激素替代治疗对绝经妇女乳腺X线密度的影响

摘要

目的 探讨不同方案激素替代治疗(HRT)对绝经妇女乳腺X线密度的影响及其临床意义.方法 90例绝经后妇女随机分成3组:A组,每日结合雌激素(CEE)0.3 mg+孕激素醋酸甲羟孕酮(MPA)2 mg+钙尔奇D 600 1片;B组,每日CEE 0.625 mg+MPA 2 mg+钙尔奇D 600 1片;C组,每日钙尔奇D 600 1片.用药1年,Wolfe和半定量法计算并比较三组乳腺X线密度及A、B组用药前后乳腺X线密度的变化.结果 用药1年,两种方法计算乳腺X线密度,三组中密度最高为B组,其次为A、C组,差异有统计学意义(P＜0.01),A、B组乳腺X线密度分别与C组比较,差异均有统计学意义(P＜0.01或0.05);B组乳腺X线密度较A组升高,但差异无统计学意义(P＞0.05).A、B组用药前后自身比较,半定量法显示,A、B组用药后较用药前均增高(但前者P＞0.05,后者P＜0.01);B组用药后增高程度较A组高,但两组间差异无统计学意义(P＞0.05).结论 HRT能增高乳腺X线密度,且增高程度可能与剂量相关,提示HRT对乳腺有不良反应,应用HRT宜选最小有效剂量.乳腺X线密度可作为HRT对乳腺影响的监测指标.%Objective To investigate effects of hormone replacement therapy with conjugated equine estrogen (CEE) in different doses combined with medroxyprogesterone acetate ( MPA) on mammographic density among postmenopausal women and its clinical significance. Methods Ninety eligible postmenopausal women were randomized into three groups with varied treatment continuously for one year, Croup A receiving 0.3 mg CEE with 2 mg MPA and caltrate 600 mg and vitamin D 125 U daily; Group B receiving 0. 625 mg CEE combined with 2 mg MPA and caltrate 600 mg with vitamin D 125 U daily; and Group C receiving caltrate 600 mg and vitamin D 125 U daily. Mammographic density was analyzed using Wolfe and semi-quantitative methods for all of them and compared each other one year after treatment, as well as mammographic density before and after treatment in Groups A and B. Results One year after treatment, mammogrphic density reached the highest in postmenopausal woman of Group B and the lowest in those of Group C, with significant difference among the three groups (P ＜ 0. 01) and between Groups A and C (P ＜ 0. 01) and between Groups B and C ( P ＜ 0. 05 ). Mammogrphic density with semi-quantitative method increased significantly in Group A ( P ＜ 0. 05 ) and Group B ( P ＜ 0. 01 ), respectively, after treatment as compared with that before it. Change in mammografic density before and after treatment was greater in Group B than that in Group A, but not reaching statistically significant level (P ＞ 0. 05). Conclusions Hormone replacement therapy can cause the increase of mammographic density in postmenopausal women, possibly in a dose-dependent pattern, which suggest that HRT has side effect on breast tissue and the lowest effective dose of estrogen should be selected in HRT. Mammographic density can be used as an indicator to monitor side effect of HRT on breast.