孕激素刺激试验和经阴道超声检查在绝经后妇女子宫内膜病变筛查中的作用

①目的 探讨孕激素刺激试验和经阴道超声检查在绝经后妇女子宫内膜病变筛查中的作用。②方法 对 10 6例无症状的绝经后妇女行阴道超声检查 ,测定其矢状面下子宫内膜前后径最大厚度 (双层 )及其形态 ,超声检查后行孕激素刺激试验及诊断性刮宫。③结果 11例妇女孕激素刺激试验阳性 ,其中 9例为异常子宫内膜。孕激素刺激试验用于检测子宫内膜疾病的灵敏度、特异度、阳性预测值、阴性预测值分别为 81.8%、97.9%、81.8%、97.9%。 2 9例妇女子宫内膜厚度≥ 5mm ,其中 10例为异常子宫内膜。以 5mm为分界点 ,阴道超声用于检测子宫内膜疾病的灵敏度、特异度、阳性预测值、阴性预测值分别为 90 .9%、77.9%、32 .3%、98.7%。对于子宫内膜厚度≥ 5mm者加用孕激素刺激试验 ,特异度将提高至 90 .5 %。④结论 孕激素刺激试验联合经阴道超声检查是简单、安全、可靠、易被接受的绝经后无症状妇女子宫内膜病变的筛查方法。

孕激素刺激试验对绝经后无症状妇女子宫内膜病变筛查的研究

目的 探讨孕激素刺激试验对绝经后无症状妇女子宫内膜病变筛查的意义。方法对106例无症状的绝经后妇女行孕激素刺激试验,口服安宫黄体酮10 mg/d,共10 d。无论孕激素刺激试验阳性或阴性,均给予分段诊刮术,以确定子宫内膜的生理或病理状态。结果11例妇女PCT为阳性,其中9例为异常子宫内膜。PCT用于检测子宫内膜疾病的敏感性、特异性分别为81.8％,97.9％。结论PCT是一种简单、安全、较可靠子宫内膜癌的筛查方法,易被绝经后无症状妇女接受。

高促性腺激素性闭经

目的：探讨高促性腺激素性闭经（ＨＧＡ）的致病因素、内分泌特点及治疗方法。方法：采用放免技术检测闭经病人血中ＦＳＨ、ＬＨ、Ｅ、ＰＲＬ、Ｔ值。结果：从３１２例闭经病人中筛选出ＨＧＡ４３例，占全部闭经患者的１３．８％。继发性闭经中，ＨＧＡ组占１３．２％，原发性闭经中，ＨＧＡ组占２７．３％，两组相比Ｐ＞０．０５。结论：对闭经病人应早期治疗，认真治疗，防止过早发展到绝经期阶段。

激素治疗在妇女健康组织报道其危害作用后的促销与使用

Context: Little is known about how the pharmaceutical industry responds to evidence of harm associated with its products, such as the publication in July 2002 of the Women s Health Initiative Estrogen Plus Progestin Trial (WHI E+ P) report demonstrating that standard dose Prempro produced significant harm and lacked net benefits. Objective: To examine pharmaceutical industry response to the WHI E+ P results by analyzing promotional expenditures for hormone therapy before and after July 2002. Design and Setting: Nationally representative and prospectively collected longitudinal data (January 2001 through December 2003) on prescribing and promotion of hormone therapies were obtained from IMS Health and Consumer Media Reports. Main Outcome Measures: Trends in quarterly prescriptions for hormone therapy and expenditures on 5 modes of drug promotion: samples, office based detailing, hospital based promotion, journal advertisements, and direct to consumer advertising. Results: Prior to the WHI E+ P report, prescribing rates and promotional spending for hormone therapy were stable. In the quarter before the WHI E+ P report (April June 2002), 22.4 million prescriptions for hormone therapy were dispensed and ＄ 71 million was spent on promotion (in annual terms, ＄ 350 per year per US physician). Within 9 months of the report s publication (quarter 1 of 2003), there was a 32% decrease in hormone therapy prescriptions, and a nadir had been reached for promotional spending (37% decrease compared with pre WHI E+ P levels). Spending decreased for all promotional activities and most hormone therapies. Overall, the greatest declines were for samples (36% decrease as of quarter 1 of 2003) and direct to consumer advertising (100% decrease). The greatest declines in promotion occurred for standard dose Prempro (61% decrease as of quarter 1 of 2003), the agent implicated by the WHI E+ P report. More recently, promotional efforts have increased, particularly for lower dose Prempro, a resurgence associated with modestly increased prescriptions for this newer agent. Conclusions: Concordant with its widespread use, hormone therapy was among the most heavily promoted medications prior to the WHI E+ P report. Following reporting of the evidence of harm from this trial, there was a substantial decline in promotional spending for hormone therapy, particularly for the agents most directly implicated in the trial. Interrelated with the impact of tine trial results themselves and the ensuing media coverage, reduced promotion may have contributed to a substantial decline in hormone therapy prescriptions.

