绝经后妇女性激素及钙调节激素

绝经后妇女性激素及钙调节激素王育敏，张仲才，王华星，刘桂花妇女绝经后易患骨质疏松，是由更年期的激素变化引起的，发病率和死亡率均较高。我们用放射免疫测定方法，对３０例正常妇女和３２例绝经后妇女的血清中雌二醇（Ｅ２）、孕酮（Ｐｒｏ）、睾酮（Ｔ）以及２５－...     

绝经后性激素替代治疗对血压的影响

绝经后性激素替代治疗（HRT）曾禁用于高血压绝经后妇女，而目前大多数人认为绝经后高血压发病率的增高可能与绝经后雌激素水平下降有关。近来研究表明，HRT对轻、中度高血压绝经后妇女，其高血压不仅没有加重，而且可能具有辅助治疗作用，尤其适用于24h血压变异大的个体。此外，HRT还能与抗高血压药物安全合用。     

绝经后心肌梗死患者性激素与脂代谢关系的临床研究

目的:探讨绝经后心肌梗死（MI）患者性激素（SH）与脂代谢之间的关系。方法:利用放免法、免疫酶法、酶法分别检测绝经后妇女MI组（30例）和绝经后妇女对照组（30例）血中雌二醇（E2）、孕酮（P）、睾酮（T）、脂蛋白（a）[Lp（a）]、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平。结果:与绝经后妇女对照组相比,绝经后MI组E2、E2/P、E2/T、HDL-C水平显著降低（100.35±41.26pmol/L:148.38±46.44pmol/L,P<0.001,90.52±65·48:149.75±116.74,P<0.05,104.52±64.24:154.22±111.34,P<0.05,0.95±0.30mmol/L:1.12±0.43mmol/L,P<0.05）,Lp（a）、LDL-C、TG、TC水平明显升高（21.31±17.93 mg/dl:13.52±13.04mg/dl,P<0.05.2.98±1.04mmol/L:2.15±1.19mmol/L,P<0.05,1.63±1.44mmol/L:1.13±0.55mmol/L,P<0.05,4.23±0.94mmol/L:3.50±1.36mmol/L,P<0.05）,E2与Lp（a）、LDL-C均呈负相关（r=-0.373,P<0.05,r=-0.635,P<0.01）,与HDL-C呈正相关（r=0.378,P<0.05）.结论:绝经后MI患者存在明显的以E2。水平不足为主的性激素紊乱和脂代谢异常,脂代谢异常和E2水平不足密切相关;E2水平不足促进脂代谢异常,可能是绝经后妇女MI发生的重要原因之一。     

绝经后性激素的替代疗法

绝经后性激素的替代疗法南京医科大学第一附属医院（２１００２９）杨怀恭杨怀恭教授绝经指女性卵巢分泌性激素的功能逐渐终止，月经停止来潮，一般在围绝经期妇女月经需停止６～１２个月才能确定已绝经。绝经年龄一般在４８～５５岁之间，平均为５１．４岁。在３５岁之前...     

绝经后性激素替代治疗对血压的影响

绝经后性激素替代治疗 (HRT)曾禁用于高血压绝经后妇女 ,而目前大多数人认为绝经后高血压发病率的增高可能与绝经后雌激素水平下降有关。近来研究表明 ,HRT对轻、中度高血压绝经后妇女 ,其高血压不仅没有加重 ,而且可能具有辅助治疗作用 ,尤其适用于 2 4h血压变异大的个体。此外HRT还能与抗高血压药物安全合用     

米非司酮在绝经后妇女取环术中的应用

为探讨米非司酮在绝经后妇女取环术中的作用，2002年2月至2003年2月，我们对100例绝经后取环的妇女进行了随机分组观察。现将结果报告如下。     

阿伦膦酸钠联合钙尔奇D治疗老年妇女骨质疏松症110例临床观察

目前全球约有2亿妇女患有骨质疏松症,其中60—70岁妇女发病率约33％,≥80岁妇女发病率约67％。近年来我们应用阿伦膦酸钠联合钙尔奇D治疗老年妇女骨质疏松症110例,效果满意。现报告如下。     

