Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in...Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)”is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Additional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a Kwindow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a“worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only^conjugated equine estro-gens”and^medroxprogesterone acetate”have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound rece展开更多
目的研究连续性神经元特异性烯醇化酶(NSE)监测是否可预测心脏骤停(CA)后亚低温治疗(MHT)患者短期及远期神经功能预后。方法前瞻性收集2013年6月至2017年11月江苏大学附属医院ICU收治的CA后恢复自主循环并且MHT的患者共计130例,收集患...目的研究连续性神经元特异性烯醇化酶(NSE)监测是否可预测心脏骤停(CA)后亚低温治疗(MHT)患者短期及远期神经功能预后。方法前瞻性收集2013年6月至2017年11月江苏大学附属医院ICU收治的CA后恢复自主循环并且MHT的患者共计130例,收集患者的一般临床资料,监测入科第1、2、3、4天NSE值,观察30d神经功能预后及6个月神经功能预后,根据脑功能分级(CPC)将30 d CPC1~2级者定为A组,30 d CPC3~5级定为B组,6个月CPC1~2级定为C组,6个月CPC3~5级定为D组,分别比较各时间点A、B两组及C、D两组NSE值,同时采用ROC曲线分析每天NSE值是否与短期及长期预后存在相关性。结果①A、B两组及C、D两组分别进行组间比较,一般临床资料如性别、年龄、CA原因、CA前心律、APACHEⅡ评分、初始乳酸水平比较差异无统计学意义(P>0.05);②A、B两组比较,第1天A组NSE值为(60.32±14.00)ng/mL,B组NSE值为(69.04±20.91)ng/mL;第2天A组NSE值为(84.63±9.01)ng/mL,B组NSE值为(101.65±15.07)ng/mL;第3天A组NSE值为(57.35±13.03)ng/mL,B组NSE值为(72.51±6.85)ng/mL;第4天A组NSE值为(48.84±12.34)ng/mL,B组NSE值为(62.73±12.03)ng/mL;各时间点A组NSE明显低于B组(P<0.05);C、D两组比较,第1天C组NSE值为(57.66±10.13)ng/mL,D组NSE值为(68.51±20.66)ng/mL,第2天C组NSE值为(85.41±9.08)ng/mL,D组NSE值为(97.30±15.98)ng/mL,第3天C组NSE值为(56.26±11.81)ng/mL,D组NSE值为(66./9±14.17)ng/mL,第4天C组NSE值为(48.81±10.92)ng/mL,D组NSE值为(57.43±12.60)ng/mL,各时间点C组NSE明显低于D组(P<0.05)。③通过ROC曲线分析,预测30dCPC值,第1天的ROC曲线下面积(AUC)0.624(P<0.05),第2天AUC0.903(P<0.001),第3天AUC0.920(P<0.001),第4天AUC0.905(P<0.001),均对预后有预测意义。④通过ROC曲线分析,预测6个月CPC值,第1天AUC 0.651(P<0.05),第2天AUC0.773(P<0.001),第3天AUC0.798(P<0.001),第4天AUC0.788(P<0.001),均对预后有预测意义。结论对于CA后MHT患者,动态监测NSE值可预测短期及长期展开更多
目的：系统评价绝经激素治疗（MHT）循证临床实践指南。方法：计算机检索PubMed、Web of Science、美国国家指南库（national guideline clearinghouse，NGC）、国际指南网（guideline intemational network，GIN）及新西兰指南组（New ...目的：系统评价绝经激素治疗（MHT）循证临床实践指南。方法：计算机检索PubMed、Web of Science、美国国家指南库（national guideline clearinghouse，NGC）、国际指南网（guideline intemational network，GIN）及新西兰指南组（New Zealand Guidelines Group，NZGG）、中国期刊全文数据库和万方数据库，纳入MHT循证临床实践指南，检索时限为2005-2015年，采用指南研究与评价工具Ⅱ（Appraisal of Guidelines for Research and Evaluation Ⅱ，AGREEⅡ）评价指南方法学质量。提取指南中MHT的主要药物雌激素（E）、孕激素（P）、E＋P、替代药物替伯龙（Tibolone）和雷洛昔芬（Rolaxifene）对适用人群可能带来的利益、风险和使用方法，并通过核对数据后制戍清单。结果：纳入的6篇指南整体质量较好，其中5个指南的总体得分≥60％，仅北美绝经学会指南评分为58％。在范围和目的、参与人员、严谨性、清晰性、应用性、编辑独立性各领域的平均得分依次为81％、74％、67％、74％、53％、65％，应用性领域平均得分最低（53％）。所有指南均强调MHT实践应注意个体化，应充分考虑不同个体的生理情况，评估MHT利益和风险，同时需征求患者意愿。评估的内容包括对患者年龄、绝经类型及年限、绝经症状程度及MHT效用、MHT后心血管疾病及肿瘤风险、家族史等。5个指南推荐使用雌激素最低有效剂量缓解绝经期症状。结论：纳入研究的6个MHT循证临床实践指南整体质量较好，在MHT指南更新或制定新指南时应加强应用性领域的考虑。在MHT的临床实践中应体现个体化原则，做好风险和利益评估工作。激素使用的剂量方面提倡个体化使用雌激素最低有效剂量缓解绝经期症状。展开更多
基金supported by National Natural Science Foundation of China(No.81671411)Beijing Municipal Administration of Hospitals’Ascent Plan of China(No.DFL20181401).
