[摘要]目的：探讨基于肾虚冲任失养理论指导下补肾调冲汤治疗围绝经期综合征的临床疗效。方法：选取2023年1月至2026年1月期间在本院接受治疗的114例围绝经期综合征（PMS）患者为研究对象，根据入院顺序编号后随机分为对照组（常规西医治疗）、观察组（常规西医+肾虚冲任失养理论指导下补肾调冲汤治疗）各57例。对比两组临床疗效及治疗前后雌激素水平、中医证候积分、改良Kupperman评分及生活质量水平。结果：与对照组治疗后临床疗效总有效率78.95%对比，观察组94.74%显著升高（P＜0.05）。治疗后观察组雌二醇（E2）水平比对照组高，卵泡刺激素（FSH）、黄体生成素（LH）水平均比对照组低（P＜0.05）。治疗后观察组烘热汗出、心烦不宁、腰膝酸软、手足心热、口干便坚症状的中医证候积分均比对照组低（P＜0.05）。治疗后观察组改良Kupperman评分、围绝经期综合征生存质量量表（MENQOL）评分均比对照组低（P＜0.05）。结论：基于肾虚冲任失养理论指导的补肾调冲汤治疗围绝经期综合征，能够显著提升疗效，调节性激素水平，降低中医证候积分，改善临床症状与生活质量，值得临床推广。

目的 分析围绝经期女性糖脂代谢水平与卵巢储备功能减退（DOR）的相关性，并探讨绝经激素治疗的应用价值。方法 回顾性选取2024年2月至2026年2月就诊于本院的194例围绝经期女性为研究对象，根据其卵巢储备功能将其分为DOR组（n=103）与卵巢储备功能正常组（NOR，n=91）。比较2组临床资料，采用Logistic回归分析围绝经期女性DOR的危险因素，绘制ROC曲线分析其预测效能，并利用Spearman相关系数分析指标相关性。同时予以所有患者绝经激素治疗（MHT），比较治疗前后的性激素指标、糖代谢指标、超声指标及安全性指标。结果 Logistic多因素结果显示：年龄、FSH、HbA1c、TG是围绝经期女性DOR的重要影响因素（P＜0.05）。ROC结果显示：联合预测的AUC=0.982，95%CI为0.964~1.000，灵敏度为0.990，特异度为0.923，校准曲线拟合性好。卵巢储备功能与年龄、FSH、HbA1c、TG均呈显著正相关（P均<0.05）。与治疗前相比，FSH、LH、HbA1c、TG、LDL-C水平有明显下降（P＜0.05），子宫内膜厚度略有增加（P＜0.05）；AMH、卵巢体积无显著变化（P＞0.05）。MHT治疗后不良反应发生率为4.64%。结论 糖脂代谢异常与围绝经期女性DOR密切相关，是其重要危险因素。规范MHT干预可有效改善内分泌代谢紊乱，且安全性可靠。

Objective To analyze the correlation between glycolipid metabolism levels and diminished ovarian reserve (DOR) in perimenopausal women, and to explore the application value of menopausal hormone therapy.Methods A total of 194 perimenopausal women admitted to our hospital from February 2024 to February 2026 were retrospectively enrolled. They were divided into the DOR group (n=103) and the normal ovarian reserve (NOR) group (n=91) according to ovarian reserve function. Clinical data were compared between the two groups. Logistic regression analysis was used to identify risk factors for DOR. Receiver operating characteristic (ROC) curves were plotted to evaluate predictive efficacy, and Spearman correlation analysis was performed to assess indicator correlations. All patients received menopausal hormone therapy (MHT). Sex hormone indicators, glycolipid metabolic indicators, ultrasonographic indicators and safety indicators were compared before and after treatment.Results Multivariate Logistic regression showed that age, folliclestimulating hormone (FSH), glycated hemoglobin A1c (HbA1c) and triglyceride (TG) were independent risk factors for DOR in perimenopausal women (P＜0.05). ROC analysis revealed that the combined prediction yielded an AUC of 0.982 (95%CI: 0.964–1.000), with a sensitivity of 0.990 and a specificity of 0.923, and good calibration curve fitting. Ovarian reserve was significantly positively correlated with age, FSH, HbA1c and TG (all P＜0.05). After treatment, levels of FSH, luteinizing hormone (LH), HbA1c, TG and lowdensity lipoproteincholesterol (LDLC) decreased significantly (P＜0.05), and endometrial thickness increased slightly (P＜0.05). No significant changes were observed in antiMüllerian hormone (AMH) and ovarian volume (P＞0.05). The incidence of adverse reactions after MHT was 4.64%.Conclusion Abnormal glycolipid metabolism is closely associated with DOR and serves as a critical risk factor in perimenopausal women. Standardized MHT can effectively improve endocrinemetabolic disorders with satisfactory safety.