性激素替代疗法的失败与绝绝后妇女的心血管病预防

绝经期妇女的冠心病患病率和死亡率明显增高 ,需要积极预防。基于雌激素有保护女性心血管系统作用的假设和一些观察性研究的结果 ,人们曾推荐在已患或易患冠心病的老年妇女人群中采用性激素替代疗法 (ＨＲＴ) [1,2 ] 。然而最近发表的几项大规模随机临床试验结果否定了ＨＲＴ的心血管病预防价值。1　ＨＲＴ无助于冠心病二级预防心脏与雌 /孕激素替代治疗试验 (ＨＥＲＳ)是第一项评价ＨＲＴ对绝经后妇女冠心病二级预防的大规模随机临床试验。2 763例患有冠心病的绝经后妇女 ,随机分入治疗组 (ｎ =13 80 )或安慰剂组 (ｎ =13 83 ) ,分别每日口…     

性激素结合球蛋白与绝经后妇女胰岛素抵抗

一、性激素结合球蛋白（SHBG）的生物学特性SHBG在激素和一些细胞因子的调控下主要由肝脏合成与分泌。人血中SHBG由两个分子量约为45000大小的多肽序列亚基形成同型二聚体糖蛋白,其在血液中的稳定性受到性激素配体、金属离子特别是钙离子的影响,性激素和钙离子对于维持二聚体形式是必须的。在循环中,SHBG与性激素有着很高的亲和力,SHBG结合了大部分的性激素使之处于无活性状态并在到达靶组织后又释放出来。相比较而言,SHBG和雄激素的结合力更强;在天然的与合成的性激素中,和SHBG结合力最强的是双氢睾酮[1]。     

绝经后妇女糖代谢的变化

卵巢功能的丧失会增加心血管疾病的危险性，在心血管疾病的危险因素中与绝经有关的脂质代谢的异常已被广大学者所证实〔１〕，但与绝经有关的糖代谢变化却研究较少。本文旨在对绝经后妇女的糖代谢改变作一初步研究。一、对象与方法１．对象（１）对照组：８例，年龄３４～３９岁，平均３６±２岁，月经正常，体重指数（ＢＭＩ）＝２３．２６±１．３７ｋｇ／ｍ２。（２）绝经组：１５例，年龄４９～６３岁，平均为５７±４岁，绝经５～１６年，平均１０±４年，ＢＭＩ＝２３．９８±１．３４ｋｇ／ｍ２。２．方法所有研究对象均于早晨空腹及…     

Insulin resistance and postmenopausal hormone replacement therapy

Insulin resistance causes hyperglycemia by disturbing glucose uptake in the tissues and increasing hepatic glucose production. Hyperinsulinemia has a predictive role in the generation of type 2 diabetes in nondiabetic individuals. Both insulin resistance and the associated disturbances are responsible for increased cardiovascular risk. Women of reproductive age are protected from cardiovascular disease although in the postmenopausal period the risk becomes equal to that in men and exceeds that in men later on. This observation leads us to consider the role of estrogen deficiency in the pathogenesis of cardiovascular disease. Hormone replacement therapy (HRT) is a successful method in the management of certain clinical situations in postmenopausal women. The interactions among estrogen, menopause, and cardiovascular risk bring forth the question of whether the HRT affects insulin resistance or not. The studies so far have yielded controversial results. The overall results of recent reports indicate that postmenopausal HRT improves insulin resistance. However, the available evidence is not strong enough to suggest the use of postmenopausal HRT as a first-line therapeutic measure in the management of insulin resistance.     

Successful treatment of hepatic sarcoidosis with hormone replacement in a postmenopausal woman

A possible supplementary effect of sex hormone replacement therapy (HRT) for the postmenopausal woman with sarcoidosis is described. A 53-year-old woman presented with a 12-year history of sarcoidosis in the eyes, in the submandibular lymph nodes and in the lungs. In the course of follow up without any medication, her liver function tests were abnormal, and she was diagnosed as having hepatic sarcoidosis. Daily administration of 0.625 mg conjugated oestrogen and 2.5 mg medroxyprogesterone improved her liver function. The results suggest that HRT may help to prevent the progression of sarcoidosis in postmenopausal patients.     

