低剂量与标准剂量结合雌激素联合天然孕酮或地屈孕酮治疗围绝经期综合征的疗效观察

发布时间：2018-01-30 04:34

本文关键词： 围绝经期综合征绝经激素治疗低剂量雌激素天然孕酮地屈孕酮　出处：《实用妇产科杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的:研究低剂量结合雌激素(CEE)与标准剂量CEE联合天然孕酮或地屈孕酮治疗围绝经期综合征的疗效比较。方法:本试验为单中心、前瞻性随机对照试验,2014年2月至2015年12月招募绝经早期有子宫、有绝经相关症状的妇女(共107例完成试验),随机分为3组:A组35例(低剂量CEE+天然孕酮)、B组37例(标准剂量CEE+天然孕酮)、C组35例(标准剂量CEE+地屈孕酮),采用连续序贯方案治疗12个周期,在第3、6、9、12周期结束后记录改良Kupperman评分,计算有效率,用药前与用药后抽血测定卵泡刺激素(FSH)、雌二醇(E2)。结果:在治疗3个周期后,改良Kupperman评分值均显著性下降(P均0.01),3组间的完全缓解率、显效率差异均无统计学意义,但B组有效率(89.2%)显著高于A组(60%,P=0.024)和C组(61.9%,P=0.035)。治疗结束后,3组的完全缓解率、显效率、有效率差异均无统计学意义(P0.05)。治疗结束后与治疗前比,3组的FSH值均有显著性降低(P0.001),E2值均显著性升高(P0.001)。治疗结束后,3组FSH值比较差异无统计学意义(P=0.26);E2值A组显著低于B组(P=0.002)及C组(P=0.004),B组与C组比较差异无统计学意义(P=0.832)。不良反应主要为阴道不规则流血和乳房胀痛,A、B、C组阴道不规则流血的发生率分别为20.91%、39.51%、19.99%,B组显著高于A与C组(PAB=0.034,PBC=0.015),A组与C组比较差异无统计学意义;乳房胀痛的发生率A、B、C组分别为30.22%、37.46%、68.06%,A、B两组差异无统计学意义,C组显著高于A、B组(PAC=0.008,PBC=0.002)。结论:低剂量雌激素补充已可满足大部分患者缓解围绝经期综合征的需求,加用天然孕酮比加用地屈孕酮对围绝经期症状的缓解作用更显著。
[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 卤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.
【作者单位】：北京协和医院;
【分类号】：R711.75
【正文快照】： 围绝经期妇女是社会中的重要人群。卵巢功能衰退所致的内分泌失衡和雌激素缺乏可以带来一系列与绝经相关的问题或疾病,包括:围绝经期综合征、泌尿生殖道萎缩、绝经后骨质疏松和心血管疾病。绝经激素治疗(menopausal hormone therapy,MHT)对缓解绝经相关症状,预防骨质疏松,减轻

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