| Objective:To explore the clinical effect of hormone replacement therapy in women of childbearing age of premature ovarian failure after blood transplantation,and to guide clinical treatment.Methods:Department of Gynecology,the First Affiliated Hospital of Suzhou University,April 2015-March 2017,64 patients Voluntary hormone replacement therapy(HRT)after blood transplantation,Patients with blood disease after transplantation to receive hormone replacement therapy were no obvious rejection,And the blood disease has been stable.Of these,44 patients had HRT for more than 6 months,The clinical data were analyzed before and after treatment,Comparison of clinical symptoms of premature ovarian failure before and after treatment,Symptom Self-Rating Scale(SCL-90),Ovarian function,Breast,bone mineral density changes.Follow the effects of follow-up hormone replacement therapy on women of childbearing age.Hormone replacement method:Estrogen and progesterone sequential treatment with Estradiol Valerate Tablets lmg/day,Even for 21 days,in the cycle of the first 12 days plus Dydrogesterone Tablets 10mg,q12h,a total of 10 days(Referred to as method one).Or with Complex Packing Estradiol Tablets,28 sheets per box,the first 14 tablets each containing estradiol 2mg,after 14 tablets each containing estradiol 2mg and Dydrogesterone 10mg),1 day in order(referred to as method two).After the end of treatment in the first 6 days of menstruation and then take the next course of treatment,Can not come to menstruation,After 14 days of withdrawal to start the next course of treatment.After the end of each course to follow-up patients with menstrual status and side effects after using hormonal drugs,According to the specific circumstances of individual adjustment of medication and dosage.Monitoring indicators:All patients were measured FSH,LH,E2,thyroid function,anti-Mullerian hormone,Uterine size,sinus follicle count,Bone density,breast molybdenum target or ultrasound(Breast size in line with the requirements of the molybdenum target to molybdenum target inspection,Breast is too small to do molybdenum target patients do breast ultrasound)before treatment.Fill in the symptom self-rating scale(SCL-90)And POF-related symptoms.HRT treatment after 6 months review FSH,LH,E2,AMH Uterine size,AFC,symptom self-rating scale(SCL-90),and premature ovarian failure symptoms.After treatment,breast mammography or B-ultrasound and bone mineral density are reviewed annually.Effects of Chemotherapeutic Drugs on Ovarian Function:To analyze the effect of cumulative dose of chemotherapy on ovarian function in patients.Elimination of chemotherapy in patients with incomplete data,Can be included in the analysis of chemotherapy patients accumulated 40 cases of patients,Which removed patients lost in 3 cases,The first dose of 2mg menstrual crescent in patients with 22 cases,The remaining 15 patients with a first dose of 1 mg can be statistically analyzed,The first dose of lmg estrogen treatment after menstrual complex in 9 cases,6 cases of non-feathers.Statistical treatment:SPSS 18.0 software was used for analysis,Metrological data are expressed as mean±standard deviation(x±s),Using the t test,Class data data were subjected to ?2 test and the exact probability method.Results:1,chemotherapy drugs:Statistical analysis of age that age and estrogen supplement after menstrual re-emergence of no statistically significant(P>0.05),There was no statistically significant difference between the cumulative dose of chemotherapeutic drug,(cyclosporine,bauxin,cytarabine and idarubicin)and menstruation after estrogen supplementation(P>0.05).According to multivariate correlation analysis,The correlation coefficient between different chemotherapeutic drugs and patients with hematologic disease after treatment with AMH values R = 0.0002921,Determine the coefficient R2=0,There was no correlation between different chemotherapeutic drugs and AMH values.2,menstrual situation:The study initially began to give 25 patients with POF estrogen for 1 mg in the cycle of alternative therapy,Of which 7 cases(28%,7/25)No menstrual complex after the end of treatment,Continue to medication 3-6 after treatment is still no menstruation.Switch to estrogen after 2mg menstruation can be complex tide.4 cases(16%,4/25)Women add 1mg estrogen after menstruation can be complex tide.But the amount of menstrual less than normal,less than 10ml.Treatment of estrogen lmg 1-6 course of treatment later changed to estrogen 2mg,Patients with menstrual flow can be restored in the range of 20-60ml.The remaining 14 cases(56%,14/25)Supplemented with estrogen 1mg menstruation can come normally.Consider 11 patients(44%,11/25)patients the first time to add estrogen 1mg menstruation can not complex tide or menstrual volume less than normal,We follow-up treatment estrogen dose to 2mg.Of the 29 patients,24(82.8%,24/29)After the end of treatment,menstrual complex tide.The remaining 7 patients(24.1%,7/29)had no menstrual complex in