Effects of postmenopausal hormone replacement therapy on insulin resistance

Postmenopausal hormone replacement therapy (HRT) protects women from the risk of cardiovascular system disease, osteoporosis, and dementia. There are conflicting reports about the effects of HRT on insulin resistance. The purpose of this study was to investigate the effects of HRT on insulin resistance with the hyperinsulinemic euglycemic clamp technique, the most sensitive technique measuring insulin resistance. Conjugated estrogen (0.625 mg/d) and medroxyprogesterone acetate (5 mg/d) were given to 15 postmenopausal women with insulin resistance. After 3 mo of HRT, the M value (total glucose consumption) increased 28% (p<0.001), low-density lipoprotein (LDL) cholesterol decreased 12.9% (p<0.044), high-density lipoprotein (HDL) cholesterol increased 17% (p<0.009), total cholesterol decreased 9.1% (p<0.016), and serum insulin decreased 33% (p<0.022) compared to baseline values before HRT was started. No significant changes in glucose, C-peptide, and triglyceride levels were observed. Whereas there were no differences regarding glucose, total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels between the insulin-resistant (n=15) and non-insulin-resistant women (n=24) (p>0.05), there were significant differences in M value, insulin, and C-peptide levels between these groups (p<0.05). We believe that HRT with this combination may protect postmenopausal women from coronary artery disease (CAD) through its beneficial effects on insulin resistance, hyperinsulinemia, and lipid levels, which are considered to be important factors in CAD pathogenesis.     

激素替代治疗与绝经后妇女心血管疾病的关系

在绝经前,女性发生心血管疾病的危险性较低,然而,伴随着更年期的到来,女性心血管疾病的发病率明显升高,激素替代治疗随之成为临床上预防心血管疾病的热点话题.激素替代治疗在预防绝经妇女心血管疾病方面的研究.结果 并不一致,其预防效果在一定程度上取决于接受治疗者个体情况的差异.因此,激素替代治疗应当注意用药的时间、用药的个体化...     

行激素补充疗法的绝经后妇女子宫内膜安全性监测

目的　探讨应用激素补充疗法(HRT)的绝经后妇女子宫内膜安全性的监测方法。　方法　对60例绝经后行HRT妇女进行血清雌二醇(E2)测定;阴道B超(TVS)监测子宫体积和子宫内膜厚度;对部分患者行子宫内膜的病理学检查和雌激素受体(ER)、孕激素受体(PR)半定量检测。　结果　应用HRT后,子宫内膜明显增厚,均值从2.8mm升至3.9mm(P＜0.05);E2显著上升,由(20.6±6.9)ng/L升至(33.8±11.7)ng/L（P＜0.01）;子宫内膜厚度与E2呈正相关关系(r=0.94,P＜0.01);20例送检内膜中,2例简单型增生过长,1例复杂型增生过长,余为萎缩型;ER(+)19例,ER(++)1例;PR均为(+)。　结论　根据临床表现,并结合血清E2和TVS检测子宫内膜厚度,可对子宫内膜安全性进行初步评估;当E2＞45ng/L,子宫内膜厚度≥5mm时,则需进一步行子宫内膜病理学检查和ER测定。     

Combined hormone replacement therapy improves endothelial function in healthy postmenopausal women

OBJECTIVES: Large scale epidemiological studies suggest that hormone replacement therapy (HRT) reduces cardiovascular events in postmenopausal women. Improvement in endothelial function may contribute to this protective effect. DESIGN: In a prospective, double blind study, 61 healthy postmenopausal women were randomized to receive either oral continuous combined HRT [oestradiol 2 mg and norethisterone acetate (NETA) 1 mg per day] or placebo. Endothelial function, assessed by flow-mediated vasodilation (FMD) of the brachial artery and expression of soluble endothelial cell adhesion molecules (CAM) were determined before, after 3 and 6 months of therapy. RESULTS: The FMD was significantly improved in women on combined HRT (from 5.97% to 10.94% after 3 months and to 10.58% after 6 months; both P < 0.01 versus baseline values) and did not change in the placebo group (6.92% at baseline, 5.86% after 3 and 6.26% after 6 months). After 3 months of combined HRT, significant decreases of 24.6% for E-selectin and 13.9% for intercellular adhesion molecule-1 (ICAM-1) were observed (both P < 0.01 versus baseline values) and were sustained after 6 months of therapy, whilst no differences emerged in the placebo group. CONCLUSIONS: Oestradiol and norethisterone acetate improve endothelial function by both enhancing FMD and reducing the levels of soluble E-selectin and ICAM-1 in healthy postmenopausal women.     

