本文選題：更年期 + 激素替代治療　； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：1、探索激素水平與更年期癥狀的相關(guān)性。2、觀察給予外源性激素替代治療后更年期綜合癥婦女的療效療效。3、建立患者體內(nèi)激素測定方法,通過檢測用藥后激素水平的變化,制定最佳給藥方案。4、比較分析服用激素前后體內(nèi)激素水平。方法：根據(jù)文獻(xiàn)確定更年期婦女的平均絕經(jīng)年齡和體內(nèi)雌激素含量的平均水平,收集2013年1月——2014年2月于瀘州醫(yī)學(xué)院附屬醫(yī)院婦產(chǎn)科確診為更年期綜合癥的患者89例,平均年齡49.8歲,平均絕經(jīng)時(shí)間1.8±1.5年,且無HRT使用禁忌癥,同時(shí)測定15例非更年期且正常生育年齡婦女血清測得雌激素水平以作為更年期婦女體內(nèi)雌激素水平降低的對(duì)照,對(duì)納入研究的病例分為三組：A組給予口服雌激素(克齡蒙)治療；B組給予雌激素貼劑(松奇)治療、C組給予外用雌激素(氯喹那多)治療。用藥一個(gè)療程后對(duì)患者復(fù)診,進(jìn)行相關(guān)的婦科常規(guī)檢查,同時(shí)對(duì)每組病人抽血用放射免疫法檢測病人用藥后卵泡刺激素(FSH)、促黃體生成素(LH)、雌二醇(E2)含量,條件適宜的需給病人進(jìn)行B超監(jiān)測觀察其子宮大小、子宮內(nèi)膜厚度；采用改良Kupperman評(píng)分法對(duì)各組病人進(jìn)行用藥前后更年期綜合癥的改善情況的評(píng)價(jià)。使用SPSS13.0版軟件包進(jìn)行數(shù)據(jù)分析,對(duì)資料進(jìn)行正態(tài)性檢驗(yàn),滿足正態(tài)性的采用t檢驗(yàn),各數(shù)據(jù)用x±s表示；不滿足正態(tài)性的采用Mann-Whitney U檢驗(yàn),數(shù)據(jù)中位數(shù)(范圍),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果：1、三組更年期綜合癥的kupperman評(píng)分變化情況：A組患者用藥前kupperman評(píng)分為25.3±4.5,口服克齡蒙一個(gè)療程后評(píng)分為14.2±4.3,與用藥前相比更年期癥狀明顯緩解,差異有統(tǒng)計(jì)學(xué)意義(P0.01)；B組患者用藥前kupperman評(píng)分為25.4±3.3,使用貼劑(松奇)一個(gè)療程后患者的kupperman評(píng)分為12.5±2.3,與用藥前相比更年期癥狀有較好緩解,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；C組患者用藥前kupperman評(píng)分為25.5±2.6,使用氯喹那多-普羅雌烯陰道片一個(gè)療程后患者的kupperman評(píng)分為8.9±2.3,更年期癥狀得到緩解效果良好,差異有統(tǒng)計(jì)學(xué)意義(P0.01)2、三組患者血清中FSH、LH、E2用藥前后的變化：A組口服克齡蒙前FSH、LH、EZ值分別為45.3±3.2、31.4±6.5、42.6±3.6,用藥1個(gè)療程后FSH、LH、E2分別為32.1±5.4、24.6±4.3、191.6±6.7,與用藥前相比E2明顯升高,FSH、LH明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；B組運(yùn)用貼劑前FSH、LH、E2值分別為52.3±4.2、11.4±6.5、20.6±3.6,用藥一個(gè)療程后FSH、LH、E2值分別為34.1±6.3、22.6±7.3、60.6±4.7,與用藥前相比E。明顯升高,FSH、LH明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。C組服用氯喹那多／普羅雌烯陰道片前FSH、LH、E2值分別為44.6±25.7、36.4±17.4、35.7±11.3,用藥一個(gè)療程后FSH、LH、E2的值分別為30.5±15.3、21.3±12.7、143.3±9.4,與用藥前相比E2明顯升高,FSH、LH明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。 3、子宮B超的監(jiān)測：子宮大小用藥前子宮長度(32.1±2.1)mm;服藥后子宮長(29.1±6.4)內(nèi)膜厚度用藥前(2.9±1.4)；用藥后(3.1±1.6),P0.05差異無統(tǒng)計(jì)學(xué)意義。結(jié)論：1、激素替代治療能有效降低血清中FSH、LH水平,提高E2的含量,對(duì)更年期綜合癥有明顯的改善作用,很好地提高更年期婦女的生活質(zhì)量。2、口服制劑改變體內(nèi)激素水平明顯,但其胃腸道反應(yīng)明顯,患者依從性差。3、貼劑、涂劑較口服激素制劑的胃腸道不良反應(yīng)小,不良反應(yīng)頻率發(fā)生率較低,給藥方便可行,依從性好。4、貼劑使用方便但難以控制劑量,且對(duì)皮膚損傷難以避免。5、陰道給藥方式治療陰道干澀等生殖器病變療效較好,而對(duì)于更年期綜合癥中神經(jīng)功能癥及心血管癥狀效果不明顯。6、對(duì)適宜用激素替代療法的病人在進(jìn)行治療時(shí)應(yīng)根據(jù)差異制定個(gè)體治療方案。7、子宮內(nèi)膜厚度在雌孕激素合用時(shí)增加不明顯
[Abstract]:Objective: 1, to explore the correlation between hormone level and menopause symptoms.2, observe the curative effect of menopausal women with exogenous hormone replacement therapy (.3), establish the method of hormone determination in the body of the patients, and establish the best regimen.4 by detecting the changes of hormone level after drug use, and compare and analyze the hormone water in the body before and after taking hormone. Method: to determine the average age of menopause and the average level of estrogen in the menopause women according to the literature, 89 patients who were diagnosed as menopause syndrome in Affiliated Hospital of Luzhou Medical College in January 2013 and February 2014 were collected, the average age was 49.8 years, the average menopause time was 1.8 + 1.5 years, and no contraindications were used in HRT, At the same time, the serum estrogen levels were measured in 15 non climacteric and normal age women as the control of estrogen levels in the menopause women. The cases included in the study were divided into three groups: group A was given oral estrogen (Ke Lingmeng); group B was given estrogen (pine) treatment, and group C was given external use of estrogen (chlorine). After a course of treatment, the patients were revisited, and the related gynecologic routine examination was