绝经激素治疗、运动可以改善患有大转子疼痛综合征的绝经后妇女的疼痛和功能吗?

2022-01-24 MedSci原创 MedSci原创

大转子疼痛综合征 (GTPS) 是一种使人衰弱的慢性疾病,在绝经后妇女中最为普遍。本研究旨在确定 MHT 和运动对 GTPS 绝经后妇女肌腱疼痛和功能的影响,进行随机对照临床试验后,为1级证据水平。

大转子疼痛综合征 (GTPS) 是一种使人衰弱的慢性疾病,在绝经后妇女中最为普遍。高雌激素水平与肌腱健康之间可能存在正相关,绝经后妇女的雌激素减少。更年期激素治疗 (MHT) 可降低肌腱异常的发生率,尤其是与运动相结合时。

本研究旨在确定 MHT 和运动对 GTPS 绝经后妇女肌腱疼痛和功能的影响,进行随机对照临床试验后,该研究为1级证据水平。

图1 文章来源

该研究将患有 GTPS 的绝经后妇女(N = 132;n = 12,失访)随机分为 MHT 和安慰剂透皮乳膏组,并结合特定肌腱运动与否来进行治疗。在整个 12 周的干预期间,所有组都接受了关于避免臀部肌腱受压、管理和避免运动负荷过高的宣教。

图2 参与者通过试验的流程图。CSI,皮质类固醇注射;心电图、心电图仪;MHT,更年期激素治疗;PRP,富含血小板的血浆

 

主要结果是由 维多利亚运动损伤康复研究中心(VISA-G)来评估臀肌腱病的具体情况,即VISA-G分数,次要结果是在基线和 12 周和 52 周时测量全球变化评级,并使用线性混合效应模型来评估差异。体重指数(BMI)作为协变量包括在内。

图3 结果测量分数随时间的变化:(A)BMI <25的参与者,(B)BMI <30的参与者,(C)BMI≥30的参与者和(D)所有参与者的VISA-G分数,BMI为协变量;(E) BMI <25 的参与者的 AQoL 评分;(F) BMI <25 的参与者的 HOOS-QoL 分数。误差线代表 95% CI。AQoL,生活质量评估–8D;BMI,体重指数;HOOS-QoL、髋关节残疾和骨关节炎结果评分——生活质量;MHT,更年期激素治疗;VISA-G,维多利亚运动损伤康复研究中心

结果显示,随着时间的推移,所有参与者组都有所改善(基线 vs 12 周,P < .001;基线 vs 52 周,P < .001)。

所有结果测量的运动组之间没有差异(VISA-G:基线,P = .97,平均差 [MD] = 0.10;12 周,P = .49,MD = 2.15;52 周,P = .32 , MD = -3.08)。

根据 BMI 水平(<25、<30、≥30)对人群进行分层。结果显示,与安慰剂组相比,在所有时间点的 BMI <25的人群中,MHT 组(有运动和宣教)的 VISA-G 结果显著更好(基线,P = 0.04,MD = -11.20,95% CI = -21.70 至 -0.70;12 周,P< .001,MD = -20.72,95% CI = -31.22 至 -10.22;52 周,P = .002,MD = -16.71,95% CI = -27.21 至 -6.22)。

MHT 或安慰剂,与特定肌肉运动或否,并与运动宣教相结合,可不同程度减轻该人群的疼痛并增强其肌腱功能。对于 BMI <25 的女性,结合了任何运动加运动宣教的 MHT 组的成效都优于安慰剂。

有针对性的锻炼或避免固定区域锻炼的策略,在进行有关避免臀肌受压和负荷管理的宣教时是有效的。

当 BMI <25 并且与任何运动和避免臀肌腱受压的宣教结合使用时,MHT 可能是绝经后 GTPS 女性的有效干预措施。从长远来看,一项以臀肌肌腱负荷和肌腱强化为特色的计划可能对这一人群更有利,尽管干预期需要延长到 12 周以进一步研究这一点。

这种治疗方案有可能使用另一种 MHT 给药方法进行探索,可能是口服或阴道给药以增加药物全身吸收的程度。在这项研究中,值得增添一个“未受过运动指导”的对照组来量化避免臀肌压缩和负荷管理的效果。