目的：探析更年安片配合芬吗通对于围绝经期综合征的治疗效果。方法：对我院诊治的82例围绝经期综合征患者进行随机分组，对照组、试验组各41例。对照组以芬吗通治疗，试验组以更年安片配合芬吗通治疗。对治疗后两组的症状严重度，生活质量，总体疗效及不良反应展开比较。结果：治疗后，相较于对照组，试验组Greene更年期症状量表（GCS）、改良Kupperman评估量表（KMI）评分更低（P＜0.05）；治疗后，相较于对照组，试验组更年期特异性生活质量量表（MENQOL）评分更低，简明健康调查量表（SF-36）评分更高（P＜0.05）；相较于对照组的75.61%，试验组92.68%的总有效率更高（P＜0.05）；试验组14.63%的不良反应发生率与对照组的9.76%无明显差异（P＞0.05）。结论：围绝经期综合征患者接受更年安片配合芬吗通治疗，能促进症状改善，起到增效作用，并能提升生活质量，且未明显增加不良反应。

目的 探讨绝经后2型糖尿病人群性激素水平与体质指数（BMI）的关系。方法 收集2022年1月—2023年1月在我院住院的2型糖尿病患者,随机选取自然绝经后女性184例,根据其BMI分组,其中肥胖组23例、超重组74例、BMI正常组87例,比较3组间临床资料及性激素差异。结果 3组间腰围、空腹血糖（FPG）、甘油三酯、高密度脂蛋白胆固醇、血尿酸、卵泡刺激素（FSH）、黄体生成素（LH）、雌激素（E₂）比较差异均有统计学意义（均P<0.05）,肥胖组和超重组的E₂高于正常组,FSH及LH低于正常组。3组间年龄、糖化血红蛋白、收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇、催乳素、睾酮、孕酮比较差异均无统计学意义（均P>0.05）。Logistic回归分析显示,过高的腰围和较低的FSH、LH是绝经后2型糖尿病女性肥胖的影响因素。结论 2型糖尿病绝经后女性应控制腹型肥胖,定期复查LH、FSH,提早干预。

Objective To investigate the relationship between sex hormone levels and body mass index（BMI）in postmenopausal women with type 2 diabetes mellitus（T2DM）．Methods A total of 184 cases of natural postmenopausal women with T2DM admitted to our hospital from January 2022 to January 2023 were randomly selected,including 23 cases of obesity,74 cases of over weight and 87 cases of normal BMI．The clinical data and sex hormones among the three groups were analyzed．Results Waist circumference,fasting plasma glucose（FPG）,triglyceride,high density lipoprotein cholesterol,uric acid,follicle-stimulating hormone（FSH）,luteinizing hormone（LH）and oestrogen（E₂）levels were significantly different among the three groups（P<0.05）．E₂ levels of the obesity group and the over weight group were significantly higher than that of the normal group,while FSH and LH levels were significantly lower than that of the normal group．There was no significant difference in age,hemoglobin A1c,systolic blood pressure,diastolic blood pressure,total cholesterol,low density lipoprotein cholesterol,prolactin,testosterone and progesterone levels among the three groups（P>0.05）．Logistic regression analysis showed that higher waist circumference and lower FSH and LH levels were significantly correlated with obesity in postmenopausal women with T2DM．Conclusions Abdominal obesity should be controlled in postmenopausal women with T2DM,and LH and FSH should be periodically reviewed,in order to treat in advance．

