不同激素治疗方案对卵巢早衰患者骨代谢的影响研究

摘要

目的 探讨卵巢早衰(POF)患者骨代谢的变化及应用性激素替代治疗(HT)对其骨代谢的影响.方法 选择68例POF患者(POF组)及80例健康女性(对照组),比较两组骨密度及骨代谢指标25-羟维生素D3(25-OH-VD3)、骨钙素(BGP)水平.将POF患者随机分为两组,A组(34例)给予戊酸雌二醇/复合雌二醇环丙孕酮(克龄蒙),B组(34例)给予结合雌激素(倍美力)0.625 mg+醋酸甲羟孕酮6 mg周期序贯治疗,服药1年,比较两组治疗前后骨密度、骨代谢指标和血脂、血糖、雌二醇(E2)等指标的变化以及不良反应的发生情况.结果 POF组腰椎、股骨颈骨密度及25-OH-VD3水平显著低于对照组,BGP水平显著高于对照组,差异有统计学意义(P＜0.05).POF患者A、B两组治疗后骨密度及25-OH-VD3水平均显著高于治疗前,BGP水平显著低于治疗前,差异有统计学意义(P＜0.05).两组患者雌激素水平均较治疗前显著升高,且A组雌激素水平治疗后高于B组,差异有统计学意义(P＜0.05);体质指数、血糖治疗后均无明显变化,差异无统计学意义(P＞0.05);A组胆固醇(TC)水平显著低于其治疗前及B组治疗后水平,差异有统计学意义(P＜0.05).两组不良反应发生情况相似,差异无统计学意义(P＞0.05).结论 POF患者骨密度降低,两种性激素替代治疗方案对POF患者骨代谢均有明显的改善作用,克龄蒙对血脂存在较有利的影响.%Objective To evaluate the change of hone metaholism in women with premature ovarian failure ( POF ) and the effcet of different regimens of hormone therapy on their bone metabolism.Methods A total of 68 POF patients and 80 healthy similar age women as control group were recruited.and their bone mineral density ( BMD ) on lumbar 2 -4 and femoral neck and index of bone metabolism including 25 - hydroxychole calciferol ( 25 - OH - VD3 ) and bone gla protein ( BGP ) , POF patients were divided into two groups randomly: group A including 34 patients managed by Estradiol Valerate and Cyproterone Acetate tablets ( Climen ), and group B also including 34 patients managed hy sequential treatment of Premarin 0.625 mg and Medroxyprogesterone Acetate ( MPA ) 6 mg for one year.The changes of indexes of BMD.bone metabolism, blood lipid, blood sugar, and estradiol ( E2 ) , as well as the side - effect of the remedy in the two groups were compared before and after the treatment.Results The level of BMD of lumbar 2 -4 and femoral neck and the 25 - OH - VD3 level in POF group were significantly lower than those in the control group ( P ＜ 0.05 ).but the level of BGP was significantly higher ( P ＜ 0.05 ).After the treatment.the levels of BMD and 25 - OH - VD3 were increased significantly in group A and B, and the BGP level was significantly lowered ( P ＜0.05 ); the E2 level in group A and B was significantly increased, and it was higher in group A than in group B after treatment ( P ＜ 0.05 ).No significant difference was found in body mass index and blood sugar ( P ＞ 0.05 ).The cholesterol ( TC ) level in group A was significantly lower A than that before the treatment, as well as that in group B after the treatment ( P ＜ 0.05 ).The incidence of side - effects were similar between group A and group B, with no statistical difference ( P ＞ 0.05 ).Conclusion Women with POF have lower hone density.Two therapies of hormone replacement can significantly improve bone metabolism of POF patients.And Climen is beneficial to blood lipid of POF women.