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发育医学电子杂志  2022, Vol. 10 Issue (5): 353-359    DOI: 10.3969/j.issn.2095-5340.2022.05.005
  围产医学   论著 |产科 |
绝经后女性长期服用替勃龙对代谢指标的影响和安全性评价
薛婉君 郭雪桃 闫雅茹 王叶叶 续晓蓓
1. 山西医科大学 第一临床医学院,山西 太原 030001;2. 山西医科大学第一医院 妇科,山西 太原030001
Effect and safety evaluation of metabolic indexes in postmenopausal women with long-term use of tibolone
Xue Wanjun, Guo Xuetao, Yan Yaru, et al
1. The First Clinical Medical College,Shanxi Medical University, Shanxi, Taiyuan 030001, China; 2. Department of Gynecology, The First Hospitalof Shanxi Medical University, Shanxi, Taiyuan 030001, China
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摘要 【摘要】 目的  探讨绝经后女性长期服用替勃龙对糖脂代谢的影响及长期用药的安全性。 方法 回顾性分析2011 年11 月至2021 年12 月在山西医科大学第一医院就诊的符合绝经激素治疗(menopausehormone therapy,MHT)的绝经后女性,纳入68 例,口服替勃龙1.25 mg/d。随访至12、24、36 个月,病例数分别为68、50、32 例。收集体质量指数(body mass index,BMI)、腰围、收缩压、舒张压、改良Kupperman 评分、空腹血糖、总胆固醇(total cholesterol,TC)、三酰甘油(triglycerides,TG)、血清高密度
脂蛋白胆固醇(high-density lipoprotein,HDL-C)及血清低密度脂蛋白胆固醇(low-density lipoprotein,
LDL-C)、肝肾功能、骨密度等资料。统计学方法采用t 检验、秩和检验。 结果 改良Kupperman 评分
的基线值为(20.0±8.9)分,替勃龙治疗3 个月后明显下降至(7.2±5.5)分,(t=11.967,P<0.001)。观察期内BMI、腰围、收缩压、舒张压均未出现明显的变化,差异无统计学意义(P 值均>0.05)。治疗12 个
月后,TC、TG 分别为[4.6(4.0,5.1)和0.9(0.7,1.1)mmol/L];治疗24 个月后,TC、TG 分别为[4.6(3.9,5.0)和0.8(0.6,1.2)mmol/L],均低于治疗前[5.0(4.4,5.4)、1.1(0.8,1.6)和 4.9(4.2,5.2) 、1.0(0.8,1.6)mmol/L,P 值均<0.05]。HDL-C 在治疗12、24、36 个月分别为[1.3(1.1,1.5)、1.3(1.1,1.6)、1.2(1.0,1.6)mmol/L],均低于治疗前[1.4(1.2,1.8)、1.6(1.3,1.9)、1.5(1.3,1.8)mmol/L,P 值均<0.01]。治疗不同时间段LDL-C 和空腹血糖下降,但差异无统计学意义(P>0.05)。治疗36 个月后,尿素(bloodurea nitrogen,Urea) 治疗后的数值低于治疗前[4.9(4.6,7.8)与4.6(3.9,4.9)mmol/L,P<0.05];治疗12个月后,肌酐(creatinine,CRE)治疗后的数值高于治疗前[57.0(26.4,66.6)与68.0(59.0,78.5) μmol/L,P<0.05],但在正常范围值内。治疗后左髋、右髋骨密度无明显变化,差异无统计学意义(P 值均>0.05);腰椎骨密度分别为[(0.934±0.104)、(0.936±0.121)、(0.986±0.156)g/cm2]均高于治疗前[(0.911±0.112)、
(0.905±0.135)、(0.919±0.171)g/cm2, P<0.05]。 结论 替勃龙用药3 个月后更年期症状明显改善甚至消失。最长用药36 个月对体质量、体态以及血压影响不大,能够有效降低TC、TG 水平,同时降低了
HDL-C 水平,对肝、肾功能无影响,提高了腰椎的骨密度,对髋部骨密度无影响。
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关键词:  替勃龙  绝经后女性  糖脂代谢  安全性  总胆固醇    
Abstract: 【Abstract】 Objective To investigate the effect and the safety on glucose and lipid metabolism inpostmenopausal women with long-term use of tibolone. Method From November 2011 to December
2021, 68 postmenopausal women who had undergone menopause hormone therapy (MHT) in the First
Hospital of Shanxi Medical University by retrospective analysis , who oral tibolone 1.25 mg/d. Follow-up to