目的 探讨围绝经期功能失调性子宫出血患者应用宫腔镜电切术联合炔诺酮治疗对临床效果的影响。方法 选取2017年1月—2020年9月在我院治疗的87例围绝经期功能失调性子宫出血患者,按照随机数字表法分成观察组(n=44)与对照组(n=43),观察组采用宫腔镜电切术联合炔诺酮治疗,对照组仅采用宫腔镜电切术治疗,比较2组临床疗效、手术情况、住院时间、不良反应发生率,分析治疗前后子宫形态、血红蛋白含量变化。结果 观察组治疗总有效率为100.00%,对照组为86.05%,观察组高于对照组(P<0.05);2组手术时间、术中出血量、膨宫液用量、住院时间比较无差异(P>0.05);2组治疗后子宫内膜厚度增加(P<0.05),血红蛋白水平下降(P<0.05),观察组子宫内膜厚度大于对照组(P<0.05),血红蛋白水平较对照组更低(P<0.05);观察组不良反应发生率为9.09%,对照组为27.91%,观察组低于对照组(P<0.05)。结论 宫腔镜电切术联合炔诺酮应用于围绝经期功能失调性子宫出血患者治疗中能够促进子宫状况改善,提高临床疗效,且安全性较高,值得临床推广。

目的 观察新疆石河子地区绝经后女性2型糖尿病(T2DM)患者糖、脂、骨代谢特征及骨密度(BMD)情况,探讨该人群中低密度脂蛋白受体相关蛋白5(LRP5)基因rs3736228、rs3781586位点的基因多态性及突变与糖、脂、骨代谢指标的关系。方法 将新疆石河子地区2016年10月—2017年10月社区、医院门诊及住院绝经后女性按照纳入标准和排除标准选取136例为研究对象,根据患者病史、糖耐量实验及骨密度仪测定骨密度分4组,糖耐量正常与骨量正常组(A组),糖耐量正常与骨量异常组(B组),T2DM与骨量正常组(C组),T2DM与骨量异常组(D组)。测定并记录患者年龄、绝经年限等基线资料,计算体质指数(BMI)等,并检测糖代谢指标(空腹血糖等)、骨代谢指标(血Ca等)、脂代谢指标(甘油三酯等)。采用MALDI-TOF-MS法测定LRP5基因该两个位点基因多态性并进行统计分析。结果 ①糖代谢指标:与A组比较,C组、D组FPG、HbA1c均高于A组(P<0.01)。脂代谢指标:与A组比较,B组、D组TG低于A组(P<0.05)。骨代谢指标:与A组比较,B组、D组BMD(L1-4)、BMD(股骨颈)低于A组(P<0.01)。②LRP5基因该两个位点SNP基因分型分布符合Hardy-Weinberg遗传平衡定律(P>0.05);同时,该两个位点不同基因型的分布频率和等位基因频率在组间的比较经Pearson Chi-Square检验后发现暂无显著差异(P>0.05)。③LRP5基因rs3736228位点:A组,与CC型(野生型)相比,CT/TT型(突变型)甘油三酯(TG)降低(P<0.05),BMD(L1-4)降低(P<0.05);C组,与CC型(野生型)相比,CT/TT型(突变型)高密度脂蛋白(HDL-C)升高(P<0.01),磷(P)升高(P<0.05);LRP5基因rs3781586位点:B组,与GG型(野生型)相比,GT/TT(突变型)高密度脂蛋白(HDL-C)升高(P<0.05)。结论 在新疆石河子地区绝经后女性2型糖尿病人群中,LRP5基因rs3736228、rs3781586位点的基因多态性可能与糖代谢无关,但LRP5基因rs3736228位点的突变可能与脂代谢(TG、HDL-C)、骨代谢(P、BMD)有关,rs3781586位点的突变可能与脂代谢(HDL)有关。

