本文選題：絕經(jīng)　切入點(diǎn)：激素補(bǔ)充治療　出處：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討絕經(jīng)后女性行激素補(bǔ)充治療(Hormone Replacement Therapy,HRT)對心血管系統(tǒng)的保護(hù)作用及機(jī)制。方法收集近10年就診于我院門診的圍絕經(jīng)及絕經(jīng)患者共194例(其中82例補(bǔ)充性激素,112例未補(bǔ)充性激素)的臨床資料,依據(jù)是否進(jìn)行激素補(bǔ)充治療將其分為兩組,比較兩組之間血脂水平、頸動(dòng)脈內(nèi)中膜厚度(IMT)、頸動(dòng)脈收縮期最大血流速度(PSV)等的差異。其中HRT組患者中,切除子宮患者予單純雌激素(戊酸雌二醇、17β-雌二醇)或替勃龍連續(xù)補(bǔ)充治療;具有完整子宮者,未絕經(jīng)者予雌孕激素序貫治療;絕經(jīng)者予雌孕激素連續(xù)聯(lián)合治療或替勃龍連續(xù)補(bǔ)充治療。結(jié)果(1)HRT組TC、TG、LDL水平低于非HRT組,HDL水平高于非HRT組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);HRT組頸動(dòng)脈相關(guān)指標(biāo)優(yōu)于非HRT組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)將HRT組與非HRT組患者均按照絕經(jīng)時(shí)間分組,分為絕經(jīng)時(shí)間1年、1≤絕經(jīng)時(shí)間3、3≤絕經(jīng)時(shí)間5、絕經(jīng)時(shí)間≥5四亞組,HRT組患者TC、TG、HDL、LDL水平均優(yōu)于非HRT組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)將處于同一絕經(jīng)年限的HRT組與非HRT組兩組患者血脂水平與頸動(dòng)脈內(nèi)中膜厚度、流速等指標(biāo)進(jìn)行比較:(1)血脂比較絕經(jīng)時(shí)間1年,血脂水平、頸動(dòng)脈相關(guān)指標(biāo)水平均無明顯差異(P0.05);1≤絕經(jīng)時(shí)間3年,HRT組LDL水平低于非HRT組(P0.05),HDL水平高于非HRT組(P0.05),TC、TG水平無顯著差異(P0.05);3≤絕經(jīng)時(shí)間5年,HRT組TC、LDL水平明顯低于非HRT組(P0.05),HDL水平高于非HRT組(P0.05),TG水平無顯著差異(P0.05);絕經(jīng)時(shí)間≥5,HRT組TC、TG、LDL水平低于非HRT組(P0.05),HDL水平無顯著差異(P0.05)。(2)頸動(dòng)脈比較絕經(jīng)時(shí)間1年,HRT組R-ICA IMT小于非HRT組(P0.05),ICA PSV慢于非HRT組(P0.05),HRT組其余指標(biāo)無明顯差異(P0.05);1≤絕經(jīng)時(shí)間3年,除L-CCA分叉處IMT、L-CCAPSV外,HRT組其余指標(biāo)HRT組均優(yōu)于非HRT組(P0.05);3≤絕經(jīng)時(shí)間5年,除CCA分叉處IMT外,HRT組其余指標(biāo)均優(yōu)于非HRT組(P0.05);絕經(jīng)時(shí)間≥5,除R-CCA IMT及分叉處IMT外,HRT組其余指標(biāo)均優(yōu)于非HRT組(P0.05);相同絕經(jīng)年限內(nèi),HRT組與非HRT組頸動(dòng)脈內(nèi)膜病變及斑塊無明顯差異(P0.05)。(4)將HRT組患者按照HRT時(shí)間1、1≤HRT時(shí)間3、3≤HRT時(shí)間5、HRT時(shí)間≥5分為四亞組,四亞組之間血脂水平無明顯差異(P0.05);頸動(dòng)脈IMT、PSV、內(nèi)膜、斑塊無顯著差異(P0.05)。結(jié)論圍絕經(jīng)及絕經(jīng)期盡早行HRT治療,可有效改善血脂水平,減少脂質(zhì)沉積,降低頸動(dòng)脈內(nèi)中膜厚度、降低血流速度,延緩動(dòng)脈粥樣硬化等心血管疾病的發(fā)生,從而有效保護(hù)心血管。
[Abstract]:Objective to investigate the protective effect and mechanism of hormone replacement therapy (HRT) on cardiovascular system in postmenopausal women. Methods A total of 194 postmenopausal and postmenopausal women (82 of them) were enrolled in our hospital in recent 10 years. Clinical data of 112 cases without hormone supplementation. They were divided into two groups according to whether they were treated with hormone supplementation or not. The differences of blood lipid levels, carotid intima-media thickness (IMT), maximum systolic blood flow velocity (PSV) of carotid artery were compared between the two groups. Patients with resected uterus were treated with estrogen (estradiol valerate 17 尾 -estradiol) or tibolone continuously, while those with intact uterus and unmenopausal women were given sequential treatment of estrogen and progesterone. Results the level of TCG in HRT group was lower than that in non HRT group, and the difference was statistically significant (P 0.05). The carotid artery related indexes in HRT group were better than those in non HRT group. The difference was statistically significant (P 0.05). The patients in HRT group and non HRT group were divided into two groups according to menopausal time: 1 year postmenopause 1 鈮，

本文編號：1658389