绝经早期妇女不同药物治疗的疗效分析  

Analysis of the effects on menopausal symptoms, quality of Life, and cardiovascular risk factors of five different therapy in women at early stage of menopause

作　　者：薛薇[1] 孙爱军[1] 郑婷萍[1] 蒋建发[1] 王亚萍[3] 张颖[2] 陈凤领[2] 邓燕[1] 王艳芳[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,100730 [2]首都医科大学附属北京朝阳医院妇产科 [3]中国医学科学院北京协和医学院北京协和医院检验科,100730

出　　处：《中华医学杂志》2016年第29期2327-2331,共5页National Medical Journal of China

基　　金：“十一五”国家科技支撑计划课题（2008BA1578004）

摘　　要：目的 探讨绝经早期不同药物治疗对妇女绝经症状、生活质量及心血管危险因素的影响.方法 为随机、开放、前瞻性临床研究.选择2008年12月至2012年6月在北京协和医院妇科门诊就诊的符合纳入排除标准的绝经早期妇女,共143例.将143例妇女随机分为5组：结合雌激素（CEE）＋醋酸甲羟孕酮片（MPA）组30例,戊酸雌二醇（E2V）＋MPA组27例,E2V＋黄体酮胶丸（P）组29例,坤泰胶囊组30例,升麻提取物希明婷组27例.激素治疗组服用12个周期,坤泰胶囊组及升麻提取物组服用12个月.分别于治疗前,治疗3、6、9及12个月评估入组患者的绝经症状（KMI）及绝经期生活质量（MENQOL）,治疗前与治疗12个月评估患者心血管危险因素相关的血清学指标：血清总胆固醇（TC）、总甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、空腹血糖（FBG）及空腹胰岛素（FI）.结果 （1）KMI：治疗后各个药物组的差异有统计学意义（P＜0.01）,CEE＋ MPA组最低（13±1）,治疗后各测量时间点均比治疗前低（P＜0.01）.（2） MENQOL：治疗后各个药物组的差异有统计学意义（P＜0.01）,CEE＋ MPA组最低（84 ±3）,其次为坤泰组（85±3）,治疗后各测量时间点均比治疗前低（P＜0.01）.（3）心血管危险因素指标变化：CEE＋ MPA组FBG用药后比用药前降低（P ＜0.05）;E2V＋ MPA组TC、LDL、FI用药后比用药前降低（P ＜0.05）;E2V＋P组FBG与FI用药后比用药前降低（P＜0.05）.结论 激素补充治疗与植物药、中成药均可有效改善绝经症状,提高患者的生活质量,并在一定程度预防心血管危险因素,均可为绝经早期,深受绝经症状困扰患者有效的治疗方法.Objective To explore the effects of five different therapy in women at early stage of menopause on menopausal symptoms,quality of Life and cardiovascular risk factors.Methods A total of 140 women at early stage of menopause were randomly divided into five groups.Thirty women took Conjugated estrogen and medroxyprogesterone acetate （CEE ＋ MPA） sequential therapy,27 women took estradiol valerate and medroxyprogesterone acetate （E2 V ＋ MPA） sequential therapy,26 women took estradiol valerate and Progesterone Soft Capsules（E2V ＋ P） sequential therapy,30 women took Kuntai capsule,and 27 took Cohosh extract.Patients in the Menopausal Hormone Therapy （MHT） groups took twelve cycles of treatment course,in the botanical drug and Chinese patent drug groups took twelve months.The KMI scalewas used to measure the level of menopausal symptoms.MENQOL scale was used to measure the health-related quality of life before and at the 3rd month,6th month,9rd month and 12th month after the treatment.Some serological indicators which related to cardiovascular risk factors were collected before and at the 12th month after the treatment.Results （1） KMI：It showed that the KMI in five groups after the treatment were significantly different（P 〈 0.01）,the group of CEE ＋ MPA decreased most（13 ± 1）.The KMI after the treatment were all significantly lower than that before.（2） MENQOL：It showed that the MENQOL in five groups were significantly different （P 〈 0.01）,the group of CEE ＋ MPA decreased most （84 ± 3）,then the group of Kuntai （85 ± 3）.The MENQOL after the treatment were all significantly lower than that before.（3） The change of cardiovascular risk factors：it showed that the serological indicators FBGin group of CEE ＋ MPA after the treatment were significantly lower than that before（P 〈 0.05）;the TC,LDL,FI in group of E2V ＋ MPA after the treatment were significantly lower than that before（P 〈0.05）;the FBG,FI in group of E2V ＋ P after the treatment wer

关 键 词：绝经期 绝经期激素治疗 生活质量 心血管疾病 危险因素 

分 类 号：R711.75[医药卫生—妇产科学]