2019 年第 11 期 第 14 卷

超低剂量雌激素对伴绝经症状围绝经期综合征患者激素代谢和糖脂代谢的影响

Effect of ultra-low dose of estrogen on hormone metabolism and glycolipid metabolism in patients with menopausal and perimenopausal syndromes

作者：兰代群

英文作者：

单位：551700海南省儋州市，海南西部中心医院妇产科

英文单位：

关键词：绝经症状；围绝经期综合征；雌激素；剂量

英文关键词：

• 摘要：

• 【摘要】目的    探究超低剂量雌激素对伴绝经症状围绝经期综合征（PMS）患者激素代谢、糖脂代谢的影响。方法    抽取2018年6月至2019年2月海南西部中心医院收治的伴绝经症状PMS患者180例，以随机数字表法分为A、B、C组，每组60例。以28 d为1个周期，A、B、C组分别连续服用戊酸雌二醇片2、1、0.5 mg/d，每周期第14天起均连续服用地屈孕酮片10 mg/d。比较3组治疗前和治疗3、6个周期后改良Kupperman评分和治疗6个周期后临床疗效。比较3组治疗前与治疗6个周期后激素代谢指标［促卵泡生长激素（FSH）、雌二醇］和糖脂代谢指标［空腹血糖、空腹胰岛素（FINS）、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇（HDL-C）］，分析改良Kupperman评分与激素代谢指标和糖脂代谢指标的相关性，统计治疗过程中不良反应发生情况。结果    治疗3、6个周期后3组改良Kupperman评分均明显低于治疗前（均P＜0.05），治疗6个周期后A组改良Kupperman评分明显低于B、C组［（5.9±1.2）分比（8.0±1.8）、（8.1±1.8）分］（均P＜0.05），但3组总有效率比较，差异无统计学意义（P=0.635）。A组治疗6个周期后FSH明显低于B、C组，雌二醇明显高于B、C组（均P＜0.05）。3组治疗6个周期后各项糖脂代谢指标水平比较差异均无统计学意义（均P＞0.05）。改良Kupperman评分与FSH、空腹血糖、FINS、LDL-C水平呈正相关，与雌二醇、HDL-C水平呈负相关（均P＜0.05）。C组不良反应发生率明显低于A组［5.0%（3/60）比16.7%（10/60）］（P=0.040）。结论    标准剂量、低剂量、超低剂量雌激素治疗PMS均可取得较好的疗效，标准剂量在缓解PMS患者的绝经症状、改善激素代谢方面更突出，超低剂量在耐受性方面更有优势，临床应结合患者实际情况确定剂量。

• 【Abstract】Objective    To investigate the effect of ultra-low dose of estrogen on hormone metabolism and glycolipid metabolism in patients with perimenopausal syndrome(PMS) and menopausal symptoms. Methods    A total of 180 PMS patients with menopausal symptoms admitted to Central Hospital of Western Hainan from June 2018 to February 2019 were randomly divided into group A, B and C, with 60 cases in each group. Group A, B and C took estradiol valerate tablets 2, 1 and 0.5 mg/d respectively, with 28 days as a cycle, and took dydrogesterone tablets 10 mg/d on the 14th-28th days. Modified Kupperman score was measured before and after 3, 6 cycles of treatment. Clinical efficacy was observed after 6 cycles of treatment. Hormone metabolism indexes［follicle growth stimulating hormone(FSH) and estradiol］, glycolipid metabolism indexes［fasting blood glucose(FBG), fasting insulin(FINS), total cholesterol, triglyceride, low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C)］ were detected before and after 6 cycles of treatment. Correlations among modified Kupperman score, hormone metabolism and glycolipid metabolism indexes were analyzed. Occurrence of adverse reactions was observed. Results    Modified Kupperman score significantly decreased after 3 and 6 cycles of treatment in the 3 groups(all P＜0.05); the score in group A after 6 cycles of treatment was significantly lower than that in group B and C［（5.9±1.2） vs （8.0±1.8）,（8.1±1.8）］(both P＜0.05). There was no significant difference in the total effective rate among the 3 groups(P=0.635). After 6 cycles of treatment, FSH in group A was significantly lower and estradiol was higher than those in group B and C(all P＜0.05). There were no significant differences in glycolipid metabolism indexes among the 3 groups(all P＞0.05). Modified Kupperman score was positively correlated with FSH, FBG, FINS, LDL-C and negatively correlated with estradiol and HDL-C(all P＜0.05). Incidence of adverse reactions in group C was significantly lower than that in group A［5.0%（3/60） vs 16.7%（10/60）］（P=0.040）. Conclusions    Standard dose, low dose and ultra-low dose of estrogen can achieve good curative effect on PMS. Standard dose of estrogen is more effective in relieving menopausal symptoms and improving hormone metabolism. Ultra-low dose of estrogen shows more advantages with respect to the tolerance. Clinical dose should be determined according to the individual condition of patients.