经皮用雌二醇凝胶预防绝经早期骨丢失的三年探索性观察  

Observation of preventing of bone loss during early postmenopause by percutaneous estradiol in Chinese postmenopausal women

作　　者：孙爱军[1] 林守清[1] 魏扬[2] 余卫[3] 秦明伟[3] 陈风领[1] 张颍[1] 

机构地区：[1]中国医学科学院北京协和医院妇产科,100730 [2]北京铁路总医院妇产科 [3]中国医学科学院北京协和医院放射科

出　　处：《中华妇产科杂志》2001年第6期348-351,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　探索经皮用雌二醇 (E2 )凝胶在中国妇女中预防绝经早期骨丢失的用法。方法将 6 0例身体健康、绝经 1～ 5年的妇女 ,开放随机分为 4组 ,每组 15例 ,采用周期联合方法分别予含0 75或 1 5mgE2 的经皮 17β E2 凝胶 (E2 凝胶 )与 10 0mg微粉化天然黄体酮 (MP)或 2mg醋甲羟孕酮(MPA)口服 ,每日睡前应用 ,每月连用 2 5d ,停药 5d。用单光子吸收法测前臂皮质骨骨密度 ;定量CT法测腰椎松质骨骨密度 ;双能X线吸收法测腰椎与髋部骨密度。在治疗 0、6、12、18、2 4与 36个月时分别测量骨密度、骨代谢生化指标 ,行绝经症状评分。结果　 5 9例 (98% )完成 1年 ;5 6例 (93% )完成 2年 ,5 1例 (85 % )完成 3年。治疗 6个月时 ,4个组症状缓解率平均约 80 % ;2年时腰椎松质骨骨密度升高平均为 4 3 %～ 7 5 % ;3年时第 2～ 4腰椎骨密度升高 4 2 %～ 6 2 % ;股骨颈骨密度升高 1 6 %～3 8%。与治疗前相比 ,差异均有显著性 (P <0 0 5 ) ;4组间比较 ,骨密度的改善差异无显著性 (P>0 0 5 )。阴道出血率 1 5mgE2 凝胶 +2mgMPA治疗者、0 75mgE2 凝胶 +2mgMPA治疗者较高 ,其他两组较低。结论　每日 0 75mg与 1 5mgE2 凝胶可有效缓解绝经相关症状 ,预防绝经早期骨丢失。雌孕激素补充治疗 3年 ,可连续增加腰椎骨密度 。Objective To investigate the optimal regimen for application of percutaneous estradiol gel in preventing bone loss in Chinese postmenopausal women. Methods A 3 year 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 (naturally menopause for l to 5 years) were recruited and divided into four groups according to estrogen dosage and two kinds of progestin. All were given for 25 d/month. The cortical bone mineral density (BMD) of right radius was measured by single photon absorptiometry. The trabecular BMD in lumbar vertebrae was meaured by quantitative CT. The spine and hip BMD were also measured by dual energy X ray absorptiometry at baseline, 6, 12, 18, 24 and 36 months, respectively. The bone metabolic markers, scores of menopausal symptoms were also evaluated. Results Fifty nine patients (98%) completed 1 year and 56 patients (93%) 2 years, 51 (85%) 3 years of study. The symptoms were alleviated by 80% after 6 months treatment on average. By the end of 24 month, the mean increases of BMD ranged from 4 3% to 7 5% in trabecular bone, and by the end of 36 month 4 2% to 6 2% in the lumbar (L) 2～4, 1 6% to 3 8% in the femur neck, with significant differences ( P <0 05). Comparing the 4 groups with each other, no significant differences ( P >0 05) were found in improvement of symptoms, bone markers and BMD. Conclusions Both daily estrogel containing 0 75 mg and 1 5 mg E 2 are effective to prevent the early postmenopausal bone loss and improve the menopausal symptoms. During 3 years treatment, the BMD of lumbar increased continously and the BMD of hip increased in the first 2 years and then plateau.

关 键 词：雌二醇 凝胶类 骨密度 骨质疏松 孕酮 甲羟孕酮 绝经 

分 类 号：R458.7[医药卫生—治疗学]