Objective To observe the characteristics of glucose, lipid and bone metabolism and bone mineral density (BMD)in postmenopausal women with type 2 diabetes mellitus (T2DM)in Shihezi district of Xinjiang province, and to investigate the relationship in the polymorphism and mutation of rs3736228 and rs3781586 of LRP5 gene and glucose,lipid and bone metabolism indexes in this population. Method A total of 136 postmenopausal Han women, who were related in the outpatient department, community, and hospital after hospitalization in Shihezi district of Xinjiang province from October 2016 to October 2017, were selected as the study subjects by the inclusion criteria and exclusion criteria.According to the patient's medicalhistory, glucosetolerance test results and bone mineral density (BMD), they were divided into 4 groups: normal glucose tolerance and normal bone mass (group A), normal glucose tolerance and abnormal bone mass (group B), type 2 diabetes and normal bone mass (group C), and type 2 diabetes mellitus and abnormal bone mass (group D). Baseline data such as patient's age, menopause years were measured and recorded, and body mass index (BMI)was calculated. Simultaneously, glucose metabolism indicators including fasting blood glucose (FBG, etc), bone metabolism indicators (blood Ca, etc), lipid metabolism indicators(triglycerides, etc)were detected. The polymorphisms of rs3736228 and rs3781586 of LRP5 gene were determined by Maldi-Tof-Ms and those data were analyzed statistically. Results ①Glucose metabolism index: compared with group A: FPG and HbAlc in group C, group D were all higher than group A (P<0.01). Lipid metabolism index: compared with group A, TG in group B and group D was lower than that in group A (P<0.05). Bone metabolism index: compared with group A, BMD (L1- 4)and BMD (femoral neck)in group B and group D were lower than those in group A (P<0.01). ②The distribution of SNP genotypes at rs3736228, rs3781586 of LRP5 conformsed to the Hardy-Weinberg genetic equilibrium law (P>0.05). The distribution frequency and allele frequency of LRP5 genotypes rs3736228, rs3781586 were compared among the groups. Pearson chi-square test showed no significant difference (P>0.05). ③Rs 3736228 locus of LRP5 gene:in group A, compared with CC (wild type), CT/TT (mutated type)triglyceride (TG)decreased (P<0.05), BMD (L1- 4)decreased (P<0.05). In group C, compared with CC (wild type), CT/TT (mutated type)high-density lipoprotein (HDL-C)increased (P<0.05), phosphorus increased (P<0.05). Rs 3781586 locus of LRP5 gene: in group B, compared with GG (wild type), GT/TT (mutated type)high-density lipoprotein (HDL-C)increased (P<0.05).Conclusion In the Xinjiang Shihezi district among postmenopausal women with type 2 diabetes, rs3736228, rs3781586 loci of LRP5 gene polymorphism may be irrelevant to glucose metabolism, but the mutation of rs3736228 of LRP5 gene locus may be related to lipid metabolism and bone metabolism (TG, HDL-C, BMD, P), and the mutation of rs3781586 may be related to lipid metabolism (HDL-C).

目的 了解城市围绝经期妇女绝经综合征的发生现状及分析相关影响因素,为进一步加强围绝经期妇女的保健工作提供理论依据。方法 纳入2019年2月—2020年2月就诊于广州市妇女儿童医疗中心中西医妇科门诊、天河及越秀区某社区的40～60岁女性共1 013名,采用问卷调查及Kupperman评分表收集出生日期,月经情况(初潮、绝经年龄等),孕产史,既往疾病史,身高、体质量,工作性质、家庭收入及个性等特征。结果 1 013例妇女的平均年龄是(47.70±4.95)岁,已绝经267例,未绝经女性中月经规律458例、月经紊乱288例,平均绝经年龄(49.49±3.26)岁。Kupperman评分超过15分(即诊断为绝经综合征)392 例(38.7%),其中轻度(15～20分) 222例(56.63%),中度(21～35分)162例(41.33%),重度(>35分)8例(2.04%)。多因素Logistic 回归分析表明,有慢性疾病较无慢性疾病史,月经紊乱、绝经较月经规律,家庭情况一般较和睦女性出现围绝经期症状风险升高,未观察到婚姻状况、个性特征、上班时长、社会适应、负性事件经历与围绝经期症状的出现相关。结论 广州城市存在绝经综合征的女性以轻中度为主,有慢性疾病、月经紊乱、绝经、家庭关系一般女性的绝经综合征发生风险较高,故应重视对全社会进行围绝经相关知识的宣教,重视家庭关系的和谐维护,当围绝经期妇女出现相关症状须及时寻求帮助,以保障广大围绝经期妇女顺利度过围绝经期阶段。

