低剂量激素补充治疗对年轻宫颈鳞癌患者绝经相关症状的干预效果评价  

Effect evaluation of the low-dose hormone replacement therapy on menopausal-related symptoms of young patients with cervical squamous cell carcinoma

作　　者：吴婉莉[1] 李春明 应倩 马麟娟[2] 周坚红[2] 于爱军[1] WU Wan-li;LI Chun-ming;YING Qian;MA Lin-juan;ZHOU Jian-hong;YU Ai-jun(Department of Gynecology,Zhejiang Cancer Hospital,Hangzhou,Zhejiang 310022,China)

机构地区：[1]浙江省肿瘤医院妇科,浙江杭州310022 [2]浙江大学医学院附属妇产科医院妇科 [3]肿瘤学杂志社

出　　处：《预防医学》2019年第10期1007-1011,1016,共6页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：浙江省医药卫生重大科技计划项目(WKJ-ZJ-1621);浙江省医药卫生重大科技计划项目(JBZX-201803);浙江省医药卫生一般研究计划(2016KYA049)

摘　　要：目的评价低剂量激素补充治疗(HRT)对年轻宫颈鳞癌患者绝经相关症状的干预效果。方法选取2016年3月—2018年9月在浙江省肿瘤医院和浙江大学医学院附属妇产科医院确诊为医源性绝经,年龄<45岁的Ⅰ、Ⅱ期宫颈鳞癌患者80例,随机纳入低剂量治疗组(戊酸雌二醇1 mg/d或替勃龙1.25 mg/d)40例,标准剂量治疗组(戊酸雌二醇1 mg/d+替勃龙1.25 mg/d)20例,空白对照组(未行HRT)20例,比较3组患者干预前和干预后1、3、6个月的雌二醇(E2)、促卵泡生成激素(FSH)水平、绝经相关症状(改良Kupperman量表评分)和不良反应发生率。结果3组患者E2、FSH和改良Kupperman评分差异均有统计学意义(P<0.05);随治疗干预时间增加,低剂量治疗组和标准剂量治疗组的E2水平均先上升后下降,FSH水平和改良Kupperman评分均下降(P<0.05);与空白对照组相比,标准剂量治疗组E2、FSH和改良Kupperman评分变化幅度均更明显,低剂量治疗组E2、FSH水平变化幅度均小于标准剂量治疗组(P<0.05),而改良Kupperman评分下降幅度与标准剂量治疗组接近。低剂量治疗组的不良反应发生率为2.50%,低于标准剂量治疗组的20.00%(P<0.05)。结论对于年轻宫颈鳞癌患者,低剂量较标准剂量HRT对E2、FSH水平的影响要小,但对绝经相关症状的治疗效果接近。Objective To evaluate the effect of low-dose hormone replacement therapy(HRT)on menopausal-related symptoms in young patients with cervical squamous cell carcinoma.Methods From March 2016 to September 2018,eighty patients aged 45 years below with cervical squamous cell carcinoma of stageⅠ-Ⅱand iatrogenic menopause were recruited,who were diagnosed at Zhejiang Cancer Hospital and Women's Hospital Affiliated to Medical College of Zhejiang University.Fourty of them performed low dose HRT(1 mg estradiol valerate a day or 1.25 mg tibolone a day),twenty performed standard dose HRT(1 mg estradiol valerate and 1.25 mg tibolone a day),another twenty do not perform HRT as a control group.The levels of follicle stimulating hormone(FSH),estradiol(E2),menopausal symptoms(the improved Kupperman score)and incidence of side effects were assessed before and 1,3,6 months after the intervention.Results There were significant differences in E2 levels,FSH levels and improved Kupperman scores among the low dose group,the standard dose group and the control group(all P<0.05).With the extension of intervention time,E2 levels in the low dose group and the standard dose group increased first and then decreased,FSH levels and improved Kupperman scores decreased(all P<0.05).Compared with the control group,E2 levels,FSH levels and improved Kupperman scores in the standard dose group changed more significantly(all P<0.05).E2 and FSH levels in the low dose group changed less than that in the standard dose group(all P<0.05),while improved Kupperman scores was close to that in the standard dose group.The incidence rate of side effects in the low dose group was 2.50%,which was lower than 20.00%in the standard dose group(P<0.05).Conclusion For young patients with cervical squamous cell carcinoma,using low dose HRT may less affects E2 and FSH levels than using the standard dose,but could achieve similar effects in treatment of menopausal-related symptoms.

关 键 词：激素补充治疗 宫颈鳞癌 绝经 干预效果 低剂量 

分 类 号：R271.116[医药卫生—中医妇科学]