孕激素刺激试验和性激素水平测定对绝经后妇女子宫内膜病变筛查的意义

目的 探讨孕激素刺激试验和性激素测定对于筛查绝经后妇女子宫内膜病变的意义。方法 对 10 6名绝经后无症状妇女进行E2 、P、FSH、LH、T的测定 ,并行孕激素刺激试验。对孕激素刺激试验阳性或阴性者均给予分段诊刮术 ,以确定子宫内膜的生理或病理状态。同时对 31例绝经后子宫内膜癌患者进行了E2 、P、FSH、LH、T的测定。结果 11例妇女PCT为阳性 ,其中 9例为异常子宫内膜。PCT用于检测子宫内膜疾病的敏感性、特异性、阳性预测值、阴性预测值分别为 81 8%、97 9%、81 8%、97 9%。子宫内膜癌组及PCT阳性组妇女的E2水平高于PCT阴性组。结论 PCT是一种简单、安全、可靠、容易耐受的绝经后无症状妇女子宫内膜癌的筛查方法。

以闭经为首发症状的肝豆状核变性1例

患者，女，18岁，因闭经2年，四肢抽动半天于2014年10月4日入院。患者2年前无明显诱因出现闭经，始未在意。持续半年无月经，于外院查性激素（雌二醇、睾酮、孕酮、催乳素、促性腺激素释放激素、卵泡刺激素、黄体生成素）、肝肾功能、血糖、血脂、甲状腺功能及凝血功能均未见异常；行垂体兴奋试验及雌、孕激素试验均正常；查消化系、泌尿系、生殖系统B超、头颅CT及MR均正常。2年来就诊多家医院，诊断为“继发性闭经”，原因不明。

垂体生长激素瘤致继发性闭经一例

患者27岁，孕0产0，因月经周期延长3年，停经6个月余于2017年1月就诊于中山大学孙逸仙纪念医院。患者既往月经规律，2013年年末出现月经周期延长，5a／（3～4）个月，2015年年初才在外院就诊，妊娠试验阴性（-），妇科B超检查未见明显异常，孕激素试验有出血，撤退性出血第3天血催乳素1．656nmol／L（即36．39ng／m[），FSH4．0lU／L，LH1．82U／L，雌二醇56．0pmol／L，考虑为高催乳素血症。2015年9月起外院予醋酸环丙孕酮．乙炔雌二醇片（其他名称：

绝经后无症状子宫内膜增厚妇女256例临床分析

目的:探讨绝经后无症状子宫内膜增厚的临床处理。方法:对256例绝经后无症状、经阴道超声检查子宫内膜厚度≥5 mm妇女行孕激素试验(PCT)、宫腔镜检查或治疗、诊断性刮宫及病理检查。结果:171例妇女PCT阳性,活性内膜167例(97.66%),其中单纯性增生9例,复杂性增生5例,不典型性增生3例,子宫内膜癌1例,4者占总数的6.64%;85例PCT阴性,活性内膜19例(22.35%),无1例子宫内膜增殖症或子宫内膜癌,两组比较差异有统计学意义(P<0.05)。结论:绝经后无症状子宫内膜增厚妇女应行PCT检查,PCT阴性者可免于行诊断性刮宫,但应密切随访。

脑子出毛病也能导致不孕

小林白白胖胖,一副杨贵妃的富态像。本来属于晚婚的她,很想尽早生儿育女,以满足长辈的厚爱。可“胎”不作美,两年下来子宫还是“空关房”。为此夫妻俩真可谓费尽心血,最后得到大夫的答复竟是“肥胖性生殖无能综合征”。 对于这一名称,夫妻二人从未听说过。最难过的还是小林,什么生殖无能,从不服输的她怎么也不愿接受这个现实。她四处找专家请教,天天翻经典医书,终于明白了其中的奧秘。