超声观察绝经后长期小剂量激素替代疗法对子宫、卵巢和乳腺的影响
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摘要
目的 观察长期小剂量激素替代疗法(hormone replacementtherapy，HRT)对绝经后妇女子宫、卵巢和乳腺的影响和相应的超声影像学特点。以及不同类型的激素所产生的影响差异，在超声影像学方面的表现。
方法 52例绝经后妇女，根据不同用药方案分为利维爱组和雌孕激素组，分别给予小剂量激素(利维爱或雌激素联合孕激素)替代治疗，用药时间5～31年，应用经阴道超声及高频超声观察子宫、卵巢和乳腺的形态结构特征。
结果 利维爱组和雌孕激素组妇女的子宫体积、内膜厚度、双侧卵巢面积、双侧乳腺腺体层厚度及导管宽度均大于对照组，其中两个用药组的内膜厚度与对照组相比较，差异均具有显著性(P＜0.05)；雌孕激素组的子宫体秋和乳腺腺体层厚度显著大于或厚于对照组(P＜0.05)。乳腺结构改变方面，除局灶纤维化型以外，其余四型(小叶增生型、导管增生型、囊肿型及纤维腺瘤样增生型)的发生率均高于对照组。小叶增生型中利维爱组和雌孕激素组的发生率较对照组显著增高(利维爱组P＜0.05，雌孕激素组P＜0.005)；导管增生型中仅雌孕激素组与对照组的差异具有显著性(P＜0.05)。两个用药组之间比较，差异均无显著性。经超声检查，用药组妇女的子宫、卵巢和乳腺均未发现恶性肿瘤表现。
结论 长期小剂量HRT能够延缓子宫、卵巢和乳腺的萎缩进程，子宫体积、内膜厚度、双侧卵巢面积及乳腺腺体层厚度均大于对照组；不同的用药方案对上述靶器官的影响有所不同，低剂量激素利维爱对子宫和乳腺的刺激性弱于小剂量雌孕激素联合应用；小剂量HRT对发生子宫内膜癌、卵巢癌和乳腺癌的危险性无明显影响；在应用HRT过程中，运用超声检查监测子宫、卵巢和乳腺的变化具有重要意义。
Objective To investigate the effects of uterus, ovary and breast in postmenopausal women under long-term and low-dose hormone replacement therapy (HRT) by using ultrasonography.
Methods Total of 52 healthy postmenopausal women was divided into two study groups according to different schedule in medicine. One study group was used low-does of Livial (generic:Tibolone); another group was given low-does of estrogen plus progestin(E-P). Duration of all subjects was from 5 to 31 years. The appearance and structural features of uterus, ovary and breast were observed by transvaginal ultrasonography and mammary ultrasonography.
Results When compared with the non-HRT women, the uterine volume, endometrial thickness, bilateral ovarian area, bilateral breast glandular section thickness and breast duct width after HRT were higher than control group, but significant difference in endometrial thickness was found (p<0.05). The uterine volume and breast glandular section thickness in the women with estrogen and progestin were significantly different from those with non-HRT (p<0.05). No variation was observed in the two treatment groups. The breast structure changes occurrence of the subjects with HRT was higher than that of non-HRT except the type of local focus fibrosis. The incidence of lobule hyperplasic type in either treatment groups was higher than control group (the group with Livial :P<0.05, the group with E-P:
方法 52例绝经后妇女，根据不同用药方案分为利维爱组和雌孕激素组，分别给予小剂量激素(利维爱或雌激素联合孕激素)替代治疗，用药时间5～31年，应用经阴道超声及高频超声观察子宫、卵巢和乳腺的形态结构特征。
结果 利维爱组和雌孕激素组妇女的子宫体积、内膜厚度、双侧卵巢面积、双侧乳腺腺体层厚度及导管宽度均大于对照组，其中两个用药组的内膜厚度与对照组相比较，差异均具有显著性(P＜0.05)；雌孕激素组的子宫体秋和乳腺腺体层厚度显著大于或厚于对照组(P＜0.05)。乳腺结构改变方面，除局灶纤维化型以外，其余四型(小叶增生型、导管增生型、囊肿型及纤维腺瘤样增生型)的发生率均高于对照组。小叶增生型中利维爱组和雌孕激素组的发生率较对照组显著增高(利维爱组P＜0.05，雌孕激素组P＜0.005)；导管增生型中仅雌孕激素组与对照组的差异具有显著性(P＜0.05)。两个用药组之间比较，差异均无显著性。经超声检查，用药组妇女的子宫、卵巢和乳腺均未发现恶性肿瘤表现。
结论 长期小剂量HRT能够延缓子宫、卵巢和乳腺的萎缩进程，子宫体积、内膜厚度、双侧卵巢面积及乳腺腺体层厚度均大于对照组；不同的用药方案对上述靶器官的影响有所不同，低剂量激素利维爱对子宫和乳腺的刺激性弱于小剂量雌孕激素联合应用；小剂量HRT对发生子宫内膜癌、卵巢癌和乳腺癌的危险性无明显影响；在应用HRT过程中，运用超声检查监测子宫、卵巢和乳腺的变化具有重要意义。
Objective To investigate the effects of uterus, ovary and breast in postmenopausal women under long-term and low-dose hormone replacement therapy (HRT) by using ultrasonography.
