绝经激素治疗对不同绝经年龄和绝经方式女性骨密度的影响

Effects of menopausal hormone therapy on bone mineral density in women of different menopausal ages and modes

摘要

目的 探讨绝经激素治疗(MHT)对不同绝经年龄和绝经方式女性骨密度(BMD)的影响。方法 选择2012年1月至2021年12月就诊于西安交通大学第一附属医院的绝经后女性869人为研究对象,按照绝经年龄将其分为40~44岁组(n=127)、45~49岁组(n=348)、50~54岁组(n=305)、55~59岁组(n=89);按照治疗方式将其分为MHT组(n=521)与非MHT组(n=348),再根据治疗时间分为<1年组(n=94)、1~<3年组(n=258)、3~<5年组(n=110)、≥5年组(n=59).观察研究对象的腰椎(L1~L4)BMD、股骨BMD、T值,分析MHT对不同绝经年龄、绝经方式、治疗时间女性BMD的影响。结果 不同绝经年龄组的腰椎(L1~L4)BMD、股骨BMD、T值比较差异均有统计学意义(F值分别为3.205、3.807、4.558,P<0.05),绝经年龄越早BMD越低.40~44岁组、45~49岁组手术绝经者的腰椎(L1~L4)BMD、股骨BMD、T值均明显低于自然绝经者,经比较差异均有统计学意义(t值分别为2.490、2.550、2.907、2.210、2.308、2.775,P<0.05),而50~54岁组、55~59岁组手术绝经与自然绝经者的腰椎(L1~L4)BMD、股骨BMD、T值比较差异均无统计学意义(t值分别为1.009、1.121、1.209、0.701、0.865、0.962,P>0.05).MHT组的腰椎(L1~L4)BMD、股骨BMD、T值均明显高于非MHT组,差异均有统计学意义(t值分别为3.769、4.120、4.303,P<0.05);不同绝经年龄组MHT治疗后腰椎(L1~L4)BMD、股骨BMD均明显高于治疗前,差异均有统计学意义(t=2.579~4.018,P<0.05);MHT组在治疗2年后低骨量、骨质疏松的患病率均低于治疗前,差异均有统计学意义(χ²值分别为24.563、4.262,P<0.05),而非MHT组低骨量、骨质疏松的患病率比较差异均无统计学意义(χ²值分别为1.357、1.043,P>0.05).自然绝经MHT组的腰椎(L1~L4)BMD、股骨BMD、T值均明显高于非MHT组,差异均有统计学意义(t值分别为2.450、2.637、3.102,P<0.05),手术绝经MHT组的腰椎(L1~L4)BMD、股骨BMD、T值改善效果更为明显,差异均有统计学意义(t值分别为4.079、4.202、4.615,P<0.01),随着治疗时间的延长,MHT不同时间组的腰椎(L1~L4)BMD、股骨BMD、T值增加值均明显升高,差异均有统计学意义(F值分别为3.508、3.946、4.785,P<0.05)。结论 MHT可显著改善绝经后女性BMD,使用时间越早,效果越显著;绝经后女性应在专业医生指导下,排除禁忌证后尽早开始MHT,特别是因手术绝经的年轻女性.

Abstract

Objective To investigate the effects of menopausal hormone therapy (MHT) on bone mineral density (BMD) in women with different menopausal ages and modes. Methods A total of 869 postmenopausal women admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January 2012 to December 2021 were selected as study subjects, and they were divided into 40-44 years old group (n=127), 45-49 years old group (n=348), 50-54 years old group (n=305), 55-59 years old group (n=89) according to menopause age, and then according to the treatment modality into the group of MHT group (n=521) and non-MHT group (n=348), and then according to the treatment time, they were divided into <1 year group (n=94), 1-<3 years group (n=258), 3-<5 years group (n=110), and ≥5 years group (n=59). The lumbar (L1-L4) BMD, femoral BMD, and T-value of the study participants were observed, and the effects of MHT on BMD in women with different menopausal ages, menopausal modes, and treatment time were analyzed. Results There were significant differences in lumbar (L1-L4) BMD, femoral BMD and T values among women of different menopause age groups (F=3.205, 3.807 and 4.558, respectively, P<0.05), the earlier menopause age, the lower the BMD. The lumbar (L1-L4) BMD, femoral BMD, and T values of surgical menopausal patients in the 40-44 and 45-49 age groups were significantly lower than those of naturally menopausal patients, and the differences were statistically significant (t=2.490, 2.550, 2.907, 2.210, 2.308 and 2.775, respectively, P<0.05), there was no significant difference in lumbar (L1-L4) BMD, femoral BMD, and T values between the 50-54 and 55-59 age groups (t=1.009, 1.121, 1.209, 0.701, 0.865 and 0.962, respectively, P>0.05). The lumbar (L1-L4) BMD, femoral BMD, T-value of MHT group were significantly higher than those of non-MHT group, and the differences were statistically significant (t=3.769, 4.120 and 4.303, respectively, P<0.05). The BMD of lumbar spine (L1-L4) and femoral BMD were significantly higher after MHT treatment in different menopausal age groups than before treatment, and the differences were statistically significant (t=2.579-4.018, P<0.05). The prevalence of low bone mass and osteoporosis were lower than that before treatment in MHT group after 2 years of treatment, and the differences were statistically significant (χ ²=24.563 and 4.262, respectively, P<0.05), while there was no significant difference in the prevalence of low bone mass and osteoporosis in the non-MHT group (χ²=1.357 and 1.043, respectively, P>0.05). The lumbar (L1-L4) BMD, femoral BMD, and T values of the natural menopausal MHT group were significantly higher than those of the non-MHT group, and the differences were all statistically significant (t=2.450, 2.637 and 3.102, respectively, P<0.05). The increased values of lumbar (L1-L4) BMD, femoral BMD, and T value were more obvious in the surgically menopausal MHT group, and the differences were all statistically significant (t=4.079, 4.202 and 4.615, respectively, P<0.01). With the prolongation of the treatment time, the increased values of lumbar (L1-L4) BMD, femoral BMD, and T value of the MHT groups with different time were all significantly higher, and the differences were statistically significant (F=3.508, 3.946 and 4.785, respectively, P<0.05). Conclusion MHT can significantly improve BMD in postmenopausal women, the more significant effect were observed when MHT was used earlier. Postmenopausal women should start MHT as early as possible after excluding contraindicated syndrome under the guidance of professional doctors, especially young women after surgical menopause.

关键词

绝经激素治疗 / 绝经年龄 / 绝经方式 / 骨密度 / 影响

Key words

menopausal hormone therapy / menopausal age / menopause mode / bone mineral density / effects

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基金资助

陕西省卫生健康科研基金项目(2018D054)