patients,1 case of treatment after 4 courses found vaginal anterior and posterior wall adhesions,1 case of treatment after 2 courses found cervical adhesions,1 case of treatment after 5 courses menstruation for the first time complex tide.2 cases of menstruation has not been complex tide.3,vasomotor symptoms:44 patients started hormone replacement therapy,3 cases were younger than 15 years old,15-25 years old in 22 cases,26-35 years old in 13 cases,more than equal to 36 years old 6 cases.25 patients were younger than 25 years old,the average age is 20.6 ± 0.6 years old,did not appear hot flashes night sweats,upset irritability.19 patients older than 25 years old,The average age was 33.9±1.33 years old,Seven patients had vasomotor symptoms before treatment,3 cases of obvious symptoms,Affect the quality of life.Hormone supplementation was followed up after 1 month,and 100%of the symptoms were relieved.4,symptom self-rating scale:SCL-90 includes somatization,obsessive-compulsive symptoms,interpersonal sensitivity,depression,anxiety,hostility,terror,paranoia and psychosis 9 subscales.The total score of SCL-90 and each factor(Somatization,compulsion,interpersonal sensitivity,depression,anxiety,hostility,horror,paranoia,psychosis,other)was compared before and after treatment,the difference was statistically significant(P<0.05).Pre-treatment patients with hostile,interpersonal sensitivity to the higher incidence of psychological disorders,respectively 40.9%and 31.8%.After the hormone supplements were treated,the susceptibility of the patients was significantly reduce,respectively 15.9%and 20.5%.5,6 months after treatment,comparison anti-Mullerian hormone,sex hormone levels,uterine size and sinus follicle count FSH and LH were decreased in 44 patients after hormone therapy,AMH values were slightly higher than before,the difference was statistically significant(P<0.05).Before treatment,ultrasound monitoring of follicles,Of the 44 patients,6(13.6%)of Pelvic ultrasound can be seen unilateral follicle 0-1,the rest did not explore the follicle,6 months after treatment review,the patient did not change the sinus follicles,still in the unilateral follicles 0-1,or not explored follicles.The size of the uterus was increased after the treatment of hormone supplementation,the difference was statistically significant(P<0.05).6,changes in bone mineral density:64 patients with POF who underwent bone mineral density before hormone replacement therapy,Among them,35(54.7%)cases showed a decrease in bone mineral density,and the decrease in bone mineral density was less pronounced at 20 years of age than at 20 years of age(P = 0.035).A case of bone mineral density decreased in patients with bone mineral density after conversion to the normal range.Other patients after treatment L1-L4 bone mineral density was not statistically significant P>0.05,Although the bone mineral density did not change,but the double femoral bone density after treatment became statistically significant,P<0.05.7,breast monitoring situation:64 cases of POF patients were treated before breast mammography or ultrasound examination,1 case of 41-year-old patients due to breast molybdenum target high-density nodules,not hormone replacement therapy,6 cases found breast nodules,US-BI-RADS II-III class,15 cases found breast side or bilateral hyperplasia,the remaining 42 cases of breasts did not find significant abnormalities.More than one year after hormone therapy,11 patients were followed up for breast molybdenum or B-ultrasound,and no significant changes were found before and after treatment.Conclusions:1,on the current study that blood disease after POF patients with hormone replacement therapy after menstruation is not associated with age and chemotherapy drug accumulation.After the use of chemotherapy drugs on the recovery of female ovarian reserve function there is a direct negative impact.2,blood disease after transplantation POF women of childbearing age,hormone replacement therapy can relieve vasoconstriction symptoms,improve the mental health of patients,improve the quality of life.3,adult osteoporosis peak before the occurrence of ovarian dysfunction in young women more prone to bone loss and osteoporosis.4,the current study data that blood disease after transplantation POF women of childbearing age bone loss and length of amenorrhea is not directly related.5,hormone replacement therapy is conducive to blood disease after POF patients with bone mineral density treatment and maintenance.6,blood disease after transplantation POF women of childbearing age hormone therapy can not help restore ovarian function.7,blood disease after transplantation POF women of childbearing age hormone therapy can improve the state of uterine atrophy,maintaining uterine morphology and function.8,blood disease after transplantation POF women of childbearing age hormone replacement therapy has not yet found an increased risk of breast cancer. |
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