Methods Total of 52 healthy postmenopausal women was divided into two study groups according to different schedule in medicine. One study group was used low-does of Livial (generic:Tibolone); another group was given low-does of estrogen plus progestin(E-P). Duration of all subjects was from 5 to 31 years. The appearance and structural features of uterus, ovary and breast were observed by transvaginal ultrasonography and mammary ultrasonography.
Results When compared with the non-HRT women, the uterine volume, endometrial thickness, bilateral ovarian area, bilateral breast glandular section thickness and breast duct width after HRT were higher than control group, but significant difference in endometrial thickness was found (p<0.05). The uterine volume and breast glandular section thickness in the women with estrogen and progestin were significantly different from those with non-HRT (p<0.05). No variation was observed in the two treatment groups. The breast structure changes occurrence of the subjects with HRT was higher than that of non-HRT except the type of local focus fibrosis. The incidence of lobule hyperplasic type in either treatment groups was higher than control group (the group with Livial :P<0.05, the group with E-P:
引文
1 张缙熙，姜玉新．浅表器官及组织超声诊断学[M]．北京：科学技术文献出版社，2000．74-89．
2 Shimizu M, Ubmuller J, Hartwein J, et al. A comparative study of sonographic and histopathologic findings of tumors lesions in the parotid gland[J]. Oral Surg Oral Med Oral Pathol, 1999, 88(6): 723-737.
3 谢琦，陈孝岳．腮腺肿瘤的超声与手术病理对照[J]．中国医学影像技术，1999，15(10)：764．
4 Gritzmann N. Sonography of the salivary glands[J]. AJR, 1989, 153: 161-166.
5 Shimizu M, Ubmuller J, Hartwein J, et al. Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland[J]. Oral Surg Oral Med Oral Pathol, 1999, 88(2): 226-233.
6 焦明德，田家玮，任卫东，等．临床多普勒超声学[M]．北京：北京医科大学中国协和医科大学联合出版社，1997．606-611．
7 邹兆菊，马绪臣．口腔颌面医学影像诊断学(第二版)[M]．北京：人民出版社，1997．364．
8 Rinast E, Gmelin E, Hollands-Thorn B. Digital subtraction sialography, conventional sialography, high-resolution ultrasonography and computed tomography in the diagnosis of salivary gland diseases[J]. Eur J Radiol, 1989, 9: 224-230.
9 Haels J, Lenarz T. Ultrasscalldiagnostik benigner and maligner parotistutnoren[J]. Laryng Rhinol Otol. 1986, 65: 480-484.
10 Hausegger KW, Krasa H, Pelzmann W, et al. Sonographie der Speieheldrtisen. Ultraschall Med[J]. 1993, 14: 68-74.
11 李树玲．头颈部肿瘤学[M]．天津：天津科学技术出版社，1986．335-336．
12 Miwa K, Yuasa K, Yonetsu K, et al. Diagnostic accuracy of ultrasonography for salivary gland tumors[J]. J of the Japanese??Stomatologieal Society. 1995, 44: 240-244.
13 俞光岩，邹兆菊，郝凤鸣等．腮腺区肿块灰阶超声检查的初步报告[J]．中华口腔医学杂志，1998，23(6)：342．
14 Ishikawa H, Ishii Y, Ono T, et al. Evaluation of gray-scale ultrasonography in the investigation of oral and neck mass lesions[J]. J Oral Maxillofac Surg, 1983, 41: 775.
15 Ballerini G, Mantero M, Sbrocca M. Ultrasonic patterns of parotid masses[J]. JCU, 1984, 12(6): 273-277.
16 Taylor KJW, Ramos I, Carter D. Correlation of Doppler US tumor signals with neovascular morphologic features[J]. Radiol, 1988, 166(1): 157-163.
