小剂量激素替代治疗围绝经期女性骨质疏松症对患者骨密度、雌激素水平的影响

Effects of low dose hormone replacement therapy on bone mineral density and estrogen level in the treatment of perimenopausal women with osteoporosis

目的探讨小剂量激素替代疗法(HRT)治疗围绝经期女性骨质疏松症(OP)对患者骨密度、雌激素水平的影响。方法选择山东省广饶县人民医院2019年3月至2020年5月诊治的105例围绝经期OP患者,根据非随机临床同期对照研究及患者自愿原则分为常规组(给予常规药物治疗,51例)和激素组(给予小剂量HRT治疗,54例)。比较两组治疗前后骨密度、骨代谢标志物、子宫内膜厚度和激素水平,并评估安全性。结果治疗后激素组腰椎L_(2)~L_(4)和大粗隆骨密度值高于常规组[(1.23±0.25)g/cm^(2)比(1.12±0.27)g/cm^(2)、(0.62±0.16)g/cm^(2)比(0.55±0.17)g/cm^(2)],差异有统计学意义(P<0.05)。治疗后激素组骨源性碱性磷酸酶(BAP)高于常规组[(6.71±1.20)μg/L比(5.82±1.04)μg/L],抗酒石酸酸性磷酸酶-5b(TRACP-5b)、骨钙素(BGP)低于常规组[(501.42±36.66)pg/L比(536.63±38.58)pg/L、(75.86±6.39)U/L比(79.32±7.13)U/L],差异有统计学意义(P<0.05)。治疗后激素组LH和FSH低于常规组[(11.23±2.21)U/L比(13.31±1.98)U/L、(13.64±3.68)U/L比(16.47±4.04)U/L],雌二醇(E2)高于常规组[(98.46±18.34)nmol/L比(91.38±17.59)nmol/L],差异有统计学意义(P<0.05)。两组治疗前后子宫内膜厚度比较差异无统计学意义(P>0.05)。两组不良反应和不良事件发生率比较差异无统计学意义(P>0.05)。结论小剂量HRT应用于围绝经期OP患者治疗中,可有效增加骨密度值,改善性激素水平和骨代谢标志物水平,且不增加子宫内膜厚度,安全性较好。

Objective To study the effect of low dose hormone replacement therapy(HRT)on bone mineral density and estrogen level in perimenopausal women with osteoporosis(OP).Methods A total of 105 perimenopausal OP patients diagnosed and treated in Guangrao County People′s Hospital from March 2019 to May 2020 were selected and divided into the conventional group(51 cases)and the hormone group(54 cases)according to the non-randomized clinical concurrent control study and the principle of patient voluntary.The former group was given conventional drug therapy,while the latter group was given low-dose HRT.Bone mineral density(BMD),bone metabolic markers,endometrial thickness,and hormone levels were compared between the two groups before and after the treatment,and the safety was assessed.Results After the treatment,bone mineral density values of lumbar L_(2)-L_(4) and greater trochanter in the hormone group were higher than those in the conventional group:(1.23±0.25)g/cm^(2) vs.(1.12±0.27)g/cm^(2),(0.62±0.16)g/cm^(2) vs.(0.55±0.17)g/cm^(2),the differences were statistically significant(P<0.05).After treatment,the level of bone alkaline phosphatase(BAP)in the hormone group was higher than that in the conventional group:(6.71±1.20)μg/L vs.(5.82±1.04)μg/L;the levels of tartrate resistant acid phosphatase-5b(TRACP-5b),osteocalcin(BGP)in the hormone group were lower than those in the conventional group:(501.42±36.66)pg/L vs.(536.63±38.58)pg/L,(75.86±6.39)U/L vs.(79.32±7.13)U/L,the differences were statistically significant(P<0.05).After treatment,the levels of luteinizing hormone(LH)and follicle-stimulating hormone(FSH)in the hormone group were lower than those in the conventional group:(11.23±2.21)U/L vs.(13.31±1.98)U/L,(13.64±3.68)U/L vs.(16.47±4.04)U/L;the level of estradiol(E2)in the hormone group was higher than that in the conventional group:(98.46±18.34)nmol/L vs.(91.38±17.59)nmol/L,the differences were statistically significant(P<0.05).There was no significant difference in endometrial thickness between the two groups before and after the treatment(P>0.05).There were no statistically significant differences in the incidence of adverse reaction and adverse event(P>0.05).Conclusions The application of low-dose HRT in the treatment of perimenopausal OP patients can effectively increase the body mineral density value,improve the level of sex hormone and bone metabolism markers,and do not increase the endometrial thickness,with a higher safety.