Objective To investigate the menopause symptoms and factors of the premenopausal women in urban areas, and thereby provide theoretical basis for their health care. Methods The research data was collected from 1 013 patients (age between 40-60) in the gynecology clinic and adult traditional Chinese medicine clinic in Guangzhou Women and Children's Medical Center, and the communities in Tian'he and Yue'xiu during February 2019—February 2020. By applying the questionnaire and Kupperman score table, the survey was conducted on the dates of birth, menstruations, times of menarche and menopause, records on pregnancy and childbirth, previously diagnosed diseases, heights, weights, classifications of work, family incomes, and personalities, etc. Results The average age of the 1 013 women was 47.70±4.95. Among them, 267 were with menopause (happening in 49.49±3.26 years old), 458 had regular menstruation, while 288 were with menstrual disorder. In the Kupperman scale, the scores of 392 cases (38.7%) were above 15, which can be diagnosed with menopause symptoms. Among them, the majority (222 cases, 56.63%) were with slight symptoms (15-20 scores), followed by 162 cases (41.33%) with moderate symptoms (21-35 scores), and 8 cases (2.04%) with severe symptoms (above 35 scores) respectively. Logistic regression analysis demonstrated that compared with women having satisfactory family relationship, participants suffering from chronic diseases, menstrual disorder, and poor family relationships, had higher risks of perimenopause. However, it had no relations with the marital status, personalities, working hours, social adaptabilities, and negative life events. Conclusion Guangzhou urban women with menopause symptoms are mainly slight and moderate. Participants with chronic diseases, menstrual disorders and poor family relationships are at a higher risk of having menopause symptoms. Therefore, it is recommended to popularize the knowledge of menopause in the society and attach importance to the maintenance of satisfactory family relationship. When perimenopausal women have relevant symptoms, they should seek medical help in time thus they can smoothly pass the peri-menopausal stage.

目的 分析绝经前后女性2型糖尿病(type 2 diabetes mellitus,T2DM)患者C肽水平与代谢综合征(metabolic syndrome,MS)的关系。方法 选定本院2019年3月—2021年3月接诊的64例绝经前后T2DM患者作为试验组,以及同期门诊体检的64例健康女性作为参照组,检测并比较两组空腹C肽、餐后2 h C肽、血糖指标、血清炎症指标、血脂指标、血压指标,比较两组MS发生率,Pearson分析空腹C肽、餐后2 h C肽与血糖指标、血清炎症指标、血脂、血压的相关性。结果 试验组空腹C肽、餐后2h C肽、餐后2 h 血糖、空腹血糖、白细胞计数、TNF-α、IL-6、LDL-C、甘油三酯、总胆固醇、收缩压、舒张压均高于参照组,试验组HDL-C低于参照组,P＜0.05。试验组MS发生率(12.50%)高于参照组(1.56%),P＜0.05。空腹C肽、餐后2 h C肽与2 h PG、FPG、WBC、TNF-α、IL-6、LDL-C、TG、TC、SBP、DBP呈正相关性,与HDL-C呈负相关性,P＜0.05。结论 绝经前后T2DM患者普遍存在血脂、血压、血糖代谢紊乱及炎症反应,C肽水平增高会增加MS发生率,应当引起临床重视。