17 Martinoli C, Lorenzo E, Solbiati L, et al. Color Doppler sonography of salivary glands[J]. AJR, 1994, 163 (10): 933-941.
18 郭军，张玉珍，郑文，等．彩色多普勒超声在涎腺肿块诊断中的应用[J]．中华口腔医学杂志，1999，34：142-144．
19 詹维伟，燕山，龚雷萌．涎腺肿块的彩色多普勒血流显像研究[J]．中国超声医学杂志，1997，13(5)：41-44．
20 王保钢，党渭楞，李延平，等．彩色多普勒超声在涎腺肿块鉴别诊断中的应用[J]．中国超声影像学杂志，1996，5(3)：132-133．
21 林萍，祁志良．彩色多普勒超声对腮腺肿块的血流动力学研究[J]．中国超声医学杂志，1997，13(11)：31-32．
22 张青萍．关于CDE的若干技术问题及应用前景[J]．中国医学影像技术，1996，12(5)：324-326．
2 Shimizu M, Ubmuller J, Hartwein J, et al. A comparative study of sonographic and histopathologic findings of tumors lesions in the parotid gland[J]. Oral Surg Oral Med Oral Pathol, 1999, 88(6): 723-737.
3 谢琦，陈孝岳．腮腺肿瘤的超声与手术病理对照[J]．中国医学影像技术，1999，15(10)：764．
4 Gritzmann N. Sonography of the salivary glands[J]. AJR, 1989, 153: 161-166.
5 Shimizu M, Ubmuller J, Hartwein J, et al. Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland[J]. Oral Surg Oral Med Oral Pathol, 1999, 88(2): 226-233.
6 焦明德，田家玮，任卫东，等．临床多普勒超声学[M]．北京：北京医科大学中国协和医科大学联合出版社，1997．606-611．
7 邹兆菊，马绪臣．口腔颌面医学影像诊断学(第二版)[M]．北京：人民出版社，1997．364．
8 Rinast E, Gmelin E, Hollands-Thorn B. Digital subtraction sialography, conventional sialography, high-resolution ultrasonography and computed tomography in the diagnosis of salivary gland diseases[J]. Eur J Radiol, 1989, 9: 224-230.
9 Haels J, Lenarz T. Ultrasscalldiagnostik benigner and maligner parotistutnoren[J]. Laryng Rhinol Otol. 1986, 65: 480-484.
10 Hausegger KW, Krasa H, Pelzmann W, et al. Sonographie der Speieheldrtisen. Ultraschall Med[J]. 1993, 14: 68-74.
11 李树玲．头颈部肿瘤学[M]．天津：天津科学技术出版社，1986．335-336．
12 Miwa K, Yuasa K, Yonetsu K, et al. Diagnostic accuracy of ultrasonography for salivary gland tumors[J]. J of the Japanese??Stomatologieal Society. 1995, 44: 240-244.
13 俞光岩，邹兆菊，郝凤鸣等．腮腺区肿块灰阶超声检查的初步报告[J]．中华口腔医学杂志，1998，23(6)：342．
14 Ishikawa H, Ishii Y, Ono T, et al. Evaluation of gray-scale ultrasonography in the investigation of oral and neck mass lesions[J]. J Oral Maxillofac Surg, 1983, 41: 775.
15 Ballerini G, Mantero M, Sbrocca M. Ultrasonic patterns of parotid masses[J]. JCU, 1984, 12(6): 273-277.
16 Taylor KJW, Ramos I, Carter D. Correlation of Doppler US tumor signals with neovascular morphologic features[J]. Radiol, 1988, 166(1): 157-163.
17 Martinoli C, Lorenzo E, Solbiati L, et al. Color Doppler sonography of salivary glands[J]. AJR, 1994, 163 (10): 933-941.
18 郭军，张玉珍，郑文，等．彩色多普勒超声在涎腺肿块诊断中的应用[J]．中华口腔医学杂志，1999，34：142-144．
19 詹维伟，燕山，龚雷萌．涎腺肿块的彩色多普勒血流显像研究[J]．中国超声医学杂志，1997，13(5)：41-44．
20 王保钢，党渭楞，李延平，等．彩色多普勒超声在涎腺肿块鉴别诊断中的应用[J]．中国超声影像学杂志，1996，5(3)：132-133．
21 林萍，祁志良．彩色多普勒超声对腮腺肿块的血流动力学研究[J]．中国超声医学杂志，1997，13(11)：31-32．
22 张青萍．关于CDE的若干技术问题及应用前景[J]．中国医学影像技术，1996，12(5)：324-326．