(精选)【医学课件课件】Perspectives New developments in Postmenopausal HRT教学课件.pptVIP

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2018-03-21 发布于天津
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(精选)【医学课件课件】Perspectives New developments in Postmenopausal HRT教学课件.ppt

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補充雌激素加鈣比單獨補充鈣效果更好參考資料：Lindsay R. et al. Obstet Gynecol 1990,76(2):290 參考資料：Weiss N. et al., N Engl J Med 1980;303:1195. 停經後婦女髖部骨折的發生率運動適度並持之以恆的運動，可以刺激維持骨骼中的鈣，緩和骨質疏鬆的發生，同時可以增加肌肉彈性。 Estrogen and cardiovascular systempossible beneficial actions of estrogen on CV A favorable impact on the circulating lipid,decrease in total cholesterol and LDL-cholesterol and increase in HDL-cholesterol Direct antiatherosclerotic effect in arteries Augmentation of vasodilating and antiplatelet aggregation factors Vasodilation by means of endothelium-independent mechanisms Inhibition of macrophage foam cell formation Direct inotropic actions on the heart and large blood vessels Protection of endothelial cell from injury. Improvement of peripheral glucose metabolism with a subsequent decrease in circulating insulin levels HT and cardiovascular disease(I) A large body of observational clinical studies repeatedly demonstrated favorable associations between postmenopausal HRT and cardiovascular morbidity, mortality, and risk factors. The Heart and Estrogen/progestin Replacement study(HERS) A randomized,double-blind, placebo-controlled clinical trial; 1993-1997 2763 women(average age 66.7) with pre-existing coronar disease in 20 centers randomized to treatment with premarine 0.626mg+ provera 2.5mg or placebo 172 MI coronary deaths in HRT group and 176 in placebo group No effect for decrease MI, but still safe for patient with cardiovascular disease HT and cardiovascular disease(II) Advice to menopausal womenin view of HERS Healthy women HERS has no bearing on primary prevention Consideration of HRT is beneficial Women with established CAD currently taking HRT Continue therapy Support the benefit of long-time HRT as secondary prevention Women with established CAD not taking HRT Individualize the use of HRT according to patient profile Peri- and postmenopausal unopposed estrogen therapy and risk of endometrial cancer Difinite increase risk of endometrial cancer Relactive