绝经后妇女长期低剂量激素替代疗法的研究——Ⅲ.脑实质高信号磁共振成像分析  

Study of long-term low dose sex-hormone replacement therapy in postmenopausal women:Ⅲ. Analysis of MRI high-signal abnormalities of brain tissue

作　　者：胡凌[1] 左萍萍[2] 岳赟[2] 刘雁勇[2] 杨楠[2] 金征宇[1] 洪霞[1] 葛秦生[1] 

机构地区：[1]北京协和医学院,北京协和医院 [2]中国医学科学院基础医学研究所,北京协和医学院药理室

出　　处：《生殖医学杂志》2009年第1期1-5,共5页Journal of Reproductive Medicine

基　　金：科技部1999年度攀登-特别支持费资助项目(国科基字[1999]045)

摘　　要：目的应用3. 0磁共振对长期低剂量激素替代疗法(HRT)的绝经后妇女的脑实质变化进行初步研究。方法经筛选北京协和医院155名绝经后健康妇女纳入本研究,其中71例采用低剂量HRT且使用时间超过4年,为HRT组。对照组84例为未经HRT的志愿者。用简易智力状态检查量表(MMSE)检测精神状态。用酶联免疫反应测试仪测定血浆性激素水平。所有研究对象进行磁共振平扫、包括轴位自旋-自旋时间加权象(T2WI),对应层面轴位液体衰减反转恢复(FLAIR)序列,自旋点阵弛缓时间加权象(T1WI),斜冠状与海马体部垂直层面(3mm无间隔)及覆盖全脑的3D图像。结果 HRT各年龄段血浆雌二醇(E_2)水平均高于对照组(P<0. 05) ; MMSE两组未见明显差异;脑深部白质高信号(DWMH)在70岁以上者对照组明显高于HRT组(P=0. 015),其他年龄组无显著差异。脑室周围高信号(PVH)两组间无明显差异。结论长期低剂量HRT者血中高水平雌激素可保护高龄绝经后妇女脑组织,延缓其脑深部白质随增龄导致的损害。Objective： To investigate the effect of long-term low dose sex-hormone replacement therapy on the brain texture changes. Methods： A total of 155 menopausal women from Peking Union Medical College Hospital were enrolled in the study. 71 women who had used a low dose of HRT for over 4 years were selected as HRT group and 84 without HRT were as the control group. Neuropsychological state was evaluated with mini mental state examination （MMSE） and plasma levels of sex hormones were measured with ELISA. MRI was applied to all the subjects. The scanning protocol include axial T2 weighed image （T2WI）, matched FLAIR image and T1 weighted image （oblique coronal, vertical to the hippocampus） and whole brain 3D image. Results： Compared with those in control group, the plasma E2 concentrations in HRT women at all age stages were obviously higher （P〈0.05）. There was no significant difference in MMSE score between HRT and control group. In the deep white matter hyperintensities （DWMH） analysis, T2WI score in HRT women aged over 70 years was significantly higher than that of the matched subgroup in control group （P=0. 015）. There was no significant difference in PVH score between HRT and control group. Conclusion： These findings suggests that the maintained elevated estrogen levels in long-term low dose HRT subject could help preserve normal brain structure and postpone the changes in deep white matter of normal elderly women.

关 键 词：绝经后妇女 长期低剂量激素替代疗法 雌激素 磁共振成像 脑深部白质高信号 

分 类 号：R14[医药卫生—公共卫生与预防医学] R681