达到峰值骨量前后的早发性卵巢功能不全患者接受4年激素替代治疗对骨密度的影响分析

Effect of 4 years of hormone replacement therapy on bone mineral density in patients with premature ovarian insufficiency before and after peak bone mass

目的采用重复测量方差分析比较达到峰值骨量(peak bone mass,PBM)前后的早发性卵巢功能不全(premature ovarian insufficiency,POI)患者进行4年激素替代治疗(hormone replacement therapy,HRT)对骨密度的影响。方法回顾性分析2009年10月至2017年8月山西医科大学第一医院妇科内分泌门诊确诊、病历完整且接受HRT治疗4年以上的POI患者67例。按是否达PBM年龄分为≤30岁34例,>30岁33例,治疗方案为雌孕激素序贯治疗,包括周期序贯和连续序贯,观察治疗前、治疗1年、2年、3年、4年期间左侧股骨颈、左侧髋骨、腰L1、总腰椎的骨密度,分析并比较各部位骨密度随时间变化的趋势。结果重复测量方差分析结果显示:两组患者左侧髋骨、腰L1骨密度存在时间效应、组别效应和交互效应(P<0.05);左侧股骨颈骨密度只具有时间效应(P<0.05);总腰椎骨密度存在时间效应和交互效应(P<0.05)。单因素重复测量方差分析结果表明:≤30岁组患者左侧股骨颈、左侧髋骨、腰L1及总腰椎骨密度均随治疗时间而增加,差异有统计学意义(P<0.05)。>30岁组患者腰L1及总腰椎骨密度增加,差异有统计学意义(P<0.05);>30岁组左侧股骨颈、左侧髋骨骨密度增加,但差异无统计学意义(P>0.05)。结论达到PBM前比达峰后患POI对骨代谢的影响更明显。POI患者接受HRT期间骨密度均显著增加。在达到PBM前POI患者接受HRT比达峰后治疗骨密度增幅更大、疗效更好。

Objective To compare the effect of hormone replacement therapy(HRT)for 4 years on bone mineral density(BMD)in patients with premature ovarian insufficiency(POI)before and after reaching peak bone mass(PBM)by using repeated measurement analysis of variance.Methods A retrospective analysis of 67 patients with POI who were diagnosed in the Gynecological Endocrinology Clinic of the First Hospital of Shanxi Medical University from October 2009 to August 2017,with complete medical records and received HRT for more than 4 years.According to whether reached the age of PBM,the patients were divided into two groups:≤30 years old(34 cases)and>30 years old(33 cases).The treatment regimen was sequential therapy of estrogen and progesterone,including cycle sequential and continuous sequential.The BMD of left femoral neck,left hip bone,lumbar L1 and total lumbar spine were observed before treatment and 1 year,2 years,3 years and 4 years after treatment,and the trend of BMD of each site over time were analyzed and compared.Results The results of repeated measures analysis of variance showed that there were statistically significant differences in the time effect,group effect,and interaction effect of left hip bone and lumbar L1 BMD between two groups of patients(P<0.05).Only the time effect of left femoral neck BMD was statistically significant(P<0.05).The time effect and interaction effect showed on total lumbar BMD(P<0.05).The results of one-way repeated measures analysis of variance showed that the BMD of the left femoral neck,left hip bone,lumbar L1 and total lumbar spine in patients≤30 years old,and the difference was statistically significant(P<0.05).The increase of BMD of lumbar L1 and total lumbar vertebrae in patients>30 years old group was statistically significant(P<0.05).There was no statistically significant increase in BMD of left femoral neck and left hip bone in>30 years old group(P>0.05).Conclusion The effect of POI on bone metabolism is more obvious before the PBM than that after the PBM.BMD increased significantly in POI patients during HRT.The BMD of POI patients receiving HRT before reaching the PBM increased more and the curative effect was better than that after reaching the PBM.