绝经妇女激素替代治疗观点的历史演变

随着妇女平均寿命的延长 ,绝经后的问题日益受到全社会的广泛关注 ,旨在改善妇女生活质量的激素替代治疗(ＨＲＴ)所引发的问题也不断涌现 ,ＨＲＴ对绝经后妇女的生活质量究竟是否有总体益处已成为目前关注的焦点。 2 0 0 2年 7月 9日 ,美国国立卫生研究院 (ＮＩＨ)心脏、肺和血液研究所 (ＮＨＬＢＩ)宣布妇女健康初始行动 (ＷＨＩ)中雌激素加孕激素预防健康绝经后妇女的临床试验由于乳腺癌发病相对风险增加 2 6% ,且并无总体益处予以提前终止 ,这是一项按循证医学进行的重要研究结果 ,将对今后绝经后妇女ＨＲＴ产生重大影响。自从 1963年Ｗ…     

Effects of hormone replacement therapy on coagulation and fibrinolysis in postmenopausal women

It has been speculated that hormone replacement therapy (HRT) containing relatively low dose of estrogen would be different from oral contraceptive pills in causing thromboembolism because activation of coagulation depends on the amount of estrogen. In contrast to this knowledge, activation of coagulation pathways has been detected in postmenopausal women treated with HRT in the observational and clinical studies. In this regard, recent studies have reported a 2 to approximately 4 fold risk of venous thromboembolism or pulmonary embolism in postmenopausal women receiving HRT than in non-users of estrogen. On the other hands, HRT has shown to enhance systemic fibrinolysis with decreased plasma plasminogen activator inhibitor-1 (PAI-1) levels. In addition, levels of D-dimer exhibited a significant inverse correlation with PAI-1 levels, suggesting enhanced fibrinolysis potential. However, small doses of estrogen/progestogen induce increases in fibrinolytic capacity via a marked reduction of PAI-1. In other words, HRT at conventional dosages may affect fibrinolytic activity to a greater extent than coagulation activity, whereas the converse trend holds at higher estrogen doses. The increase in fibrinolytic potential was independent of any effect on coagulation of CEE at conventional dosages. However, in contrast to healthy postmenopausal women, we recently reported that HRT did not significantly decrease PAI-1 antigen levels and rather, increased tissue factor activity and prothrombin fragment F(1+2) levels from baseline in hypertensive and/or overweight postmenopausal women. Activation of coagulation following HRT may not be balanced by activation of fibrinolysis in some postmenopausal women. Thrombogenic events are considered more likely in patients with certain heritable conditions, such as platelet antigen-2 (PIA-2) polymorphisms. Further, Factor V Leiden mutation increases the risk of primary and recurrent venous thromboembolic events by three to sixfold and the risk of myocardial infarction. Indeed, HRT may decrease or increase atherothrombosis risk depending on the presence of Factor V Leiden mutation. Thus, HRT should not be initiated in women with established coronary artery disease or the coexistence of other risk factors for hypercoagulability-malignancy, immobility, obesity, diabetes, advanced age, or inherited traits. However, HRT at conventional dosages improves fibrinolysis potential in healthy postmenopausal women.     

Use of hormone replacement therapy by postmenopausal women in the United States

BACKGROUND: The benefits and risks of hormone replacement therapy (HRT) in postmenopausal women are not fully defined, and individual characteristics and preferences may influence decisions to use this therapy. Previous studies of postmenopausal women who use HRT have been conducted in local or highly selected cohorts or have not focused on current use. OBJECTIVE: To examine sociodemographic, clinical, and psychological factors associated with current use of HRT in a national population-based cohort. DESIGN: Random-digit telephone survey. SETTING: Probability sample of U.S. households with a telephone. PARTICIPANTS: 495 postmenopausal women 50 to 74 years of age in 1995. MEASUREMENTS: Current use of HRT. RESULTS: Current use of HRT was reported by 37.6% of women (58.7% of those who underwent hysterectomy and 19.6% of those who did not undergo hysterectomy; P = 0.001). In multivariable analyses, use of HRT was more common among women in the South (adjusted odds ratio, 2.67 [95% CI, 1.08 to 6.59]) and West (odds ratio, 2.76 [CI, 1.01 to 7.53]) than the Northeast. Use was more common among college graduates (odds ratio, 3.72 [CI, 1.29 to 10.71]) and less common among women with diabetes mellitus (odds ratio, 0.17 [CI, 0.05 to 0.51]). Other cardiac risk factors and most psychological characteristics were not associated with HRT use. CONCLUSIONS: Sociodemographic factors, such as region and education, may be more strongly associated with use of HRT than clinical factors, such as risk for cardiovascular disease. Future efforts should focus on understanding sociodemographic variations, defining which women are most likely to benefit, and targeting therapy to them.