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目的探讨激素补充疗法对女性围绝经期综合征症状及骨密度的影响。方法选择2015年8月-2016年7月在淳安县妇幼保健院治疗的118例围绝经期患者为研究对象,按照治疗方法不同分为观察组58例和对照组60例。对照组患者给予常规对症治疗,口服谷维素片10 mg,每天3次,28 d为1个疗程,观察组患者在此基础上口服戊酸雌二醇(补佳乐)1 mg,每天1次,28 d为1个疗程,服用倍美力14 d后加黄体酮胶囊150 mg,每天1次。观察两组患者治疗前后卵泡刺激素(FSH)、雌二醇(E_2)、黄体生成素(LH)变化;观察两组患者治疗前后的围绝经期症状,通过Kupperman评分进行评价;观察两组患者治疗前后子宫内膜变化及子宫大小;检测两组患者治疗前后骨密度变化,分别对脊椎及股骨颈进行检测。结果治疗前两组患者FSH、E_2、LH表达水平比较,差异无统计学意义(P>0.05);治疗后两组患者FSH、LH水平与治疗前比较均有所降低(t=15.74、35.59、28.30、32.91,P=0.00、0.00、0.00、0.00),E_2表达有所升高(t=19.04、62.38,P=0.00、0.00)。其中观察组改善程度均优于对照组(P<0.05);治疗前两组患者Kupperman评分及子宫大小、子宫内膜厚度水平比较,差异无统计学意义(P>0.05),治疗后两组患者Kupperman评分水平均有所降低(P<0.05),观察组降低程度大于对照组(P<0.05),而子宫体积较治疗前有所缩小,子宫内膜厚度较前有所增加,但差异无统计学意义(P>0.05);治疗前两组患者骨密度水平比较,差异无统计学意义(P>0.05),治疗后两组患者骨密度水平均有所升高(P>0.05),观察组与治疗前及对照组治疗后相比,差异有统计学意义(P>0.05)。结论激素补充治疗治疗围绝经期综合征疗效显著,能改善女性激素水平,增加骨密度。
Objective To investigate the effects of hormone replacement therapy on the symptoms and bone mineral density of perimenopausal women. Methods A total of 118 patients with perimenopausal period treated in Chunan Maternal and Child Health Hospital from August 2015 to July 2016 were selected and divided into observation group (58 cases) and control group (60 cases) according to different treatment methods. Patients in the control group were given conventional symptomatic treatment. Orally oryzanol 10 mg was given orally three times a day for 28 days for one course of treatment. Patients in the observation group were given orally administered estradiol valerate 1 mg once daily, 28 d for a course of treatment, taking betamethalone 14 days plus progesterone capsules 150 mg, 1 day. The changes of follicle stimulating hormone (FSH), estradiol (E2) and luteinizing hormone (LH) in both groups before and after treatment were observed. The peri-menopausal symptoms before and after treatment were observed and evaluated by Kupperman’s score. The changes of endometrium and the size of uterus before and after treatment were measured. The changes of bone mineral density in both groups before and after treatment were measured, and the spine and femoral neck were detected respectively. Results There was no significant difference in the expression of FSH, E_2 and LH between the two groups before treatment (P> 0.05). After treatment, the levels of FSH and LH in both groups were lower than those before treatment (t = 15.74, 35.59, 28.30,32.91, P = 0.00,0.00,0.00,0.00), E 2 expression increased (t = 19.04,62.38, P = 0.00,0.00). (P <0.05). There was no significant difference in Kupperman score, uterine size and endometrial thickness between two groups before treatment (P> 0.05). After treatment, the two groups of patients Kupperman score decreased (P <0.05), the observation group decreased more than the control group (P <0.05), while the uterus volume decreased compared with before treatment, the endometrial thickness increased compared with the previous, but the difference was not statistically significant (P> 0.05). There was no significant difference in bone mineral density between the two groups before treatment (P> 0.05). After treatment, the bone mineral density (BMD) increased in both groups (P> 0.05) Compared with before treatment and control group after treatment, the difference was statistically significant (P> 0.05). Conclusion Hormone replacement therapy is effective in treating perimenopausal syndrome and can improve female hormone level and increase bone mineral density.