使用荷爾蒙治療更年期婦女熱潮紅症狀未改善的相關原因分析; Analysis of Risk Factors Associated with No Improvements after Hormone Replacement Therapy for Postmenopausal Women with Hot Flush

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(1)ύ୯ᙴᛰεᏢύՋᙴӝࣴ‫܌ز‬ᅺγፕЎ ጓဦǺGIIM-97-9605. ࡰ Ꮴ ௲ ௤Ǻഋችኾ ௲ ௤ ӅӕࡰᏤ௲௤Ǻഋ‫ؙ‬ӓ ௲ ௤. ፕЎᚒҞ. ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ‫׳‬ԃය஁ζ዗ዊआੱ‫ރ‬҂‫ׯ‬๓‫ޑ‬ ࣬ᜢচӢϩ‫݋‬ Analysis of Risk Factors Associated with No Improvements after Hormone Replacement Therapy for Postmenopausal Women with Hot Flush. ࣴ‫ز‬ғǺ໳ඳዝ. ύ๮҇୯ΐΜΖԃΎДΒΜѤВ 1.

(2) Ҟ!ᒵ! Ҟᒵ ߄Ҟᒵ ύЎᄔा ಃ΋ക. ߻‫ق‬. ಃ΋࿯. ࣴ‫ز‬ङඳ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!1!. ಃΒ࿯. ࣴ‫୏ز‬ᐒϷҞ‫ ޑ‬ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ. 2. ಃΒക Ў᝘௖૸ ಃ΋࿯. ‫׳‬ԃය‫ޑ‬ύᙴᢀᗺ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ. 3. ಃΒ࿯. ‫׳‬ԃයੱংဂ‫ੰޑ‬౛ᐒᙯ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾ. 5. ಃΟ࿯. ዗ዊआ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ. 7. ಃΟക ‫׷‬਑ᆶБ‫ݤ‬ ಃ΋࿯. ᖏ‫׉‬၂ᡍ೛ी ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!11. !!ಃΒ࿯!!!!‫׷‬਑ᆶБ‫!!ݤ‬ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!15! !!ಃΟ࿯!!!!၂ᡍ‫؁‬ᡯᆶБ‫!!ݤ‬ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!16! !!ಃѤ࿯!!!!ຑ՗Ϸ಍ीϩ‫!!݋‬ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!17! ಃѤക ่݀!!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!18! ಃϖക ૸ፕ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ. 24. ಃϤക ่ፕ !!ಃ΋࿯!!!!่ፕ!!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!28! ಃΒ࿯. ҂ٰ৖ఈ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 28. ୖԵЎ᝘ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 29 ߕᒵ!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!33! मЎᄔा!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!34! ᖴᜏ!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!35. iv.

(3) ߄Ҟᒵ! ! ߄ 3/2!!!!዗ዊआ‫ࡌޑ‬᝼‫ݯ‬ᕍᄔा!!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!10! ߄ 4/2!!!!ሟᐟનલЮੱ‫ރ‬Ծ‫ך‬ຑ՗߄!!ǾǾǾǾǾǾǾǾǾǾǾǾ!!12! ߄ 5/2!!!!ϩ‫݋‬ԖਏಔϷคਏಔ‫ޑ‬ᖏ‫୷׉‬ҁၗ਑!!ǾǾǾǾǾǾǾǾ!!18! ߄ 5/3!!!ϩ‫݋‬ԖਏಔϷคਏಔ‫ޑ‬ମࣧ๚ᔠࢗϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀! !!!!!!!!!!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!19! ߄ 5/4!!!!ϩ‫݋‬ԖਏಔϷคਏಔ‫಻ޑ‬ᅟᆾೀБᛰ‫!!ނ‬ǾǾǾǾǾǾǾ!!20! ߄ 5/5!!!!ϩ‫݋‬ԖਏಔϷคਏಔ‫஁ޑ‬ౢࣽຬॣ‫ݢ‬ᔠ่ࢗ݀!!ǾǾǾǾ!!21! ߄ 5/6!!!!ϩ‫݋‬ԖਏಔϷคਏಔ‫ޑ‬Ոమғϯॶᔠᡍ่݀!!ǾǾǾǾǾ!!22! ߄ 5/7!!!಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓ಔ࣬ᜢӒᓀӢηᛥӓථ଑ᘜ! ϩ‫!!่݀݋‬ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ!!23!. v.

