超声影像学监测绝经后长期激素替代疗法对乳腺的影响

Monitoring the Breast Changes of Chinese Postmenopausal Women under Long-term Hormone Replacement Therapy by Mammary Ultrasonography

目的超声影像学方法监测长期激素替代疗法(HRT)对乳腺的影响。方法60例身体健康、绝经1～5年的妇女,随机分为4组,每组15例;采用周期联合方法分别给予含1.5或0.75mgE2的经皮17-βE2凝胶与100mg微粉化天然黄体酮(MP)或2mg醋酸甲羟孕酮(MPA),睡前口服,每月连用25d;HRT前及第2年后每年用乳腺超声观察双侧乳腺腺体层的厚度、导管宽度、小叶形态结构及彩色多普勒血流显像;于治疗周期的第15～25天取血,测定E2;作乳腺胀痛日记。结果(1)HRT后乳腺腺体厚度高于HRT前,呈逐年上升的趋势;乳腺导管的宽度呈逐年下降的趋势,第5年与第6年比较有显著差异(P<0.05)。(2)新发生乳腺结构改变者共计22例,累积发生率41.5%。新生乳腺实性结节5例(8.3%),乳腺囊肿1例(1.7%);HRT第2年后有乳腺结构改变者的雌激素水平高于无改变者,第6年两者比较有显著性差异(P<0.05);第2年后有乳腺结构改变者的腺体厚度高于无改变者,第5、6年两者比较有显著性差异(P<0.05)。(3)HRT后各年有乳腺胀痛者的雌激素水平高于无乳腺胀痛者,第2、6年两者间有显著性差异(P<0.05)。结论HRT后乳腺组织中的腺体成分有增加的趋势,发生乳腺结构改变者有血清雌激素水平升高及乳腺腺体厚度增加的趋势,发生乳腺胀痛者有血清雌激素水平升高的趋势。超声可用于监测HRT中?

Objective To investigate the effects of long-term hormone replacement therapy(HRT)on the breasts of postmenopausal women using mammary ultrasonography.Methods An open randomized clinical study was designed.The percutaneous estradiol gel was used in a cyclic regimen combined with micronized progesterone(MP)or medroxyprogesterone acetate(MPA).Sixty healthy women(natural menopause for1to5years)were recruited and divided into four groups according to the dosage of estrogen and two kinds of progestin.All were given for25days per month.Mammary ultrasonography was used to observe breast glandular section thickness,breast duct width,the morphology of lobular unit and the blood flow of color Doppler imaging at baseline and every year from the second to seventh year of HRT.The serum estradiol was also measured from the15th to25th day of the cycle.Breast pain was recorded by the subjects.Results(1)The breast glandular section thickness after HRT was larger than that of before HRT.The breast glandular section thickness became larger gradually over time while the breast duct width became smaller over time.The breast duct width of the fifth year of HRT was significantly different from that of the sixth year(P<0.05).(2)Twenty-two persons had new breast structure changes after HRT,and the accumulated incidence was41.5%.New solid lesions formation occurred in five subjects(8.3%)and new cyst formation occurred in one subject(1.7%).After the second year of HRT,the serum estradiol level of the subjects with breast structure changes was higher than that of without breast structure changes and in the sixth year of HRT,and the difference was significant (P<0.05).After the second year of HRT,the breast glandular section thickness of the subjects with breast structure changes was larger than that of without breast structure changes and in the fifth and sixth year of HRT,the difference was significant (P<0.05).(3)After HRT,the serum estradiol level of subjects with mastalgia was higher than that of without mastalgia and in the second and sixth follow-up year,the difference was significant (P<0.05).Conclusions There is an increasing trend of the percentage of glandular tissues of the breast after HRT.There is an increasing trend of the serum estradiol level and the breast glandular section thickness among the subjects with the breast structure changes;there is an increasing trend of the serum estradiol level among the subjects with mastalgia.Mammary ultrasonography can be used to monitor breast structure changes and breast lesions during HRT.