Castelo-Branco C, Vicente J J, Figueras F, Sanjuan A, Martínez de Osaba M J, Casals E, Pons F, Balasch J, Vanrell J A
Department of Gynaecology and Obstetrics, Hospital Clínic i Provincial de Barcelona, Spain.
Maturitas. 2000 Feb 15;34(2):161-8. doi: 10.1016/s0378-5122(99)00096-1.
The main goals of estrogen replacement therapy (ERT) are the prevention of osteoporosis and cardioprotection and the improvement of quality of life (QL). Androgens and tibolone therapy may increase bone mineral density (BMD) to a greater extent than ERT and offer an increase in QL. Lipid and cardiovascular effects, however, are still a major concern.
To evaluate whether the addition of a weak androgen to ERT may improve postmenopausal bone loss and sexual activity without adverse effects on lipid pattern and to compare these effects with those observed after tibolone therapy.
This prospective study enrolled 120 surgical postmenopausal women; of these, 96 completed the 1-year follow-up. Patients were allocated to one of four groups. The first group (A; n = 23) received 4 mg of estradiol valerate plus 200 mg of enanthate of dihydroandrosterone im monthly. The second group (E; n = 26) received 50 microg/day of transdermal 17-b-estradiol continuously; the third (T; n = 23) received 2.5 mg of tibolone every day; and finally, the fourth group (C; n = 24) constituted a treatment-free control group. Bone mass (dual X-ray absorptiometry), serum total cholesterol, HDL, LDL, triglycerides, apolipoproteins A1 and B and sexual activity were evaluated before starting therapy and at the end of follow-up.
All active treatment groups showed an increase in BMD. This increase was higher in the A treatment group (4.08% P < 0.01). Sexuality improved significantly with therapy; however, tibolone and androgens increased scores to a greater extent than ERT. Androgen therapy was associated with significant increases in total cholesterol, LDL and triglycerides. Cholesterol and LDL fall into groups E and T, HDL into groups A and T and triglycerides in group T only.
The combined regimen of androgens and ERT increased vertebral bone mass and enhance sexual activity in postmenopausal women equal to that of tibolone and to a greater extent than ERT alone; its effects on lipids, however, are clearly adverse.
雌激素替代疗法（ERT）的主要目标是预防骨质疏松症、心脏保护以及改善生活质量（QL）。雄激素和替勃龙疗法可能比ERT更能增加骨矿物质密度（BMD），并提高生活质量。然而，脂质和心血管方面的影响仍是主要关注点。
评估在ERT中添加弱雄激素是否可改善绝经后骨质流失和性功能，且对脂质模式无不良影响，并将这些影响与替勃龙治疗后的效果进行比较。
这项前瞻性研究纳入了120名绝经后接受手术的女性；其中96名完成了1年的随访。患者被分配到四组中的一组。第一组（A组；n = 23）每月接受4毫克戊酸雌二醇加200毫克二氢雄甾酮庚酸酯皮下注射。第二组（E组；n = 26）每天持续接受50微克经皮17-β-雌二醇；第三组（T组；n = 23）每天接受2.5毫克替勃龙；最后，第四组（C组；n = 24）为未接受治疗的对照组。在开始治疗前和随访结束时评估骨量（双能X线吸收法）、血清总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯、载脂蛋白A1和B以及性功能。
所有积极治疗组的BMD均有所增加。A治疗组的增加幅度更高（4.08%，P < 0.01）。治疗后性功能显著改善；然而，替勃龙和雄激素比ERT使评分增加的幅度更大。雄激素治疗与总胆固醇、低密度脂蛋白和甘油三酯的显著增加有关。胆固醇和低密度脂蛋白在E组和T组下降，高密度脂蛋白在A组和T组上升，甘油三酯仅在T组上升。
雄激素与ERT联合方案可增加绝经后女性的椎骨骨量并增强性功能，与替勃龙相当，且比单独使用ERT的效果更好；然而，其对脂质的影响明显不利。
