一项随机、开放标签、交叉研究，比较口服与经皮雌激素疗法对自然绝经女性血清雄激素、甲状腺激素和肾上腺激素的影响。

A randomized, open-label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones, and adrenal hormones in naturally menopausal women.

作者信息

Shifren Jan L, Desindes Sophie, McIlwain Marilyn, Doros Gheorghe, Mazer Norman A

机构信息

Vincent Obstetrics and Gynecology Service, Massachusetts General Hospital, Boston, MA 02114, USA.

出版信息

Menopause. 2007 Nov-Dec;14(6):985-94. doi: 10.1097/gme.0b013e31803867a.

DOI:10.1097/gme.0b013e31803867a

PMID:17507833

Abstract

OBJECTIVE

To compare the changes induced by oral versus transdermal estrogen therapy on the total and free serum concentrations of testosterone (T), thyroxine (T4), and cortisol (C) and the concentrations of their serum binding globulins sex hormone-binding globulin, thyroxine-binding globulin, and cortisol-binding globulin in naturally menopausal women.

DESIGN

Randomized, open-label, crossover. Interventions included a 6-week withdrawal from previous hormone therapy (baseline), followed in randomized order by 12 weeks of oral conjugated equine estrogens (CEE) (0.625 mg/d) and 12 weeks of transdermal estradiol (TD E2) (0.05 mg/d), with oral micronized progesterone (100 mg/d) given continuously during both transdermal estrogen therapy regimens.

RESULTS

Twenty-seven women were enrolled in the study, and 25 completed both treatment periods. The mean(SD) percentage changes from baseline of sex hormone-binding globulin, total T, and free T with oral CEE were +132.1% (74.5%), +16.4% (43.8%), and -32.7% (25.9%), respectively, versus +12.0% (25.1%), +1.2% (43.7%), and +1.0% (45.0%) with TD E2. The mean (SD) percentage changes of thyroxine-binding globulin, total T4, and free T4 with oral CEE were +39.9% (20.1%), +28.4% (29.2%), and -10.4% (22.3%), respectively, versus +0.4% (11.1%), -0.7% (16.5%), and +0.2% (26.6%) with TD E2. The mean (SD) percentage changes of cortisol-binding globulin, total C, and free C with oral CEE were +18.0% (19.5%), +29.2% (46.3%), and +50.4% (126.5%), respectively, versus -2.2% (11.3%), -6.7% (30.8%), and +1.8% (77.1%) with TD E2. Concentrations of all hormones and binding globulins were significantly different (P < or = 0.003) during administration of oral versus transdermal estrogen therapy, except for free T4 and free C.

CONCLUSIONS

Compared with oral CEE, TD E2 exerts minimal effects on the total and free concentrations of T, T4, and C and their binding proteins.

摘要

目的

比较口服雌激素疗法与经皮雌激素疗法对自然绝经女性血清总睾酮（T）、游离睾酮、甲状腺素（T4）和皮质醇（C）浓度及其血清结合球蛋白（性激素结合球蛋白、甲状腺素结合球蛋白和皮质醇结合球蛋白）浓度的影响。

设计

随机、开放标签、交叉试验。干预措施包括在6周内停用先前的激素疗法（基线期），然后随机依次接受12周的口服共轭马雌激素（CEE）（0.625毫克/天）和12周的经皮雌二醇（TD E2）（0.05毫克/天），在两种经皮雌激素治疗方案期间均持续给予口服微粒化孕酮（100毫克/天）。

结果

27名女性参与了该研究，25名完成了两个治疗期。口服CEE时，性激素结合球蛋白、总T和游离T相对于基线的平均（标准差）百分比变化分别为+132.1%（74.5%）、+16.4%（43.8%）和-32.7%（25.9%），而TD E2组分别为+12.0%（25.1%）、+1.2%（43.7%）和+1.0%（45.0%）。口服CEE时，甲状腺素结合球蛋白总T4和游离T4相对于基线的平均（标准差）百分比变化分别为+39.9%（20.1%）、+28.4%（29.2%）和-10.4%（22.3%），而TD E2组分别为+0.4%（11.1%）、-0.7%（16.5%）和+0.2%（26.6%）。口服CEE时，皮质醇结合球蛋白、总C和游离C相对于基线的平均（标准差）百分比变化分别为+18.0%（19.5%）、+29.2%（46.3%）和+50.4%（126.5%），而TD E2组分别为-2.2%（(11.3%）、-6.7%（30.8%）和+1.8%（77.1%）。除游离T4和游离C外，口服雌激素疗法与经皮雌激素疗法期间所有激素和结合球蛋白的浓度均有显著差异（P≤0.003）。