绝经后不同时间对心功能的影响

目的：了解绝经后不同时间对心功能的影响。方法：采用超声多普勒诊断仪测定35例绝经妇女(绝经早期15例、绝经晚期20例)及24例育龄妇女的心脏血流动力学参数。结果：绝经晚期组反映心脏收缩功能、舒张功能及泵血功能的多项指标发生不利变化;绝经早期组多项有关指标的变化差异虽无显著性,但已显示出对心功能有不利影响的趋势。结论：绝经后低雌激素状态即能对心功能产生不利影响,随着绝经时间的延长,对心功能的不利影响将更加显著。     

小剂量激素治疗对绝经早期妇女生活质量和血液生化的影响

目的探讨小剂量激素对绝经早期妇女生活质量及血液生化的影响。方法中国医科大学附属二院妇产科于2002年3月至2004年9月选择绝经早期有明显围绝经期综合征症状的病人40例,每日口服小剂量激素及钙剂共6个月,比较用药前后临床症状及血液生化指标的变化。结果治疗前后比较除失眠症状一项为差异有显著性(P<0.05)外,其余差异均有非常显著性意义(P<0.01)。对血液生化的影响除HDLC升高和血小板轻微降低的作用外,均未见明显不利影响。结论小剂量激素治疗能明显提高绝经早期妇女的生活质量,对血液生化无明显不利影响。     

绝经后妇女用结合雌激素治疗加安宫黄体酮对代谢的影响

加用孕激素(P)对雌激素(E)替代治疗保护心脏的作用是否有不利影响,需待长期前瞻性随机的有关心肌梗塞死亡的研究才能提供确切的资料。为评估采用E替代的绝经后妇女加用不同剂量安宫黄体酮(MPA)后对脂、糖代谢和凝血的影响,开展     

激素替代治疗对绝经妇女血管内皮生长因子水平的影响

为探讨激素替代治疗对子宫切除及未切除绝经妇女体内血管内皮生长因子(VEGF)水平的影响,对199例闭经在5年以上,无子宫内膜炎、卵巢囊肿、子宫纤维瘤、肿瘤疾病、心脏疾病及深部静脉栓塞病史的健康绝经妇女进行研究,其中132例子宫未切除,67例子宫切除。将199例患者随机分为4组,第1组40例(其中6例子宫切除)未接收任何替代     

绝经后妇女激素替代治疗对24小时动态血压的影响

<正>流行病学研究结果显示,激素替代治疗(HRT)能使心血管疾病的发病率降低50％[1]。雌激素可作用于血管内皮细胞,使绝经后妇女血管舒张,降低血压,从而保护心脏功能。我们对32例绝经后行雌激素替代治疗的妇女进行了24小时动态血压变化检测,现报道如下。     

绝经后激素替代治疗对葡萄糖代谢的影响

目前关于绝经后激素替代治疗(HRT)对葡萄糖代谢影响的研究结果表明，HRT对葡萄糖代谢无明显的不利影响，绝经后的糖尿病妇女并非应用HRT的禁忌证。HRT降低绝经后妇女心血管疾病的发病率和死亡率的有益作用也涉及对葡萄糖代谢的作用。     

绝经后激素替代治疗对葡萄糖代谢的影响

目前关于绝经后激素替代治疗（HRT）对葡萄糖代谢影响的研究结果表明，HRT对葡萄糖代谢无明显的不利影响，绝经后的糖尿病妇女并非应用HRT的禁忌证。HRT降低绝经后妇女心血管疾病的发病率和死亡率的有益作用也涉及对葡萄糖代谢的作用。     

雌激素在围绝经和绝经后妇女的应用

绝经是妇女生殖能力的停止,此时妇女的卵巢功能衰竭,分泌的激素水平急剧降低,引起机体发生许多生理变化.妇女绝经是一个自然现象,但由此产生的低雌激素状况不仅对生殖系统产生巨大影响,也对脑、骨骼、皮肤、心血管和泌尿道等靶器官有不利影响,将会带来许多的生理和心理不适,包括绝经相关症状如潮热、盗汗、情绪波动等,以及与长期雌激素缺乏有关的心血管疾病、骨质疏松症、泌尿生殖道萎缩相关问题和认知功能障碍等.     