这种治疗方案可以在患有其他持续性肌腱疾病的人群中进行探索,例如绝经后人群中的跟腱、肩袖和肘外侧肌腱病。

这项研究的结果表明,随着 BMI 的增加,局部 MHT 的吸收可能会有所改变,但没有证据证明这一理论。指南确实表明激素补充处方应针对个人量身定制。 MHT 可能通过积极影响更年期症状(如血管舒缩和情绪)以及其他生活质量指标来影响疼痛感知。

但这项研究没有跟踪干预后 12 至 52 周的参与者。一些参与者可能在此期间进行了独立干预,而在 52 周的随访中没有考虑到这些干预措施。

总之,MHT 或安慰剂与肌腱特异性或假运动相结合,再加上关于避免臀肌腱受压和负荷管理的宣教,可减轻该人群的疼痛并增强功能。BMI <25 的女性在任何运动加宣教中分配 MHT 的结果比在任何运动加宣教中分配安慰剂霜的女性要好。

 

原始文章:

Cowan RM, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. Am J Sports Med. 2021 Dec 13:3635465211061142.

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    2022-04-20 cyzj007

    不错

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    2022-01-24 萌宝嘟嘟

    谢谢分享,好东西!

    0

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    2022-01-24 查查佳佳

    尿酸血症与痛风密不可分。治疗一段时间后,患者的血清尿酸值得到控制,痛风症状

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1212821, encodeId=12d0121282186, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Wed Apr 20 12:14:53 CST 2022, time=2022-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1187773, encodeId=9102118e7733b, content=谢谢分享,好东西!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Mon Jan 24 18:49:26 CST 2022, time=2022-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1187693, encodeId=671d118e6937e, content=尿酸血症与痛风密不可分。治疗一段时间后,患者的血清尿酸值得到控制,痛风症状, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Jan 24 13:39:06 CST 2022, time=2022-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1257304, encodeId=58de125e3047f, content=<a href='/topic/show?id=cdfce8879b1' target=_blank style='color:#2F92EE;'>#绝经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78879, encryptionId=cdfce8879b1, topicName=绝经)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1307469, encodeId=d18f130e469f9, content=<a href='/topic/show?id=b1d766836e4' target=_blank style='color:#2F92EE;'>#激素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66836, encryptionId=b1d766836e4, topicName=激素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332032, encodeId=6361133203260, content=<a href='/topic/show?id=0ab6e8887cc' target=_blank style='color:#2F92EE;'>#绝经后妇女#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78887, encryptionId=0ab6e8887cc, topicName=绝经后妇女)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18b32500069, createdName=108807375_62823127, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432240, encodeId=68f8143224037, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1631663, encodeId=fe9a163166361, content=<a href='/topic/show?id=6395e888343' target=_blank style='color:#2F92EE;'>#绝经后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78883, encryptionId=6395e888343, topicName=绝经后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b921798518, createdName=zxxiang, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1212821, encodeId=12d0121282186, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Wed Apr 20 12:14:53 CST 2022, time=2022-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1187773, encodeId=9102118e7733b, content=谢谢分享,好东西!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Mon Jan 24 18:49:26 CST 2022, time=2022-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1187693, encodeId=671d118e6937e, content=尿酸血症与痛风密不可分。治疗一段时间后,患者的血清尿酸值得到控制,痛风症状, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Jan 24 13:39:06 CST 2022, time=2022-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1257304, encodeId=58de125e3047f, content=<a href='/topic/show?id=cdfce8879b1' target=_blank style='color:#2F92EE;'>#绝经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78879, encryptionId=cdfce8879b1, topicName=绝经)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1307469, encodeId=d18f130e469f9, content=<a href='/topic/show?id=b1d766836e4' target=_blank style='color:#2F92EE;'>#激素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66836, encryptionId=b1d766836e4, topicName=激素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332032, encodeId=6361133203260, content=<a href='/topic/show?id=0ab6e8887cc' target=_blank style='color:#2F92EE;'>#绝经后妇女#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78887, encryptionId=0ab6e8887cc, topicName=绝经后妇女)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18b32500069, createdName=108807375_62823127, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432240, encodeId=68f8143224037, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1631663, encodeId=fe9a163166361, content=<a href='/topic/show?id=6395e888343' target=_blank style='color:#2F92EE;'>#绝经后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78883, encryptionId=6395e888343, topicName=绝经后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b921798518, createdName=zxxiang, createdTime=Fri Jan 14 12:12:53 CST 2022, time=2022-01-14, status=1, ipAttribution=)]
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