更年期综合征的合理用药(张成志).ppt

* * * 随访及调整用药 应用HRT至少一年要进行一次随访 包括：体检，家族史，相关实验室和影像学 检查； 与病人进行生活方式、预防及合并其他代谢性疾病策略讨论； 酌情乳腺钼钯及细胞学检测。 HRT使用时限 目前没有理由限制时间。 续用HRT应充分知情同意，医患双方审慎决定。 根据患者特殊目的，对后续风险和收益来客观评估。 * * * * * 药物治疗是必不可少的 其中包括对症治疗和对因治疗 对症治疗：能起到暂时缓解症状的作用，不能从根本上解决问题，更无法预防远期健康风险 对因治疗：即科学的激素补充治疗，这是从根本解决问题的办法，不但能缓解近期症状，而且能预防远期疾病风险，更能全面提升生活质量 * 请注意烯丙雌醇是一种雌烷,属于19-去甲基睾酮类 孕激素类药物分为天然孕激素和合成孕激素. 合成孕激素的结构接近于要么与黄体酮要么接近于睾酮. References Schindler AE, Campagnoli C, Druckmann R, Huber J, Pasqualini JR, Schweppe KW, Thijssen JH. Classification and pharmacology of progestins. Maturitas. 2003 Dec 10;46 Suppl 1:S7-S16 Lobo RA, Stanczyk FZ. New knowledge in the physiology of hormonal contraceptives. Am J Obstet Gynecol. 1994;170:1499-1507. Stanczyk FZ. Pharmacology, pharmacokinetics and pharmacodynamics: pharmacokinetics of progestogens. Int Proc J. 1989;1:11-20. Rebar RW, Zeserson K. Characteristics of the new progestogens in combination oral contraceptives. Contraception. 1991;44:1-10. Philibert D, Bouchoux F, Degryse M, et al. The pharmacological profile of a novel norpregnane progestin (trimegestone). Gynecol Endocrinol. 1999;13:316-326. Muhn P, Krattenmacher R, Beier S, et al. Drospirenone: a novel progestogen with antimineralocorticoid and antiandrogenic activity: pharmacological characterization in animal models. Contraception. 1995;51:99-110. * * * * * * * * * * * * * * * Franke HR, Vermes I. Differential effects of progestogens on breast cancer cell lines. Maturitas. 2003;46 Suppl 1:S55-58.  Our in vitro results indicate that not all progestogens act equally on breast cancer cells. Some progestogens (medroxyprogesterone acetate (MPA), norethisterone acetate (NETA) and dienogest (dieno)) alone or combined with estradiol (E2) stimulate proliferation of breast cancer cells, while others (dihydrodydrogesterone (DHD), the major active metabolite of dydrogesterone, tibolone and progesterone (Prog)) alone or combined with estradiol induce apoptosis. Further pharmacological and clinical