激素替代疗法与心血管疾病预防的关系

在50岁以上的妇女中,心血管疾病（cardiovascular disease,CVD）的发病率超过50％。CVD发病的主要危险因素有高血压、糖尿病、肥胖、吸烟和酗酒等。由于绝经前雌激素的保护作用,女性心脏疾病的发病年龄比男性大约晚10年。绝经对发生CVD的多种因素产生负面影响。动物试验和观察性研究资料支持在绝经后进行激素治疗（hormone therapy,HT）对心血管系统有益,但近期的一些随机、安慰剂对照试验的结果并不支持HT有利于心血管疾病的预防,相反却有不利倾向。     

小剂量米非司酮治疗围绝经后期功血疗效及对VEGF的影响

目的 探讨小剂量米非司酮治疗围绝经后期功能失调性子宫出血(功血)临床疗效及对血管内皮生长因子(VEGF)的影响.方法 选取70例围绝经后期功血患者,按照随机数字表法分为对照组(口服50 mg米非司酮治疗)与研究组(口服25 mg米非司酮治疗),每组35例.对比两组临床疗效、治疗前后VEGF及绒毛膜促性腺激素(β-HCG...     

绝经后妇女血脂血糖测定及与血压关系的探讨

对绝经后妇女１５例和正常对照组８例进行了血脂、血糖与血压关系的研究。结果发现绝经后妇女收缩压和舒张压均明显高于正常对照组；甘油三酯、胆固醇和低密度脂蛋白－胆固醇在绝经后妇女明显增高，而高密度脂蛋白－胆固醇却明显低；绝经后妇女有较高的空腹血糖、胰岛素和２小时血糖、胰岛素水平，且胰岛素／血糖比值也明显高于正常对照组。提示：绝经后妇女由于卵巢功能的丧失而失去了雌激素对心血管系统的保护作用，因而出现中心型肥胖、高血脂、高血糖、高胰岛素血症及胰岛素抵抗。     

绝经后生殖系统恶性肿瘤患者骨代谢的变化

目的探讨绝经后生殖系统恶性肿瘤患者骨代谢的变化.方法分别采用放射免疫法、Behr's法及ACP酶学测定法检测了32例自然绝经患者(绝经组)和32例自然绝经后发生女性生殖系统恶性肿瘤患者(肿瘤组)血清雌二醇(E2)、骨性碱性磷酸酶(bonealkalinephosphatase,BALP)和抗酒石酸酸性磷酸酶(tartrateresistentacidphosphatase,TRAP)浓度.结果绝经组与肿瘤组血清E2浓度无显著差异(P＞0.05).肿瘤组血清BALP显著低于绝经组(P＜0.05).绝经组与肿瘤组血清TRAP无显著差异(P＞0.05).结论自然绝经后患者骨代谢紊乱程度较未发生肿瘤者更为严重.     

The effects of hormone replacement therapy in normal postmenopausal women: measurements of Doppler-derived parameters of aortic flow

In this study the effects of hormone replacement therapy on cardiac function in healthy postmenopausal women were evaluated by Doppler echocardiography that was performed before (T1) and 2.5 months after the initiation of hormone replacement therapy (T2) in the peak estrogenic phase. The following parameters of aortic flow were measured: peak flow velocity, acceleration time, and ejection time. Additional parameters were calculated: flow velocity integral and mean acceleration. The study group included 24 postmenopausal women aged 43 to 60 years (mean 51.6 years). The control group consisted of 19 postmenopausal women aged 46 to 60 years (mean 53.5 years) who were not receiving hormone replacement therapy and who underwent the same evaluation. There were no changes in all Doppler parameters between T1 and T2 in the control group. However, in the study group there were significant increases in peak flow velocity (108.3 +/- 16.7 cm/sec at T1 vs 123 +/- 20.7 cm/sec at T2; p = 0.002), flow velocity integral (17.7 +/- 3.9 vs 21.5 +/- 4.7 cm; p = 0.0003), mean acceleration (11.5 +/- 1.9 vs 13.1 +/- 2.6 m/sec/sec; p = 0.001), and ejection time (324 +/- 37.6 vs 348.8 +/- 40.7 msec; p = 0.002). There was no change in acceleration time (94.8 +/- 6.6 vs 95 +/- 10.9 msec). These results demonstrate that estrogens increase both stroke volume and flow acceleration. The latter probably reflects a combination of enhanced inotropism and vasodilatation. We assume that the cardioprotective effect of hormone replacement therapy in postmenopausal women may be due not only to changes in lipid profile but also to direct effects of estrogens on central and peripheral hemodynamic parameters.     