文摘Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)”is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Additional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a Kwindow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a“worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only^conjugated equine estro-gens”and^medroxprogesterone acetate”have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound rece
文摘目的研究连续性神经元特异性烯醇化酶(NSE)监测是否可预测心脏骤停(CA)后亚低温治疗(MHT)患者短期及远期神经功能预后。方法前瞻性收集2013年6月至2017年11月江苏大学附属医院ICU收治的CA后恢复自主循环并且MHT的患者共计130例,收集患者的一般临床资料,监测入科第1、2、3、4天NSE值,观察30d神经功能预后及6个月神经功能预后,根据脑功能分级(CPC)将30 d CPC1~2级者定为A组,30 d CPC3~5级定为B组,6个月CPC1~2级定为C组,6个月CPC3~5级定为D组,分别比较各时间点A、B两组及C、D两组NSE值,同时采用ROC曲线分析每天NSE值是否与短期及长期预后存在相关性。结果①A、B两组及C、D两组分别进行组间比较,一般临床资料如性别、年龄、CA原因、CA前心律、APACHEⅡ评分、初始乳酸水平比较差异无统计学意义(P>0.05);②A、B两组比较,第1天A组NSE值为(60.32±14.00)ng/mL,B组NSE值为(69.04±20.91)ng/mL;第2天A组NSE值为(84.63±9.01)ng/mL,B组NSE值为(101.65±15.07)ng/mL;第3天A组NSE值为(57.35±13.03)ng/mL,B组NSE值为(72.51±6.85)ng/mL;第4天A组NSE值为(48.84±12.34)ng/mL,B组NSE值为(62.73±12.03)ng/mL;各时间点A组NSE明显低于B组(P<0.05);C、D两组比较,第1天C组NSE值为(57.66±10.13)ng/mL,D组NSE值为(68.51±20.66)ng/mL,第2天C组NSE值为(85.41±9.08)ng/mL,D组NSE值为(97.30±15.98)ng/mL,第3天C组NSE值为(56.26±11.81)ng/mL,D组NSE值为(66./9±14.17)ng/mL,第4天C组NSE值为(48.81±10.92)ng/mL,D组NSE值为(57.43±12.60)ng/mL,各时间点C组NSE明显低于D组(P<0.05)。③通过ROC曲线分析,预测30dCPC值,第1天的ROC曲线下面积(AUC)0.624(P<0.05),第2天AUC0.903(P<0.001),第3天AUC0.920(P<0.001),第4天AUC0.905(P<0.001),均对预后有预测意义。④通过ROC曲线分析,预测6个月CPC值,第1天AUC 0.651(P<0.05),第2天AUC0.773(P<0.001),第3天AUC0.798(P<0.001),第4天AUC0.788(P<0.001),均对预后有预测意义。结论对于CA后MHT患者,动态监测NSE值可预测短期及长期
文摘目的：系统评价绝经激素治疗（MHT）循证临床实践指南。方法：计算机检索PubMed、Web of Science、美国国家指南库（national guideline clearinghouse，NGC）、国际指南网（guideline intemational network，GIN）及新西兰指南组（New Zealand Guidelines Group，NZGG）、中国期刊全文数据库和万方数据库，纳入MHT循证临床实践指南，检索时限为2005-2015年，采用指南研究与评价工具Ⅱ（Appraisal of Guidelines for Research and Evaluation Ⅱ，AGREEⅡ）评价指南方法学质量。提取指南中MHT的主要药物雌激素（E）、孕激素（P）、E＋P、替代药物替伯龙（Tibolone）和雷洛昔芬（Rolaxifene）对适用人群可能带来的利益、风险和使用方法，并通过核对数据后制戍清单。结果：纳入的6篇指南整体质量较好，其中5个指南的总体得分≥60％，仅北美绝经学会指南评分为58％。在范围和目的、参与人员、严谨性、清晰性、应用性、编辑独立性各领域的平均得分依次为81％、74％、67％、74％、53％、65％，应用性领域平均得分最低（53％）。所有指南均强调MHT实践应注意个体化，应充分考虑不同个体的生理情况，评估MHT利益和风险，同时需征求患者意愿。评估的内容包括对患者年龄、绝经类型及年限、绝经症状程度及MHT效用、MHT后心血管疾病及肿瘤风险、家族史等。5个指南推荐使用雌激素最低有效剂量缓解绝经期症状。结论：纳入研究的6个MHT循证临床实践指南整体质量较好，在MHT指南更新或制定新指南时应加强应用性领域的考虑。在MHT的临床实践中应体现个体化原则，做好风险和利益评估工作。激素使用的剂量方面提倡个体化使用雌激素最低有效剂量缓解绝经期症状。