(4) ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍଶ࿶ࡕ஁ζ዗ዊआੱ‫ރ‬҂‫ׯ‬๓‫࣬ޑ‬ᜢচӢϩ‫!݋‬ ࣴ‫ز‬ғ;໳ඳዝ! ࡰᏤ௲௤;ഋችኾ௲௤! ύ୯ᙴᛰεᏢ ύՋᙴ่ӝࣴ‫܌ز‬. ύЎᄔा Ҟ‫ޑ‬Ǻ‫׳‬ԃය߻ࡕ஁ζதӢᡏϣሟᐟનϩ‫ݜ‬ό‫ى‬ԶԖ዗ዊआǵѨ઀ǵ௃ᆣ όᛙǵѨပགǵ഍ၰଳᔴ฻‫׳‬ԃයੱংဂ౜ຝౢғǴ‫ځ‬ύа዗ዊआനࣁܴ ᡉϷ೷ԋѠ᡼஁ζ‫֚ޑ‬ᘋǶҁࣴ‫ز‬ஒଞჹଶ࿶ࡕ஁ζԖ‫׳‬ԃයੱ‫ރ‬ௗ‫಻ڙ‬ ᅟᆾᕍ‫ࡕݤ‬ǴԶԾ᝺዗ዊआੱ‫ރ‬҂‫ׯ‬๓Ǵ຾Չ࣬ᜢӒᓀӢη‫ޑ‬ϩ‫݋‬Ƕ Б‫ݤ‬Ǻҁ၂ᡍ௦ੰᐕӣྉБԄǴϩ‫݋‬Ծ 2008 ԃ 1 Д 1 ВଆԿ 2008 ԃ 12 Д 31 ВЗǴଶ࿶ࡕ஁ζ߃ԛ൩ບਔԖܴᡉ‫׳‬ԃයੱ‫ރ‬Ъ҂ௗ‫ڙ‬ၸ಻ᅟᆾ ᕍ‫ޣݤ‬Ǵӧਲ༜ᄪ҇ᙴଣ൩ບ‫ੰޑ‬ᐕǶ‫܌‬ሡӣྉ‫ੰޑ‬ᐕϣ৒хࡴǺ‫ݯ‬ᕍ߻ ‫ޑ‬ମࣧ๚ϣບϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ε஁ࣽຬॣ‫ݢ‬ᔠ่ࢗ݀ǵϷՈమғϯ ॶᔠᡍ่݀Ƕ٠ϩ‫ݯ݋‬ᕍ߻ࡕሟᐟનલЮੱ‫ރ‬Ծ‫ך‬ຑ՗߄༤ቪ่݀Ƕ! ่݀ǺӅᑔᒧр 120 Տ஁ζ຾Εҁ၂ᡍǴ‫ځ‬ύԖ 6 ՏܺҔ಻ᅟᆾ‫ݯ‬ᕍࡕ‫ځ‬ ዗ዊआੱ‫ރ‬҂ܴᡉ‫ׯ‬๓ȐคਏಔǴ6/120 = 5%ȑǴ114 ՏܺҔ಻ᅟᆾ‫ݯ‬ᕍ ࡕ‫ځ‬዗ዊआੱ‫ܴރ‬ᡉ‫ׯ‬๓ȐԖਏಔǴ114/120 = 95%ȑǶࣴ‫ز‬ᡉҢԃសϟ ‫ ܭ‬45 Կ 54 ྃϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ࣁว‫܈ݹ‬๺ᕭǴᆶ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ዗ ዊआੱ‫ރ‬҂‫ׯ‬๓Ԗᡉ๱Ӧ࣬ᜢǶ ่ፕǺҁࣴ‫ز‬ᡉҢǴଶ࿶ࡕ஁ζ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓‫ޑ‬Ӓᓀ Ӣηࢂԃសϟ‫ ܭ‬45 Կ 54 ྃϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ࣁว‫܈ݹ‬๺ᕭǶ ᜢᗖຒǺ!‫׳‬ԃයǵ዗ዊआǵ಻ᅟᆾ‫ݯ‬ᕍǵଶ࿶ࡕ. 1.