高危妊娠胎儿血流速度波形与不同程度胎儿窘迫的关系

对妊娠晚期的高危孕妇２４４例，于分娩前一周内行彩色多普勒超声监测胎儿脐动脉（ＵＡ）、肾动脉（ＲＡ）以及大脑中动脉（ＭＣＡ）的血流速度波形（ＦＶＷｓ）的搏动指数（ＰＩ），产后随访围产儿预后。根据新生儿出生体重、Ａｐｇａｒ评分和羊水的性质分成预后正常、轻度、中度和重度预后不良等四级。结果：２４４例高危妊娠中，１４６例围产儿预后良好，６９例为轻度预后不良，１２例中度预后不良，１７例为重度预后不良。ＵＡ、ＲＡ和ＭＣＡ的ＦＶＷｓ与围产儿预后不良的程度均有明显的相关性。ＵＡＰＩ预测中度和重度预后不良的准确性较高，ＲＡＰＩ预测中度预后不良的准确性高于轻度和重度，ＭＣＡ在重度预后不良中改变最明显。说明胎儿ＵＡ、ＲＡ和ＭＣＡ的ＦＶＷｓ在胎儿窘迫时均有改变，但在不同程度的胎儿窘迫中，其敏感性不同     

病毒性心肌炎孕产妇分娩过程血流动力学变化的初步研究

目的　探讨病毒性心肌炎产妇 (VMC)剖宫产和阴道分娩过程中心脏血流动力学的变化。方法　VMC组不同分娩方式 (剖宫产者 2 6例 ,阴道分娩 6例 )分别与无心脏病 (NHD)组阴道分娩者 15例心排量 (CO)、心率 (HR)、每搏输出量 (SV)、心室射血时间 (VET)、射血速度指数 (EVI)等心功能指标在分娩过程中的变化进行比较。结果　VMC产妇不同分娩方式的两组 ,在分娩过程中心排量等各项参数的变化过程与NHD组均无统计学意义的差异 ,都表现为在胎儿娩出和胎盘娩出后心排量显著升高 ,而在产后 1小时内都已回变。结论　无明显心肌缺血性损伤且不伴恶性心律失常的病毒性心肌炎孕妇其心脏功能能很好地耐受正常阴道分娩的需要。     

经阴道彩色多普勒技术对侵蚀性葡萄胎的诊断价值

为探讨经阴道彩色多普勒超声（ＴＶＣＤ）对侵蚀性葡萄胎的早期诊断，对１９例侵蚀性葡萄胎行ＴＶＣＤ血流检测，以９１例正常早孕、３５例正常非孕子宫、１３例良性葡萄胎作为对照组。结果：侵蚀性葡萄胎肌壁血流丰富，子宫动脉和螺旋动脉ＰＳ值明显增高（ｐ〈０．００５），ＲＩ、ＰＩ值明显降低（ｐ〈０．００５）。以肌壁血窦〉５ｍｍ作为侵蚀性葡萄胎的诊断标准，其敏感性９５％，特异性１００％。表明ＴＶＣＤ是检测侵蚀性葡萄     

