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摘要: 目的 探讨与分析激素补充治疗(MHT)在围绝经期女性慢性耳鸣治疗中的效果及适应证。方法 选取100例围绝经期慢性耳鸣患者，根据Kupperman评分分为轻度组和中重度组，再根据患者自身意愿是否进行MHT而进一步划分为MHT组和无MHT组。所有受试者于治疗前后进行血清5-羟色胺水平检测、耳鸣残疾评估量表(THI)和匹兹堡睡眠质量指数(PSQI)量表评价并进行比较和疗效评价。结果 在中重度围绝经期耳鸣患者中，MHT组的5-羟色胺水平、THI评分和PSQI在治疗前、后对比差异均有统计学意义(P < 0.05)，而未MHT组治疗前后对比则无显著差异；在轻度围绝经期耳鸣患者中，MHT组及无MHT组的5-羟色胺水平、THI评分和PSQI在治疗前后对比均无显著性差异；5-羟色胺水平与THI之间具有相关性，5-羟色胺水平越低，耳鸣越严重。结论 MHT有助于围绝经期慢性耳鸣的治疗，尤其是中重度围绝经期患者，推荐临床使用。Abstract: Objective To explore and analyze the effect and indication of hormone replacement therapy(HRT) in perimenopausal women with chronic tinnitus.Methods The perimenopausal women with chronic tinnitus were divided into mild group and moderate to severe group according to Kupperman score of menopause, and then were divided into treatment group and untreated group according to whether they received MHT treatment or not. The serum 5-HT level, tinnitus handicap inventory (THI) and Pittsburgh sleep quality index (PSQI) were compared before and after treatment.Results In moderate to severe perimenopausal tinnitus, the serum 5-HT level, THI and PSQI in the treatment group were statistically different before and after treatment(P < 0.05), and no significant difference was found in the untreated group. In mild perimenopausal tinnitus, there was no significant difference in 5-HT levels, THI and PSQI between the treated group and the untreated group before and after treatment. The 5-HT levels were correlated with THI. The lower the 5-HT level was, the more severe tinnitus was.Conclusion HRT is helpful in the treatment of perimenopausal chronic tinnitus, especially in moderate to severe perimenopausal patients, and is recommended for clinical use.
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Key words:
- tinnitus /
- perimenopause /
- hormones /
- tinnitus handicap inventory /
- sleep disorders
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表 1 各组围绝经期女性纯音听阈测定结果的对比
dB HL, x±s 组别 轻度 中重度 治疗前平均听阈 治疗后平均听阈 t P 治疗前平均听阈 治疗后平均听阈 t P MHT组 24.8±5.5 23.4±5.7 1.195 0.411 25.3±6.2 23.9±6.8 1.531 0.180 无MHT组 24.3±5.2 24.1±5.5 0.973 0.632 24.9±6.5 24.6±6.9 0.899 0.901 t 0.977 0.936 1.055 1.342 P 0.701 0.782 0.578 0.263 
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表 2 各组围绝经期女性血清5-羟色胺水平治疗前后对比
μmol/ L, x±s 组别 轻度 中重度 治疗前5-羟色胺 治疗后5-羟色胺 t P 治疗前5-羟色胺 治疗后5-羟色胺 t P MHT组 1.277±0.435 1.342±0.479 1.297 0.393 0.597±0.356 1.339±0.491 7.011 0.000 无MHT组 1.301±0.458 1.353±0.566 1.056 0.577 0.647±0.285 0.653±0.324 0.872 0.931 t 0.911 0.883 1.053 6.733 P 0.754 0.912 0.581 0.000
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表 3 各组围绝经期女性治疗前后THI评分的对比
分, x±s 组别 轻度 中重度 治疗前THI 治疗后THI t P 治疗前THI 治疗后THI t P MHT组 38.08±20.14 36.96±18.50 2.010 0.061 44.12±16.80 20.22±14.40 10.513 0.000 无MHT组 36.44±18.40 36.06±18.10 1.196 0.310 43.24±16.46 42.62±16.30 1.122 0.331 t 2.058 1.329 1.254 9.212 P 0.056 0.208 0.301 0.000
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表 4 各组围绝经期女性治疗前后睡眠质量的对比
例(%) 组别 轻度 中重度 治疗前睡眠异常 治疗后睡眠异常 t P 治疗前睡眠异常 治疗后睡眠异常 t P MHT组 9(36) 5(20) 1.587 0.208 16(64) 8(32) 5.128 0.024 无MHT组 8(32) 7(28) 0.095 0.758 14(56) 12(48) 0.321 0.571 χ2 0.089 0.439 0.333 1.333 P 0.756 0.508 0.564 0.248
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