262例绝经女性临床资料及激素治疗效果分析

发布时间：2017-12-28 07:06

本文关键词：262例绝经女性临床资料及激素治疗效果分析　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:总结分析女性绝经后相关症状,观察使用绝经激素治疗(Menopausal hormone therapy,MHT)对女性绝经后相关症状的控制和对血压、血脂、骨密度及颈动脉内-中膜厚度的改变,研究MHT对改善血脂代谢水平、改善阴道微环境、预防骨质疏松及提高生活质量的影响。方法:选取2014年1月-2015年8月在重庆医科大学附属第二医院妇科更年期门诊就诊的绝经患者,通过询问病史了解病情,并进行必要的辅助检查,整理后分析女性绝经相关症状,选取有MHT适应症患者,排除禁忌症,告知患者MHT使用利弊后自愿选择MHT,根据患者病情给予个体化MHT方案,共有262例患者坚持完成连续使用6个月MHT。于治疗前及治疗后第1、3、6个月测定患者子宫内膜、Kupperman改良评分;于治疗前及治疗后6个月测定患者血压、体重指数(Body Mass Index,BMI)、血清促卵泡生成激素(follicle stimulating hormone,FSH)、雌二醇(Estradiol,E2)、总胆固醇(Total Cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL)、骨密度(Bone mineral density,BMD)、颈动脉内-中膜厚度(Carotid intima-media thickness,CIMT)、阴道健康评分、sf-36生活质量评分,进行对比分析。安全性评估采取比较治疗前后患者子宫内膜厚度的变化,随访乳腺彩超,记录治疗期间不良反应的发生及处理方式和结果。结果:1.女性绝经后相关症状多种多样,发生率最高的依次为疲乏(58.40%,153/262),性生活障碍(57.25%,150/262)、情绪异常(54.96%,144/262)、肌肉骨关节痛(54.58%,143/262)、潮热出汗(53.44%,140/262)、睡眠障碍(51.15%,134/262)。2.绝经女性经mht6月后血压、kupperman改良评分和血清fsh、ldl水平明显下降(p0.05),差异有统计学意义;血清e2、hdl水平、股骨颈bmd、阴道健康评分、sf-36生活质量评分明显增加,p0.05,差异有统计学意义;体重、bmi、tc、tg、cimt有下降趋势,腰椎bmd有增加趋势,但p0.05,差异无统计学意义。3.安全性评估及不良反应情况,治疗前后子宫内膜有轻微增厚趋势,但p0.05,差异无统计学意义;随访乳腺彩超治疗前后无明显改变。治疗过程中有28例(10.68%,28/262)患者出现乳房胀痛,42例(16.03%,42/262)用药后阴道点滴出血,随着治疗继续进行,这些不良反应均自行缓解,无其它特殊不良反应发生。结论:女性进入绝经期后,雌激素水平处于低下状态,出现各种绝经相关症状,其症状的复杂性导致易误诊、漏诊。女性绝经后症状与围绝经期症状临床表现有一定差异。使用mht可减轻女性绝经相关症状,一定程度上改善血脂代谢水平及阴道微环境,预防骨质疏松等,提高女性绝经后的生活质量和健康水平。
[Abstract]:Objective: To summarize and analyze the related symptoms in postmenopausal women, postmenopausal hormone therapy use observation (Menopausal hormone, therapy, MHT) to control the symptoms of postmenopausal women and on blood pressure, blood lipid, bone mineral density and carotid artery intima-media thickness changes of MHT on lipid metabolism level, improve the effect of vaginal micro environment and prevention osteoporosis and improve the quality of life. Methods: from January 2014 August -2015 in Second Hospital Affiliated to Chongqing Medical University outpatient gynecological patients with menopause menopause, the history to understand the disease, and the necessary auxiliary examinations, analysis of menopause related symptoms after finishing, selection of indication for MHT patients, exclusion of contraindications, inform patients of MHT using the pros and cons of voluntary choice MHT, given the individual MHT scheme according to the condition of patients, a total of 262 patients completed 6 months of continuous use MHT. Before and after treatment for first, third, sixth months, determination of the endometrium of patients with Kupperman score; to measure blood pressure and body mass index of patients before treatment and 6 months after treatment (Body Mass Index, BMI), serum follicle stimulating hormone (follicle stimulating, hormone, FSH), estradiol (Estradiol, E2), total cholesterol (Total Cholesterol TC), triglyceride (Triglyceride, TG), high density lipoprotein (High density, lipoprotein, HDL), low density lipoprotein (Low density, lipoprotein, LDL), bone mineral density (Bone mineral density, BMD), carotid artery intima-media thickness (Carotid intima-media, thickness, CIMT), vaginal SF-36 health score, life quality score, comparative analysis. Safety assessment was conducted to compare the changes of endometrial thickness before and after treatment, followed by breast color Doppler ultrasound, and recorded the occurrence and treatment of adverse reactions during treatment. Results: 1. women after menopause related symptoms varied, the highest incidence were fatigue (58.40%, 153/262), sexual disorder (57.25%, 150/262) and mood disorders (54.96%, 144/262), musculoskeletal pain (54.58%, 143/262), sweating (53.44%, 140/262), sleep disorders (51.15%. 134/262). 2. postmenopausal women with mht6 months after the blood pressure, Kupperman score and serum FSH, LDL levels were significantly decreased (P0.05), the difference was statistically significant; the serum levels of E2, HDL, BMD of the femoral neck and vaginal health score, life quality score of SF-36 was significantly increased, P0.05, the difference was statistically significant; body weight, BMI, TC, TG and CIMT decreased, lumbar BMD increased, but P0.05, the difference was not statistically significant. 3., safety assessment and adverse reactions. There was a slight thickening trend of endometrium before and after treatment, but there was no significant difference in P0.05. During treatment, 28 cases (10.68%, 28/262) had breast distention and 42 cases (16.03%, 42/262) had bleeding after vaginal administration. With the treatment continuing, these adverse reactions were relieved spontaneously, and no other special adverse reactions occurred. Conclusion: after women enter the menopause, the level of estrogen is in a low state, and there are various menopause related symptoms. The complexity of the symptoms leads to misdiagnosis and missed diagnosis. There are certain differences between the symptoms of postmenopausal women and the clinical manifestations of perimenopausal symptoms. The use of MHT can reduce the symptoms of menopausal women, to a certain extent, improve the level of lipid metabolism and vaginal microenvironment, prevent osteoporosis, and improve the quality of life and health of women after menopause.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R711

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