本文關(guān)鍵詞： 圍絕經(jīng)期綜合征 絕經(jīng)激素治療 低劑量雌激素 天然孕酮 地屈孕酮　出處：《實(shí)用婦產(chǎn)科雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的:研究低劑量結(jié)合雌激素(CEE)與標(biāo)準(zhǔn)劑量CEE聯(lián)合天然孕酮或地屈孕酮治療圍絕經(jīng)期綜合征的療效比較。方法:本試驗(yàn)為單中心、前瞻性隨機(jī)對(duì)照試驗(yàn),2014年2月至2015年12月招募絕經(jīng)早期有子宮、有絕經(jīng)相關(guān)癥狀的婦女(共107例完成試驗(yàn)),隨機(jī)分為3組:A組35例(低劑量CEE+天然孕酮)、B組37例(標(biāo)準(zhǔn)劑量CEE+天然孕酮)、C組35例(標(biāo)準(zhǔn)劑量CEE+地屈孕酮),采用連續(xù)序貫方案治療12個(gè)周期,在第3、6、9、12周期結(jié)束后記錄改良Kupperman評(píng)分,計(jì)算有效率,用藥前與用藥后抽血測(cè)定卵泡刺激素(FSH)、雌二醇(E2)。結(jié)果:在治療3個(gè)周期后,改良Kupperman評(píng)分值均顯著性下降(P均0.01),3組間的完全緩解率、顯效率差異均無(wú)統(tǒng)計(jì)學(xué)意義,但B組有效率(89.2%)顯著高于A組(60%,P=0.024)和C組(61.9%,P=0.035)。治療結(jié)束后,3組的完全緩解率、顯效率、有效率差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療結(jié)束后與治療前比,3組的FSH值均有顯著性降低(P0.001),E2值均顯著性升高(P0.001)。治療結(jié)束后,3組FSH值比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.26);E2值A(chǔ)組顯著低于B組(P=0.002)及C組(P=0.004),B組與C組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.832)。不良反應(yīng)主要為陰道不規(guī)則流血和乳房脹痛,A、B、C組陰道不規(guī)則流血的發(fā)生率分別為20.91%、39.51%、19.99%,B組顯著高于A與C組(PAB=0.034,PBC=0.015),A組與C組比較差異無(wú)統(tǒng)計(jì)學(xué)意義;乳房脹痛的發(fā)生率A、B、C組分別為30.22%、37.46%、68.06%,A、B兩組差異無(wú)統(tǒng)計(jì)學(xué)意義,C組顯著高于A、B組(PAC=0.008,PBC=0.002)。結(jié)論:低劑量雌激素補(bǔ)充已可滿足大部分患者緩解圍絕經(jīng)期綜合征的需求,加用天然孕酮比加用地屈孕酮對(duì)圍絕經(jīng)期癥狀的緩解作用更顯著。
[Abstract]:Objective: to compare the efficacy of low dose combined estrogen (CEE) with standard dose CEE combined with natural progesterone or diproprogesterone in the treatment of peri-menopausal syndrome. Prospective randomized controlled trials were conducted in women with early menopause and menopausal symptoms from February 2014 to December 2015 (107 women completed the trial). They were randomly divided into 3 groups: group A (n = 35) (group B) (n = 37), group B (n = 37), group B (n = 37), group C (n = 35), group C (n = 35) (standard dose CEE). After 12 cycles of continuous sequential therapy, the modified Kupperman score was recorded at the end of the 12th cycle, and the effective rate was calculated. The follicle stimulating hormone (FSH) and estradiol (E 2) were measured before and after treatment. Results: after 3 cycles of treatment. The improved Kupperman scores were significantly decreased (P < 0.01). There was no significant difference in the effective rate among the three groups. But the effective rate of group B was significantly higher than that of group A (P 0.024) and group C (61.9%). There was no significant difference in the effective rate (P 0.05). The FSH values of the three groups after treatment and before treatment were significantly lower than those before treatment (P 0.001). The level of E _ 2 was significantly higher than that of control group (P 0.001). There was no significant difference in FSH value among the three groups after treatment (P = 0.26). The E 2 value of group A was significantly lower than that of group B (P 0.002) and group C (P 0.004). There was no significant difference between group B and group C (P < 0. 832). The main adverse reactions were irregular vaginal bleeding and breast distending pain. The incidences of irregular vaginal bleeding in group C were 20.91 and 19.99, respectively, which were significantly higher than those in group A and C (P < 0.05). There was no significant difference between group A and group C; The incidence of breast distending pain in group A was 30.22 鹵37.46. There was no significant difference between group A and group A, and there was no significant difference between group C and group A. Conclusion: low dose estrogen supplementation can meet the needs of most patients with perimenopausal syndrome. The effect of natural progesterone on the remission of peri-menopausal symptoms was more significant than that of tertroprogesterone.
【作者單位】： 北京協(xié)和醫(yī)院;
【分類號(hào)】：R711.75
【正文快照】： 圍絕經(jīng)期婦女是社會(huì)中的重要人群。卵巢功能衰退所致的內(nèi)分泌失衡和雌激素缺乏可以帶來(lái)一系列與絕經(jīng)相關(guān)的問(wèn)題或疾病,包括:圍絕經(jīng)期綜合征、泌尿生殖道萎縮、絕經(jīng)后骨質(zhì)疏松和心血管疾病。絕經(jīng)激素治療(menopausal hormone therapy,MHT)對(duì)緩解絕經(jīng)相關(guān)癥狀,預(yù)防骨質(zhì)疏松,減輕

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