Ushiroyama T, Sakuma K, Ikeda A, Ueki M
Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki 569-8686, Japan.
J Med. 2004;35(1-6):281-94.
The purpose of this study was to clarify the adequate reduction rate of pituitary gonadotropins in ideal clinical management of shortterm hormone replacement therapy (ST-HRT) in postmenopausal women with undefined symptoms. Subjects included a total 324 postmenopausal patients between 48 and 61 years of age who visited the Department of Obstetrics and Gynecology at Osaka Medical College Hospital for the consult of menopausal symptoms. Administration of conjugated equine estrogen (0.625 mg/day) and progestin (2.5 mg/day) in the patients for 8 weeks. HRT was markedly effective in 28.7% of cases, effective in 40.7%, fairly effective in 21.9%, and ineffective in 8.6% of cases. The plasma concentration of FSH and LH after administration decreased significantly (P < 0.001) by 58.1% and 59.9% for markedly effective cases, and by 31.0% and 36.1% for effective cases. On the other hand, decreases in FSH and LH concentration were 14.1% and 1.3% for the fairly effective and 8.5% and -5.1% for ineffective cases, demonstrating a significantly greater decrease in plasma FSH and LH levels in the markedly effective and effective cases than those in ineffective cases (P < 0.001). There were significant differences in the reduction rates of plasma FSH and LH levels between in cases showing (59.9% and 53.2%) and not showing the side effects (24.8% and 25.9%), respectively (P < 0.0001). In conclusion, efficacy of ST-HRT was significantly correlated to the degree of decrease in plasma FSH and LH levels in patients with undefined symptoms. In addition, efficacy appeared to be correlated to the incidence of side effects. The degree of reduction of FSH (24.8-31.0%) and LH (25.9-36.1%) from the baseline may possibly be used as the suitable therapeutic window for hormone levels during HRT. The present results suggest that plasma gonadotropin levels could be a useful indicator for the management of patients undergoing short-term HRT for women with menopausal symptoms.
本研究的目的是明确在绝经后症状不明确的女性短期激素替代疗法（ST-HRT）的理想临床管理中，垂体促性腺激素的适当降低率。研究对象包括324名年龄在48至61岁之间的绝经后患者，她们因绝经症状前往大阪医科大学医院妇产科咨询。患者服用结合马雌激素（0.625毫克/天）和孕激素（2.5毫克/天）8周。HRT在28.7%的病例中显著有效，40.7%有效，21.9%效果尚可，8.6%无效。给药后，显著有效病例的血浆FSH和LH浓度分别显著降低（P<0.001）58.1%和59.9%，有效病例降低31.0%和36.1%。另一方面，效果尚可病例的FSH和LH浓度降低分别为14.1%和1.3%，无效病例降低8.5%和-5.1%，表明显著有效和有效病例的血浆FSH和LH水平降低幅度明显大于无效病例（P<0.001）。出现（59.9%和53.2%）和未出现副作用（24.8%和25.9%）的病例之间，血浆FSH和LH水平的降低率存在显著差异（P<0.0001）。总之，ST-HRT的疗效与症状不明确患者血浆FSH和LH水平的降低程度显著相关。此外，疗效似乎与副作用的发生率相关。FSH（24.8-31.0%）和LH（25.9-36.1%）相对于基线的降低程度可能作为HRT期间激素水平的合适治疗窗口。目前的结果表明，血浆促性腺激素水平可能是绝经症状女性短期HRT患者管理的有用指标。
