低剂量结合雌激素与标准剂量CEE联合天然黄体酮或地屈孕酮对围绝经期综合征患者骨密度的影响研究
Effects of low-dosage and standard-dosage conjugated equine estrogens plus natural progesterone or dydrogesterone on bone mineral density in perimenopausal syndrome patients
  
DOI:10.3969/j.issn.1006-7108.2020.02.009
中文关键词:  低剂量  标准剂量  雌激素  天然黄体酮  地屈孕酮  围绝经期综合征  骨密度
英文关键词:low-dosage  standard-dosage  conjugated equine estrogens  natural progesterone  dydrogesterone  perimenopausal syndrome  bone mineral density
基金项目:湖北优秀医学学术带头人计划和湖北省卫生计生科研项目(WJ2015MA024);湖北省自然科学基金项目(2017CFB335);2017年湖北省卫生计生委重点支撑项目(WJ2017Z002 )
作者单位
张慧君1 沈志娟1 覃小敏1 李琳1 周敏1 徐敏2 何敏2 张伟3 王丽3 郭红1* 张燕4 1. 湖北文理学院附属医院/襄阳市中心医院妇产科湖北 襄阳 441053 2. 湖北文理学院附属医院/襄阳市中心医院手术室湖北 襄阳 441053 3. 湖北文理学院附属医院/襄阳市中心医院超声科湖北 襄阳 441053 4.武汉大学人民医院妇产科湖北 武汉 430000 
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中文摘要:
      目的 探讨低剂量雌激素与标准剂量雌激素联合天然黄体酮或地屈孕酮对围绝经期综合征患者骨密度的影响。方法 选取2015年1月至2017年1月间我院收治的围绝经期综合征患者83例,按照随机数字表法将其分为Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组,Ⅰ组28例采用低剂量雌激素联合天然黄体酮治疗,Ⅱ组27例采用低剂量雌激素联合地屈孕酮治疗,Ⅲ组26例采用标准剂量雌激素联合天然黄体酮治疗,Ⅳ组26例采用标准剂量雌激素联合地屈孕酮治疗,对比各组治疗前后体内相关激素水平、更年期 Kupperman评分结果、不良反应等。结果 治疗前四组临床症状及促卵泡素(FSH)、黄体生成素(LH)、雌二醇(E2)等各项指标对比差异无统计学意义(P>0.05);治疗1个周期及3个周期后,各组Greene评分均有所降低,且各组FSH、E2、LH较治疗前有不同程度的好转,其中Ⅰ组和Ⅲ组FSH高于其他组别,E2、LH水平明显低于其他组,差异有统计学意义(P<0.05),治疗前各组L1~4骨密度、股骨颈骨密度差异对比无统计学意义(P>0.05);治疗后各组L1~4骨密度、股骨颈骨密度均有所提升,但相比之下,Ⅰ组和Ⅲ组的L1~4骨密度、股骨颈骨密度好转情况更加显著,差异有统计学意义(P<0.05)。结论 采用低剂量雌激素联合天然黄体酮既能满足患者症状缓解的需求,同时也有助于体内激素水平的改善,且不会对骨密度造成负面影响,建议采纳。
英文摘要:
      Objective To study the effects of low-dosage and standard-dosage CEE (Conjugated Equine Estrogens) plus natural progesterone or dydrogesterone on bone mineral density (BMD) in perimenopausal syndrome patients. Methods 83 perimenopausal syndrome patients treated from January 2015 to June 2017 in our hospital were selected and randomly assigned to group I (n=28), group II (n=27), group III (n=26) and group IV (n=26). Patients took low-dosage ECC plus natural progesterone, low-dosage ECC plus dydrogesterone, standard-dosage ECC plus natural progesterone or standard-dosage ECC plus dydrogesterone, respectively. Comparisons between groups were made for hormone levels before and after treatment, Kupperman scores at menopausal period and adverse reactions. Results Before treatment, the clinical symptom scores and the related index including FSH (follicle-stimulating hormone), E2 (estradiol) and LH (luteinizing hormone) for each group were not significantly different (P>0.05). After one to three treatment courses, the Greene scores for each group were reduced, with statistically significant differences among groups (P<0.05); the values of FSH, E2 and LH for each group were improved, but the FSH values in group I and group III were higher than the other groups and the values of E2 and LH were lower (P<0.05). Before treatment, the BMD of L1~4 and femoral neck for each group was not significantly different (P>0.05). After treatment, the BMD of L1~4 and femoral neck for each group was improved, especially in group I and group III (P<0.05). Conclusion The standard-dosage CEE plus natural progesterone could remarkably relieve the clinical symptoms. However, the low-dosage CEE plus natural progesterone could not only relieve the clinical symptoms, but also improve the hormone levels and produce no negative effect on BMD. The proper dosage of CEE should be taken according to the patient’s actual conditions.
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