绝经激素治疗对颈动脉内膜中层增厚及斑块影响的观察研究

发布时间：2018-05-23 13:40

本文选题：绝经激素治疗 + 动脉粥样硬化　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:彩色超声观察绝经激素治疗(menopause hormone therapy,MHT)对女性颈动脉内膜中层增厚及相关因素影响,了解MHT对颈动脉内膜增厚及斑块的影响作用。方法:选择2011年12月至2014年12月就诊我院妇科内分泌门诊,有子宫和至少一侧卵巢,自然绝经有绝经后症状且从未接受过MHT的40-60岁女性,按个人意愿选择不同治疗方法,分为接受MHT(周期序贯或连续联合)治疗的68例为观察组,未治疗组87例为对照组。观察两组患者两年治疗前后的临床资料并进行比较。测量患者体质量(身高、体重)、血压,检测血脂四项和空腹血糖,选用彩色超声观察双侧颈动脉内膜中层厚度及斑块形成情况,并采用Crouse积分对斑块进行定量分析。结果:(1)观察组和对照组入组时平均年龄分别为(50.8±3.1、49.6±3.8)岁,两组患者入组时临床资料比较差异无统计学意义(p0.05),组间具有可比性。治疗2年后,观察组的颈动脉异常率为20.59%(14/68),Crouse积分为1.71±0.22,对照组分别为40.23%(35/87)、2.22±0.65,两组比较差异有统计学意义(p0.05)。两组间收缩压(SBP)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、空腹血糖(FPG)比较差异有统计学意义(p0.05),观察组SBP、TC、LDL和FPG明显低于对照组,HDL高于对照组,两组间舒张压(DBP)、体重指数(BMI)、总甘油三脂(TG)比较差异无统计学意义(p0.05)。(2)观察组治疗前后各观察指标比较差异均无统计学意义(p0.05);对照组随访2年后患者SBP、TC、LDL水平均大于入组时,且差异有统计学意义(p0.05)。结论:(1)两年MHT治疗组颈动脉异常增加量明显少于未治疗组,斑块进展速率低于未治疗组,MHT可能能延缓颈动脉内膜中层增厚及斑块形成速率,延缓动脉粥样硬化形成;(2)观察组治疗两年后血压、血脂等较入组时有降低趋势,但无统计学意义,可能与观察年限较短有关,对照组SBP、TC、LDL水平较两年前升高,动脉粥样硬化的危险因素增加,MHT可能能减缓动脉粥样硬化危险因素进展。
[Abstract]:Objective: to observe the effect of menopausal hormone therapy on carotid intima-media thickening and its related factors, and to understand the effect of MHT on carotid intimal thickening and plaque. Methods: from December 2011 to December 2014, 40 to 60 years old women with uterus and at least one ovary, who had postmenopausal symptoms and had never received MHT, were selected to choose different treatment methods according to their personal wishes. The patients were divided into observation group (n = 68) and untreated group (n = 87). The clinical data before and after two years treatment were observed and compared between the two groups. Body mass (height, weight, blood pressure, blood lipid and fasting blood glucose) were measured. Color ultrasound was used to observe the intima-media thickness and plaque formation of bilateral carotid artery. The plaque was quantitatively analyzed by Crouse score. Results the mean age of the observation group and the control group were 50.8 卤3.1 卤49.6 卤3.8 years old, respectively. There was no significant difference in clinical data between the two groups. After 2 years of treatment, the abnormal rate of carotid artery in the observation group was 20.5914 / 68% and the Crouse score was 1.71 卤0.22, which was significantly higher than that in the control group (40.23% / 87% 2.22 卤0.65). There was a significant difference between the two groups (p 0.05). The systolic blood pressure (SBP), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), fasting blood glucose (FBG) in the two groups were significantly higher than those in the control group (P 0.05). The levels of FPG and FPG in the observation group were significantly lower than those in the control group. There was no significant difference in DBP, BMI, TGG between the two groups before and after treatment. There was no significant difference between the two groups before and after treatment, and in the control group, the levels of SBPnTCfU LDL were higher than those in the control group after 2 years of follow-up, and there was no significant difference between the two groups before and after treatment, and the levels of SBPnTCfLDL in the control group were higher than those in the control group after 2 years follow-up. The difference was statistically significant (P 0.05). Conclusion the abnormal increase of carotid artery in the MHT treatment group was significantly lower than that in the untreated group for two years, and the plaque progression rate was lower than that in the untreated group, which might delay the carotid intima-media thickening and plaque formation rate. After two years of treatment, the blood pressure and blood lipid in the observation group were lower than those in the control group, but there was no statistical significance, which might be related to the shorter period of observation, and the level of TCU LDL in the control group was higher than that of the control group two years ago. Increased risk factors for atherosclerosis may slow down the progression of atherosclerosis risk factors by MHT.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.75

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