Objective To analyze the relationship between C-peptide and metabolic syndrome (MS) in premenopausal and postmenopausal women with type 2 diabetes mellitus (T2DM). Methods A total of 64 premenopausal and postmenopausal T2DM patients in our hospital from March 2019 to March 2021 were included in the experimental group, and 64 healthy women in the same period were selected as the control subjects. Fasting C-peptide, postprandial 2h C-peptide and blood glucose, serum inflammatory factors, blood lipid and blood pressure were detected and compared between the two groups. The incidence of MS was compared between the two groups. The relationship among fasting C-peptide, postprandial 2h C-peptide and blood glucose, serum inflammation, blood lipid and blood pressure were analyzed by Pearson correlation. Results Fasting C-peptide,postprandial 2h C-peptide, 2hPG, FPG, WBC, TNF-a, IL-6, LDL-C, TG, TC, SBP, DBP of the experimental group were higher than those of the control group. HDL-C of the experimental group was lower than that of the control group, P<0.05. The incidence of MS in the experimental group (12.50%) was higher than that in the control group (1.56%), P< 0.05. Fasting C-peptide and postprandial 2h C-peptide were positively correlated with 2hPG, FPG, WBC, TNF-a, IL-6, LDL-C, TG, TC, SBP and DBP, and negatively correlated with HDL-C (P<0.05). Conclusion The metabolic disorder of blood lipid, blood pressure, blood glucose and inflammatory reaction were common in T2DM patients before and after menopause. The increase of C-peptide level would increase the incidence of MS, which should be paid attention in clinic practice.

目的 比较阿那曲唑与他莫昔芬治疗激素受体阳性绝经后转移性乳腺癌[HR（+）MBC]的疗效和安全性。方法 本次研究对象为在我院诊治的80例HR（+）MBC患者,选取时间段为2016年1月—2018年1月,随机分为各40例的阿那曲唑组与他莫昔芬组,比较两组临床疗效及安全性差异。结果 治疗3个月后,阿那曲唑组的临床缓解率（92.50%）优于他莫昔芬组（72.50%）,性激素E2、LH、P水平低于他莫昔芬组,T水平高于他莫昔芬组（P<0.05）;治疗期间,两组患者的不良反应发生率（30.00%、25.00%）比较无统计学意义（P>0.05）。结论 阿那曲唑治疗HR（+）MBC效果确切,有利于调节机体性激素水平,减慢癌症进展,对于提高患者的生存质量有重要意义。

目的 观察尝试采用激素替代疗法(hormonereplace menttherapy,HRT)治疗更年期疾病的干眼症的临床疗效。方法 将80例(160眼)干眼症患者随机分成2组,治疗组40例(80眼)在滴人工泪液的基础上采用激素替代疗法(HRT)口服治疗。对照组40例(80眼)单纯采用人工泪液滴眼液滴双眼。两组同时给予综合护理。3个月后观察疗效。结果 治疗组总有效率82.5%,对照组总有效率60%,两组总有效率比较差异有统计学意义(P<0.05),治疗组疗效优于对照组。结论 在人工泪液滴眼液滴双眼的基础上尝试采用激素替代疗法(HRT)治疗更年期疾病的干眼症患者,效果优于单纯应用人工泪液点眼。

Objective To investigate the role of hormone replace menttherapy (HRT) in treating xerophthalmia among patients with climacteric disease. Methods Eighty xerophthalmia patients (160 eyes) were randomly divided into two groups. Forty patients in the treatment group (80 eyes) were treated using combined HRT and artificial drops. Forty patients in the control group (80 eyes) were treated using artificial drops alone. All patients were provided comprehensive nursing. The evaluation of clinical effects was performed after 3 months of treatment. Results The total effective rate of both groups was 82.5% in the treatment group and 60% in the control group, respectively (P<0.05). Conclusion Combined HRT and artificial drops is more effective in treating climacteric disease-related xerophthalmia than using artificial drops only.