HRT治疗更年期综合症临床药学研究

发布时间：2018-06-07 08:47

本文选题：更年期 + 激素替代治疗　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：1、探索激素水平与更年期症状的相关性。2、观察给予外源性激素替代治疗后更年期综合症妇女的疗效疗效。3、建立患者体内激素测定方法,通过检测用药后激素水平的变化,制定最佳给药方案。4、比较分析服用激素前后体内激素水平。方法：根据文献确定更年期妇女的平均绝经年龄和体内雌激素含量的平均水平,收集2013年1月——2014年2月于泸州医学院附属医院妇产科确诊为更年期综合症的患者89例,平均年龄49.8岁,平均绝经时间1.8±1.5年,且无HRT使用禁忌症,同时测定15例非更年期且正常生育年龄妇女血清测得雌激素水平以作为更年期妇女体内雌激素水平降低的对照,对纳入研究的病例分为三组：A组给予口服雌激素(克龄蒙)治疗；B组给予雌激素贴剂(松奇)治疗、C组给予外用雌激素(氯喹那多)治疗。用药一个疗程后对患者复诊,进行相关的妇科常规检查,同时对每组病人抽血用放射免疫法检测病人用药后卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)含量,条件适宜的需给病人进行B超监测观察其子宫大小、子宫内膜厚度；采用改良Kupperman评分法对各组病人进行用药前后更年期综合症的改善情况的评价。使用SPSS13.0版软件包进行数据分析,对资料进行正态性检验,满足正态性的采用t检验,各数据用x±s表示；不满足正态性的采用Mann-Whitney U检验,数据中位数(范围),以P0.05为差异有统计学意义。结果：1、三组更年期综合症的kupperman评分变化情况：A组患者用药前kupperman评分为25.3±4.5,口服克龄蒙一个疗程后评分为14.2±4.3,与用药前相比更年期症状明显缓解,差异有统计学意义(P0.01)；B组患者用药前kupperman评分为25.4±3.3,使用贴剂(松奇)一个疗程后患者的kupperman评分为12.5±2.3,与用药前相比更年期症状有较好缓解,差异有统计学意义(P0.05)；C组患者用药前kupperman评分为25.5±2.6,使用氯喹那多-普罗雌烯阴道片一个疗程后患者的kupperman评分为8.9±2.3,更年期症状得到缓解效果良好,差异有统计学意义(P0.01)2、三组患者血清中FSH、LH、E2用药前后的变化：A组口服克龄蒙前FSH、LH、EZ值分别为45.3±3.2、31.4±6.5、42.6±3.6,用药1个疗程后FSH、LH、E2分别为32.1±5.4、24.6±4.3、191.6±6.7,与用药前相比E2明显升高,FSH、LH明显降低,差异均有统计学意义(P0.05)；B组运用贴剂前FSH、LH、E2值分别为52.3±4.2、11.4±6.5、20.6±3.6,用药一个疗程后FSH、LH、E2值分别为34.1±6.3、22.6±7.3、60.6±4.7,与用药前相比E。明显升高,FSH、LH明显降低,差异均有统计学意义(P0.05)。C组服用氯喹那多／普罗雌烯阴道片前FSH、LH、E2值分别为44.6±25.7、36.4±17.4、35.7±11.3,用药一个疗程后FSH、LH、E2的值分别为30.5±15.3、21.3±12.7、143.3±9.4,与用药前相比E2明显升高,FSH、LH明显降低,差异均有统计学意义(P0.05)。 3、子宫B超的监测：子宫大小用药前子宫长度(32.1±2.1)mm;服药后子宫长(29.1±6.4)内膜厚度用药前(2.9±1.4)；用药后(3.1±1.6),P0.05差异无统计学意义。结论：1、激素替代治疗能有效降低血清中FSH、LH水平,提高E2的含量,对更年期综合症有明显的改善作用,很好地提高更年期妇女的生活质量。2、口服制剂改变体内激素水平明显,但其胃肠道反应明显,患者依从性差。3、贴剂、涂剂较口服激素制剂的胃肠道不良反应小,不良反应频率发生率较低,给药方便可行,依从性好。4、贴剂使用方便但难以控制剂量,且对皮肤损伤难以避免。5、阴道给药方式治疗阴道干涩等生殖器病变疗效较好,而对于更年期综合症中神经功能症及心血管症状效果不明显。6、对适宜用激素替代疗法的病人在进行治疗时应根据差异制定个体治疗方案。7、子宫内膜厚度在雌孕激素合用时增加不明显
[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.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R969

【参考文献】