CAJ | 학술논문

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.
목적 탐토불동방안격소체대치료(HRT)대절경부녀유선X선밀도적영향급기림상의의.방법 90례절경후부녀수궤분성3조:A조,매일결합자격소(CEE)0.3 mg+잉격소작산갑간잉동(MPA)2 mg+개이기D 600 1편;B조,매일CEE 0.625 mg+MPA 2 mg+개이기D 600 1편;C조,매일개이기D 600 1편.용약1년,Wolfe화반정량법계산병비교삼조유선X선밀도급A、B조용약전후유선X선밀도적변화.결과 용약1년,량충방법계산유선X선밀도,삼조중밀도최고위B조,기차위A、C조,차이유통계학의의(P＜0.01),A、B조유선X선밀도분별여C조비교,차이균유통계학의의(P＜0.01혹0.05);B조유선X선밀도교A조승고,단차이무통계학의의(P＞0.05).A、B조용약전후자신비교,반정량법현시,A、B조용약후교용약전균증고(단전자P＞0.05,후자P＜0.01);B조용약후증고정도교A조고,단량조간차이무통계학의의(P＞0.05).결론 HRT능증고유선X선밀도,차증고정도가능여제량상관,제시HRT대유선유불량반응,응용HRT의선최소유효제량.유선X선밀도가작위HRT대유선영향적감측지표.
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.