Effect of low-dose estrogen on hemodynamic response to stress

OBJECTIVE: To determine the effect of low-dose esterified estrogen on hemodynamic responses at rest and during stress in postmenopausal women, and to compare the changes with those seen with conjugated equine estrogen. DESIGN: Open-label study of esterified estrogen compared with a double-blind, placebo-controlled investigation of conjugated equine estrogen. SETTING: Healthy volunteers in an academic research environment. PATIENT(S): Postmenopausal women with normal endometrium, not currently using hormones. INTERVENTION(S): Cardiovascular parameters at rest and in response to stressors were assessed in 11 postmenopausal women before and 6 months after receiving 0.3 mg esterified estrogen. Responses were compared with 42 postmenopausal women randomized to 0.625 mg conjugated equine estrogen or placebo. MAIN OUTCOME MEASURE(S): Changes in mean arterial pressure (MAP) and vascular resistance index from before to after treatment. RESULT(S): At rest, MAP increased 3.3 +/- 1.5 mm Hg (+/-SD) in the placebo group, while declining 2.3 +/- 1.5 mm Hg and 4.8 +/- 1.4 mm Hg, respectively, in the esterified estrogen and conjugated equine estrogen groups after treatment. During mental stressors, MAP dropped significantly in both treatment groups. At rest and during mental stressors, vascular resistance index decreased with estrogen treatment. CONCLUSION(S): Low-dose esterified estrogen improved hemodynamic patterns similar to standard doses of conjugated equine estrogen in postmenopausal women.     

Changes in hemodynamic parameters and volume homeostasis with the menstrual cycle among women with a history of preeclampsia

OBJECTIVE: Among women with a history of preeclampsia the prevalence of hemodynamic and clotting disorders is elevated. In this study we tested the hypothesis that the normal cyclic variation in hemodynamic and renal function parameters with the menstrual cycle that is seen among healthy women would be preserved in women with a history of preeclampsia irrespective of whether they had an underlying hemodynamic or clotting disorder.Study Design: We compared the hemodynamic and volume cyclic variations during the menstrual cycle among women with a history of preeclampsia (n = 39) with those among healthy parous control women (control group, n = 10). The participants with a history of preeclampsia were subdivided into groups of women with hypertension with or without thrombophilia (hypertension group, n = 10), women with a normotension and a thrombophilic disorder (thrombophilia group, n = 17), and women without either of these abnormalities (symptom-free group, n = 12). We measured > or =5 months post partum, once during the follicular phase of the menstrual cycle (day 5 +/- 2) and once during the luteal phase (day 22 +/- 2), the following variables: body weight and length, mean arterial pressure, heart rate, cardiac output, plasma volume, glomerular filtration rate, effective renal plasma flow, and concentrations of renal volume homeostatic hormones, reproductive hormones, and catecholamines. From the measured data we calculated body mass index, cardiac index, left ventricular work, total peripheral and renal vascular resistances, effective renal blood flow, and renal filtration fraction. RESULTS: The hypertension group differed from the control group in having higher baseline (follicular phase) values for cardiac output, cardiac output, left ventricular work, renal vascular resistance, and atrial natriuretic peptide and norepinephrine levels. The symptom-free group differed from the control group in having a lower baseline plasma volume and higher baseline cardiac output and left ventricular work values. Women in the thrombophilia group were comparable to those in the control group with respect to baseline hemodynamic and renal function variables except for a higher renal vascular work value. In the control group heart rate, plasma volume, effective renal plasma volume, effective renal blood flow, and concentrations of renin-angiotensin-aldosterone system hormones and norepinephrine were increased during the luteal phase with respect to values during the follicular phase, whereas the renal vascular resistance and atrial natriuretic peptide values were decreased. In the three subgroups of women with a history of preeclampsia this cyclic pattern with the menstrual cycle was preserved for most of these parameters. CONCLUSION: Although baseline hemodynamic and volume status among women with a history of preeclampsia differed from that among healthy parous control subjects, the cyclic variation with the menstrual cycle was largely preserved.     

米非司酮药物流产时绒毛膜及蜕膜组织的超微结构改变

目的 探讨米非司酮药物流产时,绒毛膜及蜕膜的形成学变化。方法 应用光镜和透射电镜对10例米非司酮药物流产患者（观察组）和10例人工流产患者（对照组）在流产当时留取绒毛膜和蜕膜进行形态学观察。结果 观察组标本中绒毛膜和蜕膜组织细胞均表现出一种自噬性凋亡倾向。蜕膜组织中颗粒细胞内的分泌颗粒减少或消失,间质内网状纤维溶解,断裂。结论 米非司酮药物流产时,绒毛膜及蜕膜细胞均呈现一种自噬性凋亡倾向,同时释放大量松弛素,引起网状纤维溶解。断裂,蜕膜组织崩解,剥脱。