更年期激素治疗规范管理的有效性及安全性评价  

Efficacy and safety evaluation of standardized management of hormone therapy in menopausal women

作　　者：张俊丽[1] 阮祥燕[1] 刘玉兰[1] 甄洁[1] 殷冬梅[1] 王娟[1] 柳顺玉[1] 

机构地区：[1]首都医科大学附属北京妇产医院内分泌科,北京100026

出　　处：《首都医科大学学报》2013年第4期512-518,共7页Journal of Capital Medical University

基　　金：北京市自然科学基金(3082011);首都医学发展基金重点支持项目(2007-2045);北京市卫生系统高层次卫生技术人才培养计划项目(2009-3-52)~~

摘　　要：目的观察更年期女性激素治疗规范化管理的有效性、安全性,为临床规范化激素治疗提供理论依据。方法前瞻性研究分析2005年至2013年在首都医科大学附属北京妇产医院门诊就诊的更年期妇女,按患者意愿分为激素治疗组及对照组,随访时间5年,最后符合条件的激素治疗组20例,对照组16例。激素治疗组给予健康指导加个体化激素治疗,对照组给予健康指导。分析2组患者Kupperman评分、体质量指数(body mass index,BMI)、每公斤体质量静息能量消耗(resting energy expenditure,REE/kg)、全身脂肪含量(body fat percent,BF%)、血脂、肝功能、肾功能、乳腺腺体等随观察时间的变化,评估激素治疗的有效性及安全性。结果①激素治疗组Kupperman评分呈降低趋势(P>0.05)。②激素治疗组及对照组BMI治疗期间差异无统计学意义(P>0.05);对照组BF%在观察第2年明显升高(P<0.05),而激素治疗组BF%在治疗第4年比第3年减少(P<0.05);对照组REE/kg在第2年明显降低(P<0.05),而激素治疗组REE/kg呈升高趋势(P>0.05)。③对照组总胆固醇(TC)、三酰甘油(TG)呈升高趋势,低密度脂蛋白胆固醇(LDL-C)第5年与第4年相比明显升高(P<0.05),而激素治疗组TC、TG及LDL呈降低趋势,但差异无统计学意义(P>0.05),高密度脂蛋白胆固醇(HDL-C)治疗期间差异无统计学意义。④激素治疗组肝肾功能在治疗期间变化差异无统计学意义。激素治疗起始与治疗第5年相比,乳腺腺体变化差异无统计学意义(P>0.05)。结论激素补充治疗可有效缓解更年期症状;可在一定程度上缓解绝经女性血脂的异常改变,同时可通过增加静息能量消耗,缓解更年期妇女全身脂肪含量逐年增加的趋势,进而缓解绝经后腹型肥胖的进展,在一定程度上可降低心血管疾病风险;规范化、个体化激素治疗乳腺癌风险小。Objective To evaluate efficacy and safety of standardized management of hormone therapy in menopausal women. Methods The menopausal women visited the endocrine clinic of Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University after 2003 were divided into two group, hormone therapy and control group. There were 55 cases in hormone therapy group, and 34 cases in control group. We analyzed the variation of Kupperman sore, serum lipoprotein, resting energy expenditure, body fat, liver and renal function and mammary glands in the hormone therapy, so that assess the effectiveness and safety of hormone replacement therapy. Results ① The Kupperman scores tended to decrease. ② BMI did not change significantly in HT group and control group（ P〉0.05 ） ; BF% in the control group was significantly higher in the second year than the first year （P〈0.05）, while, compared with the first three years, the hormone therapy group BF% in the fourth year of treatment decreased significantly （P〈0. 05 ）. Compared with the first year, REE/kg was reduced gradually in the second year in control group, however, REE/kg increased in HT group. ③ TC in control group increased gradually; LDL increased significantly in the second year（P〈0.05 ）. However, TC, TG and LDL-C were became lower gradually in HT group. @ Liver and renal function was not significantly different during HT. The glands group of mammary gland between the first year and 5th year was not significantly different. Conclusion Hormone replacement therapy can relieve menopause-related symptoms; hormone therapy may alleviate abnormal blood lipids change in menopausal women; at the same time, it increases REE, eases the trend of BF%increase in menopausal women, so alleviates the progress of abdominal obesity after menopause, and to certain extent, it can reduce the risk of cardiovascular disease. During the standardized and individualized hormone therapy, the breast cancer risk is small.

关 键 词：更年期 激素治疗 有效性 安全性 

分 类 号：R749.42[医药卫生—神经病学与精神病学]