摘要：目的 旨在评价植物雌激素对绝经前期及绝经后期妇女子宫内膜厚度的影响。方法 在Embase、PubMed、Web of Science、CNKI、WangFang、VIP数据库中搜索了自建库至2021年3月的随机对照试验(RCTs),确定并审查了纳入文献的资格,对纳入文献进行资料提取及质量评价,并使用RevMan5.3.5进行统计分析。结果 对43项随机对照试验进行了Meta分析,总共包括了6 271名受试者,结果显示,与安慰剂相比,子宫内膜厚度的变化无统计学意义(P=0.78)。与HT相比,植物雌激素更有利于降低子宫内膜厚度(P=0.02)。亚组分析显示:植物雌激素中,莉芙敏降低子宫内膜厚度功效最强(P=0.01),其次是异黄酮(P=0.03);对中国人群及美国人群使用植物雌激素更有利于降低子宫内膜厚度(中国组:P=0.01;美国组:P=0.009);实验设计的不同可能会不同。平行RCT更倾向于得出子宫内膜厚度减少的结论[WMD=-0.07,95%CI(-0.13~-0.00),P=0.04],同时,小规模(≤100人)的实验更倾向于得出子宫内膜厚度减少的结论[WMD=-0.21,95%CI(-0.39~-0.04),P=0.02];≤6个月的短期使用植物雌激素更有利于降低子宫内膜厚度[WMD=-0.23,95%CI(-0.39~-0.08),P=0.003];60~120 mg/d的剂量更有利于降低子宫内膜厚度[WMD=-0.21,95%CI(-0.40~-0.02),P=0.03]。敏感性分析结果显示,中国组、平行RCT、≤100人、<6个月组、60~120 mg/d组结果均不稳定,但均未显示出对子宫内膜厚度的不良影响。结论 目前的证据不支持补充植物雌激素会导致子宫内膜增厚,甚至植物雌激素在类型、作用人群发生变化时还可能导致子宫内膜厚度下降。但由于纳入文章存在较高异质性,所以,有必要进一步的全方位试验或进行高质量的RCT研究。

摘要：[目的]观察四子养通汤治疗肝肾亏虚型月经减少疗效。[方法]使用前瞻性设计方法,60例门诊四子养通汤(补骨脂、菟丝子、女贞子、覆盆子、黄芪各15g,熟地、凌霄花、茯苓各12g,当归、鹿角胶各10g,葛根9g,升麻、柴胡各6g,玫瑰花3g;有血块、痛经加川芎、白芍、延胡索活血祛瘀、柔肝止痛;体型肥胖,合二陈汤化裁;面色萎黄将黄芪、茯苓加量益气健脾养血),1剂/d,水煎400m L,早晚口服。连续治疗3个月为1疗程。观测临床症状、性激素指标、子宫内膜厚度、不良反应。治疗1疗程,随访6个月,判定疗效。[结果]痊愈18例,显效21例,有效16例,无效5例,总有效率91.67%。性激素指标、子宫内膜厚度均有明显改善(P<0.01)。[结论]四子养通汤治疗肝肾亏虚型月经减少,疗效满意,无严重不良反应,值得推广。

摘要：Objective: The objective of the study was to evaluate the relationship among polyp site, number, diameter, and symptomatology in endometrial polyps in reproductive and postmenopausal women. Study design: One hundred fifty-five subjects with endometrial polyps were evaluated retrospectively. Sociodemographic characteristics, endometrial thickness, polyp number, diameter, and site were reviewed, and their relations with abnormal uterine bleeding were tested. Results: A total of 36.1% of the patients in the postmenopausal group and 44.4% of the patients in the reproductive-aged group were asymptomatic. In addition, 37.3% of polyps in the reproductive-aged and 29.2% in the postmenopausal group were multiple. Polyp number, diameter, and site were not different among the 2 groups (P = .282, P = .469, and P = .485, respectively). When patients were evaluated as a whole, symptomatology was not related with polyp number, diameter, and site (P = .677, P = .334, and P = .699, respectively). Conclusion: Many endometrial polyps are asymptomatic and multiple in nature. Polyp site, number, and diameter do not correlate with symptomatology.