不同年龄段的早发性卵巢功能不全患者进行激素替代治疗对骨密度疗效的比较  

Comparison of the effect of hormone replacement therapy on bone mineral density in patients with premature ovarian insufficiency at different ages

作　　者：续晓蓓 郭雪桃[2] 王叶叶 解富 Xu Xiaobei;Guo Xuetao;Wang Yeye;Xie Fu(The First Clinical Medical College,Shanxi Medical University,Taiyuan 030012,China;Department of Gynecology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一临床医学院,山西太原030012 [2]山西医科大学第一医院妇科,山西太原030001

出　　处：《实用药物与临床》2023年第10期888-892,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的 比较不同年龄段早发性卵巢功能不全(POI)患者接受1年激素替代治疗(HRT)对骨密度(BMD)的影响。方法 回顾性总结2009年10月至2020年9月山西医科大学第一医院妇科内分泌门诊确诊为POI的患者,病历完整且接受HRT治疗1年以上患者98例。按骨量积累的不同阶段进行分组:≤20岁组32例,21~30岁组33例,31~40岁组33例。治疗方案为雌孕激素序贯治疗,包括周期序贯[戊酸雌二醇片/戊酸雌二醇醋酸环丙孕酮片复合包装(2 mg/1 mg)、戊酸雌二醇加黄体酮(2 mg/100 mg)、结合雌激素加黄体酮(0.625 mg/100 mg)]和连续序贯[雌二醇片/雌二醇地屈孕酮片复合包装(1 mg/10 mg或2 mg/10 mg)],观察治疗前后左侧股骨颈、髋骨、腰L1及总腰椎骨密度及Z值,分析并比较各年龄段患者治疗前后骨密度的变化。结果 三组患者治疗前后比较:(1)≤20岁组和21~30岁组:治疗后左侧股骨颈、髋骨、腰L1及总腰椎的骨密度及Z值与治疗前相比均显著增加,差异有统计学意义(P<0.05)。(2)31~40岁组患者腰L1及总腰椎治疗后的骨密度及Z值与治疗前相比均显著增加,差异有统计学意义(P<0.05);而左股骨颈、髋骨与治疗前相比,仅Z值增加,差异有统计学意义(t=2.574,P=0.015;t=2.355,P=0.025),骨密度与治疗前相比,增幅较小,差异无统计学意义(t=1.797,P=0.082;t=1.955,P=0.059)。各年龄组患者各部位骨密度及Z值治疗前后差值的组间比较:(1)骨密度:3个年龄组左侧股骨颈、髋骨、腰L1、总腰椎治疗后骨密度的增幅不同,差异有统计学意义(P<0.05)。(2)Z值:3个年龄组左侧股骨颈、腰L1、总腰椎治疗后Z值的增幅不同,差异有统计学意义(F=6.426,P=0.002;F=13.082,P<0.001;F=12.913,P<0.001);仅左侧髋骨三组间治疗后Z值增幅差异较小,差异无统计学意义(F=2.676,P=0.074)。治疗前后骨量异常率[Z≤-2.0(低骨量)]比较:(1)≤20岁组:左髋、总腰椎治疗前后比较,差异有统计学意义(P<0.05);(2)21~30岁Objective To compare the effect of one-year hormone replacement therapy(HRT)on bone mineral density in patients with premature ovarian insufficiency(POI)in different age groups.Methods From October 2009 to September 2020,98 patients diagnosed with POI in the Department of Gynecology and Endocrinology of the First Hospital of Shanxi Medical University who had received hormone replacement therapy for more than 1 year with complete medical records were retrospectively summarized.According to the different stages of bone mass accumulation,the patients were divided into three groups:≤20 years old group(n=32),21~30 years old group(n=33)and 31~40 years old group(n=33).The treatment regimen was sequential treatment with estrogen and progestin,including cycle continuing[estradiol valerate plus cyproterone acetate(2 mg/1 mg),estradiol valerate plus progesterone(2 mg/100 mg),conjugated estrogen plus progesterone(0.625 mg/100 mg)]and sequential cycle[estradiol plus dydrogesterone(1 mg/10 mg or 2 mg/10 mg)].The bone mineral density(BMD)and Z score of left femoral neck,hip,the first lumbar vertebra(L1)and total lumbar spine were observed before and after treatment,and the changes of BMD in patients of different ages before and after treatment were analyzed and compared.Results Comparison of the three groups before and after treatment:①In≤20 years old and 21~30 years old group,the bone mineral density and Z score of left femoral neck,hip,the first lumbar vertebra(L1)and total lumbar spine after treatment were significantly higher than those before treatment,and the differences were statistically significant(P<0.05).②In the 31~40 years old group,the BMD and Z score of the first lumbar vertebra(L1)and total lumbar spine after treatment were significantly higher than those before treatment,and the differences were statistically significant(P<0.05).After treatment,only Z score of left femoral neck and hip increased,and the difference was statistically significant(t=2.574,P=0.015;t=2.355,P=0.025),while the increase in BMD wa

关 键 词：早发性卵巢功能不全 激素替代治疗 骨密度 峰值骨量 

分 类 号：R711.75[医药卫生—妇产科学]