围绝经期应用不同剂量绝经激素治疗的临床观察

Effects of different doses of menopause hormone therapies in perimenopausal women

目的比较不同剂量绝经激素治疗(MHT)对缓解患者绝经相关症状的有效性和安全性。方法回顾分析2012年至2017年就诊浙江大学医学院附属妇产科医院妇科内分泌门诊的围绝经期综合征患者450例,根据MHT方案中雌激素剂量分为3组,A组:标准剂量组(n=62),B组:低剂量组(n=322)及C组:超低剂量组(n=66)。以28 d为1个治疗周期,连续序贯给药。分别于治疗前后进行改良Kupperman问卷评分、生殖激素及糖脂代谢指标测定、乳腺超声检查。结果治疗前3组患者在一般资料及各临床观察指标上差异均无统计学意义(P均> 0.05)。与治疗前相比,治疗1、3、6个周期后,3组改良Kupperman评分、血清卵泡刺激素(FSH)均下降,雌二醇(E2)均上升,差异有统计学意义(P均<0. 001)。B组与C组高密度脂蛋白胆固醇在治疗6周期后均较治疗前升高,A组与B组低密度脂蛋白胆固醇在治疗6周期后均较治疗前下降,差异有统计学意义(P均<0. 01); A组与B组空腹血糖、空腹胰岛素在治疗6周期后均较治疗前下降,差异有统计学意义(P均<0. 01)。治疗前后3组乳腺腺体厚度、结节大小、导管扩张程度均无明显变化(P均> 0. 05); A组7例(11. 3%)、B组14例(4. 3%)、C组1例(1. 5%)出现乳房胀痛,发生率在A、C组间差异有统计学意义(P <0. 05)。结论标准剂量、低剂量、超低剂量MHT均有效缓解围绝经期患者的绝经症状。其中,标准剂量、低剂量MHT在改善糖脂代谢方面优于超低剂量MHT,超低剂量MHT在耐受方面具有一定优势,观察期内不同剂量MHT均对乳腺无影响。

Objective To compare the effectiveness and safety of different doses of menopause hormone therapies(MHT)in the remission of menopausal symptoms.Methods The clinical data of 450 perimenopausal women who received MHT during 2012 and 2017 were retrospectively analyzed.According to the doses of estradiol valerate,the patients were divided into 3 groups:group A(standard dose,n=62),group B(low dose,n=322)and group C(ultralow dose,n=66).One treatment cycle lasted for 28 days,during which the continuous sequential regimen was adopted.Before and after treatment,modified Kupperman menopausal index(mKMI)were surveyed,reproductive hormones and glucolipid metabolic indexes were detected,and breast ultrasound was performed.Results Before treatment,there were no significant differences in the general characters and clinical indexes among the 3 groups(all P>0.05).Compared to baseline,the mKMI scores and follicle stimulating hormone(FSH)level significantly decreased,while estradiol level significantly increased after 1,3 and 6 treatment cycles in all 3 groups(all P<0.001).After 6 treatment cycles,the level of high-density lipoprotein cholesterol(HDL-C)markedly increased in groups B and C,and the levels of low-density lipoprotein cholesterol(LDL-C),fasting blood glucose and fasting insulin significantly decreased in groups A and B(all P<0.01).There were no statistical changes in the thickness of mammary glands,size of mammary nodules and dilatation of ducts in the 3 groups before and after treatment(all P>0.05).Breast distention occurred in 7 cases(11.3%)in group A,14 cases in group B(4.3%)and 1 case in group C(1.5%),the difference in incidence between groups A and C was significant(P<0.05).Conclusion The standard,low and ultra-low doses of MHT can effectively relieve the menopausal symptoms in perimenopausal women.The standard and low dose are superior to the ultra-low dose in improving glucolipid metabolism.The ultra-low dose has advantages in tolerance.The different doses of MHT has no effects on the mammary glands during the observation period.