carried out. At the same time, the levels of FSH, luteinizing hormone (LH) and estradiol (E2) were detected by radioimmunoassay in each group. The size of the uterus and the thickness of endometrium were observed. The improved Kupperman score was used to evaluate the improvement of the climacteric syndrome before and after the use of the drugs. The data were analyzed using the SPSS13.0 software package, the data were tested in normality, the normality was met with t test, the data was expressed in X + s, and the Mann-Whitney U test was not satisfied and the data were not satisfied. The median (range) and P0.05 were statistically significant. Results: 1, the changes in Kupperman score of three groups of climacteric syndrome: the Kupperman score of group A was 25.3 + 4.5 and 14.2 + 4.3 after a course of oral administration (14.2 + 4.3), and the difference was statistically significant (P0.01) compared with that of pre medication (P0.01); B The Kupperman score of the patients in the group was 25.4 + 3.3 before medication, and the Kupperman score of the patient was 12.5 + 2.3 after a course of treatment (Song Qi). The symptoms of the menopause were better than before the medication (P0.05); the Kupperman score of the group C patients was 25.5 + 2.6 before using the drug, and a Chlorquinaldol Promestriene Vaginal Tablets therapy was used. After the course, the Kupperman score of the patients was 8.9 + 2.3, and the climacteric symptoms were relieved well. The difference was statistically significant (P0.01) 2. The changes of serum FSH, LH, E2 before and after medication in the three groups: the A group took FSH, LH, EZ values of 45.3 + 3.2,31.4 + 3.6, respectively, and 32.1 + 3.6 + 4.3 after 1 courses of medication. 191.6 + 6.7, E2 significantly increased, FSH, LH significantly decreased, the difference was statistically significant (P0.05), B group before the use of FSH, LH, E2 value was 52.3 + 4.2,11.4 + 6.5,20.6 + 3.6 respectively, after a course of medication FSH, LH, respectively 34.1 + + 4.7, compared with before the medication obviously increased. The difference was statistically significant (P0.05) in group.C, the values of FSH, LH and E2 were 44.6 + 25.7,36.4 + 11.3 respectively, and the values of FSH, LH and E2 were 30.5 + and 9.4 respectively after a course of treatment.
3, the monitoring of B-ultrasound: uterine length (32.1 + 2.1) mm before drug use, the length (2.9 + 1.4) of endometrium (2.9 + 1.4) before taking medicine (2.9 + 1.4), and (3.1 + 1.6) after medication (3.1 + 1.6), and no statistical significance. Conclusion: 1, hormone replacement therapy can effectively reduce the level of FSH, LH, and increase the content of E2 in the blood, and it is obvious to menopause syndrome. Improving the life quality of climacteric women.2, the oral preparation changes the hormone level in the body obviously, but its gastrointestinal reaction is obvious, the patient compliance is poor.3, the patch, the coating is less than the oral hormone preparation, the incidence of adverse reaction frequency is low, the drug delivery is convenient and feasible, the compliance is good.4, the patch use is used. It is convenient but difficult to control the dose, and it is difficult to avoid.5 in the skin injury. The vaginal delivery method is effective in the treatment of vaginal dryness and other genitals, but the effect of nerve function and cardiovascular symptoms in menopause syndrome is not obvious.6. The individual treatment should be made according to the difference for the patients who are suitable for the hormone replacement therapy. In.7, endometrial thickness did not increase significantly when combined estrogen and progesterone.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R969

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