的临床观察研究

Clinical observation and study of hormone replacement therapy on postoperative cervical squamous cell carcinoma

目的评价激素替代治疗(hormone replacement therapy,HRT)对宫颈鳞状细胞癌患者术后的临床疗效及其对性激素、血脂、骨质含量及肿瘤标志物水平的影响。方法回顾性分析2016年1月至2019年1月珠海市妇幼保健院收治的100例行手术治疗后宫颈鳞状细胞癌患者临床资料50例患者愿意接受HRT作为实验组,50例进行常规治疗作为对照组。采用Kupperma评分评价围绝经期症状的严重程度,分别检测两组患者治疗前后血清中性激素、血脂、骨质含量及肿瘤标志物浓度及不良反应发生情况。结果治疗前,两组患者Kupperma评分、雌二醇、卵泡刺激素、黄体生成素水平及血脂水平、骨质含量及肿瘤标志物水平比较差异均无统计学意义(P均>0.05);HRT治疗后较治疗前比较,实验组Kupperma评分明显下降[(11.47±5.12)分与(20.46±7.52)分,t=7.262,P<0.001],性激素检测中,实验组雌二醇水平明显升高[(39.26±7.43)ng/L与(13.78±7.52)ng/L,t=12.345,P<0.001],卵泡刺激素[(34.25±7.61)U/L与(62.18±19.12)U/L,t=8.245,P<0.001]、黄体生成素[(20.31±6.25)U/L与(35.08±6.27)U/L,t=5.452,P=0.004]水平明显下降;血脂水平、骨质含量及肿瘤标志物检测中,实验组高密度脂蛋白胆固醇[(1.62±0.33)mmol/L与(1.34±0.26)mmol/L,t=4.592,P=0.008]、碱性磷酸酶[(66.21±25.75)U/L与(46.88±9.06)U/L,t=5.912,P=0.001]水平明显升高,低密度脂蛋白胆固醇[(2.78±0.43)mmol/L与(2.87±0.78)mmol/L,t=4.265,P=0.012]、总胆固醇[(4.02±0.45)mmol/L与(4.23±0.91)mmol/L,t=5.761,P=0.002]水平明显下降,差异均有统计学意义(P均<0.05);实验组治疗前后血清鳞状细胞癌抗原水平差异均无统计学意义(P均>0.05);而对照组上述各指标治疗前后比较差异均无统计学意义(P均>0.05);实验组乳房肿痛(3例)、体质量增加(2例)、出血(1例)、身体疼痛(4例)、呕吐(4例)等不良反应未见明显增加,与对照组(2、1、2、3、1例)比较差异均无计学意义(P均>0.05)。结论应用HRT治疗宫颈鳞状细胞癌术后患者能显著改善低雌激素水平引起的围经期综合征,且未明显增加患者的宫颈癌的复发风险及不良反应。

Objective To observe the clinical effect of hormone replacement therapy(HRT)on patients with cervical squamous cell carcinoma after operation and its effect on sex hormone,blood fat,bone content and tumor markers,and to evaluate the clinical significance of HRT therapy.Methods From January 2016 to January 2019,a total of 100 patients with cervical squamous cell carcinoma admitted to Zhuhai Maternal and Child Health Hospital were analyzed retrospectively.After surgical treatment,50 patients were willing to receive hormone replacement therapy as the experimental group and 50 patients received routine treatment as the control group,Kupperma score was used to evaluate the severity of perimenopausal symptoms,and the serum levels of sex hormones,blood fat,bone content and tumor markers in the two groups before and after treatment were detected and the occurrence of adverse reactions were evaluated.Results Before treatment,there was no significant difference in kupperma score,estradiol,follicle-stimulating hormone,luteinizing hormone level,lipid level,bone content and tumor marker level between the two groups(all P>0.05).After HRT treatment,kupperma score in the experimental group was significantly lower than that before treatment((11.47±5.12)vs.(20.46±7.52),t=7.262).In the detection of sex hormones,the levels of estradiol in the experimental group was significantly increased((39.26±7.43)ng/L vs.(13.78±7.52)ng/L,t=12.345),and the levels of follicle stimulating hormone((34.25±7.61)U/L vs.(62.18±19.12)U/L,t=8.245)and luteinizing hormone((20.31±6.25)U/L vs.(35.08±6.27)U/L,t=5.452,P=0.004)in the experimental group were significantly decreased.In the detection of blood lipid level,bone content and tumor markers,high-density lipoprotein((1.62±0.33)mmol/L vs(1.34±0.26)mmol/L,t=4.592,P=0.008)and alkaline phosphatase levels((66.21±25.75)U/L vs.(46.88±9.06)U/L,t=5.912,P=0.001)was significantly increased,the low density lipoprotein((2.78±0.43)mmol/L vs.(2.87±0.78)mmol/L,t=4.265,P=0.012)and total cholestenone((4.02±0.45)mmol/L vs.(4.23±0.91)mmol/L,t=5.761,P=0.002)levels were significantly decreased in the experimental group,with statistically significant differences(all P<0.05).There was no significant difference in the level of serum SCC antigen between the experimental group and the control group before and after treatment(P>0.05);there was no significant difference in the above indicators between the experimental group and the control group before and after treatment(P>0.05);there was no significant increase in adverse reactions such as breast swelling and pain(3 cases),body mass increase(2 cases),bleeding(1 case),body pain(4 cases),vomiting(4 cases),etc.between the experimental group and the control group(2,1,2,3,1 case)There was no statistical significance(P>0.05).Conclusion HRT treatment of cervical squamous cell carcinoma patients after surgery can significantly improve the peri menstrual syndrome caused by low estrogen level,and did not significantly increase the risk of recurrence of cervical cancer patients and adverse reactions.