12, 24 and 36 months, the number of cases were 68, 50 and 32. Body mass index (BMI) ,waist circumference,systolic pressure, diastolic blood pressure, modified Kupperman score, fasting blood glucose, total cholesterol,triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C),liver and kidney function values, bone mineral density were collected. t-test and rank sum test were used forstatistical analysis. Result The baseline value of the modified Kupperman score was (20.0±8.9), whichwas significantly decreased to (7.2±5.5) after 3 months of tibolone treatment, the difference was statisticallysignificant (t=11.967, P<0.001). There was no statistical significance in BMI, waist circumference, systolicpressure, diastolic blood pressure, during the observation period (P>0.05). After 12 months of treatment, TCand TG were [4.6 (4.0, 5.1) vs 0.9 (0.7, 1.1) mmol/L], respectively; after 24 months of treatment, TC and TGwere [4.6 (3.9, 5.0) vs 0.8 (0.6, 1.2) mmol/L], respectively, which were lower than those before treatment[5.0 (4.4, 5.4), 1.1 (0.8, 1.6) vs 4.9 (4.2, 5.2), 1.0 (0.8, 1.6) mmol/L, all P<0.05]. HDL-C at 12, 24 and 36months of treatment were [1.3 (1.1, 1.5), 1.3 (1.1, 1.6), 1.2 (1.0, 1.6) mmol/L], respectively, which werelower than those before treatment [1.4 (1.2, 1.8), 1.6 (1.3, 1.9), 1.5 (1.3, 1.8) mmol/L, all P<0.01]. There wasno statistical significance in LDL-C and fasting blood glucose decreased in different treatment time periods(P>0.05); After 36 months of treatment, Urea was lower than before treatment [4.9 (4.6, 7.8) vs 4.6 (3.9,4.9) mmol/L], the difference was statistically significant (P<0.05). After 12 months of treatment , CRE washigher than before treatment [57.0 (26.4, 66.6) vs 68.0 (59.0, 78.5) μmol/L], the difference was statisticallysignificant (P<0.05), but within the normal range. There was no significant change in the bone mineraldensity of the left hip and right hip at different time periods (P>0.05); the bone mineral density of the lumbarspine were [(0.934±0.104), (0.936±0.121) and (0.986±0.156) g/cm2], higher than those before treatment
[(0.911±0.112), (0.905±0.135) and (0.919±0.171) g/cm2, P<0.05]. Conclusion After 3 months of
tibolone treatment, menopausal symptoms are significantly improved or even disappeared. It has little effecton body weight, body posture and blood pressure with longest medication for 36 months, it can effectivelyreduce the levels of TC and TG, while reducing the level of HDL-C, it has no effect on the liver and kidneyfunctions; the bone density of the lumbar spine is improved, and had no effect on the bone mineral density of the hip.
Key words:  Tibolone    Postmenopausal women    Glucose and lipid metabolism    Safety    Total cholesterol
收稿日期:  2022-01-27                     发布日期:  2022-09-30     
通讯作者:  郭雪桃    E-mail:  gxt_999@163.com
引用本文:    
薛婉君 郭雪桃 闫雅茹 王叶叶 续晓蓓. 绝经后女性长期服用替勃龙对代谢指标的影响和安全性评价[J]. 发育医学电子杂志, 2022, 10(5): 353-359.
Xue Wanjun, Guo Xuetao, Yan Yaru, et al. Effect and safety evaluation of metabolic indexes in postmenopausal women with long-term use of tibolone. Journal of Developmental Medicine(Electronic Version), 2022, 10(5): 353-359.
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