(5) ಃ΋കʳ ߻‫ق‬ ಃ΋࿯ ࣴ‫ز‬ङඳ ‫ ׳‬ԃ ය ஁ ζ Ӣ ᡏ ϣ ሟ ᐟ ન Π फ़ Զ ೷ ԋ ‫ ׳‬ԃ ය ੱ ং ဂ Ȑ climacteric syndromeȑ‫ޑ‬ౢғǴჹ‫ܭ‬Ѡ᡼஁ζԶ‫ق‬Ǵ‫ځ‬ύΞа዗ዊआȐhot flushȑന ࣁܴᡉϷ೷ԋ֚ᘋǴᝄख़‫ࣗޣ‬Կ཮υᘋВதғࢲϷ೷ԋᅵ઀ምᛖǶ಻ᅟᆾ ᕍ‫ݤ‬Ȑhormone therapyȑҞ߻ϝ೏ᇡࣁࢂ጗ှ‫׳‬ԃය዗ዊआੱ‫ރ‬നԖਏ‫ޑ‬ Б‫ݤ‬Ǵӄౚςຬၸኧί࿤஁ζௗ‫ڙ‬ၸ‫҅܈‬ӧௗ‫಻ڙ‬ᅟᆾᕍ‫ݤ‬Ƕη৐҂Ϫନ ‫ޣ‬ሡӝ‫ٳ‬٬ҔሟᐟનϷ໳ᡏન‫ݯ‬ᕍǴη৐ςϪନ‫߾ޣ‬໻٬Ҕሟᐟન‫ݯ‬ᕍǶ ࣬ၨ‫ܭ‬ኻऍӚ୯Ǵ٥ࢪ஁ζ‫׳ځ‬ԃය዗ዊआੱ‫ރ‬౰Չ౗ၨեǴΨ೚ᆶᅿ௼ ‫ک‬໯१ЎϯԖᜢᖄ1Ƕ ᗨฅ๊ε೽ҽ‫׳ޑ‬ԃය஁ζܺҔ಻ᅟᆾᕍ‫ځࡕݤ‬዗ዊआੱ‫ރ‬ளа‫ׯ‬ ๓ǴՠϝԖऊ 10%‫஁ޑ‬ζϝࣁԜԶ֚ᘋ2ǴԿ‫ࣁܭ‬Ֆ཮೷ԋ‫ݯ‬ᕍคਏ‫࣬ޑ‬ ᜢӒᓀӢηǴҞ߻ϝؒԖ࣬ᜢ‫ࣽޑ‬Ꮲൔ֋Ƕҁࣴ‫ز‬ஒଞჹଶ࿶ࡕ஁ζԖ‫׳‬ ԃයੱ‫ރ‬ௗ‫಻ڙ‬ᅟᆾᕍ‫ࡕݤ‬Ǵ‫ځ‬዗ዊआค‫ׯ‬๓ࣁЬǴ຾Չ࣬ᜢӒᓀӢη‫ޑ‬ ϩ‫݋‬Ƕ. 1.

(6) ಃΒ࿯ ࣴ‫୏ز‬ᐒϷҞ‫ޑ‬ ਥᏵЎ᝘ൔᏤǴܺҔ಻ᅟᆾᕍ‫஁ޑݤ‬ζऊԖ 1 Կ 2 ԋ‫׳ځ‬ԃය዗ዊआ ੱ‫ރ‬٠คܴᡉ‫ׯ‬๓2Ǵՠ҂ԖЎ᝘௖૸‫࣬ځ‬ᜢӒᓀӢη1ǶӢԜǴҁࣴ‫ز‬٬ ҔੰᐕӣྉኳԄǴ൩ਲ༜ᑜ΋୔ୱ௲Ꮲᙴଣ஁ౢࣽǴଶ࿶ࡕ஁ζӢ‫׳‬ԃය ੱ‫ރ‬ௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍǴԶԾ᝺዗ዊआੱ‫ރ‬҂‫ׯ‬๓‫࣬ޑ‬ᜢӒᓀӢηуаϩ ‫݋‬Ƕаයว౜ёૈӒᓀӢηǴԖշ‫ܭ‬҂ٰ‫׳‬ԃය஁ζ዗ዊआϐ‫ݯ‬ᕍǶ. 2.

(7) ಃΒക Ў᝘௖૸ ಃ΋࿯. ‫׳‬ԃය‫ޑ‬ύᙴᢀᗺ. ஁ζ΋૓ӧȨΎΎȩϐԃǴД࿶ಖЗǴᆀࣁȨ๊࿶ȩ‫܈‬Ȩ࿶ᘐȩǶ೽ ҽ஁ζӧ๊࿶߻ࡕՔᒿр౜΋‫س‬ӈੱং‫܈‬ᡏቻǴӵД࿶ધ໶ǵ੾ཀྵԸሳǵ ੗዗Ԡрǵय़आዊ዗ǵྠᔿܰࡗǴ‫܈‬य़ҞަᡏੌဍǵֿᓎѨ࿣ǵဈጣล ೬ǵަհߡ▋฻Ӛᅿੱ‫ރ‬Ǵឦ‫ܭ‬Ȩ࿶ᘐ߻ࡕፏੱȩ‫ޑ‬ጄᛑǴӧђжᙴᝤค ൂᐱ૶ၩǴΨคԜੰӜǴՠ‫ރੱځ‬தණ‫ـ‬ӧȨԃԴՈ஝ȩȨԃԴ࿶ᘐൺ ٰȩȨ᠌ចȩȨԭӝੰȩ฻ੰ᛾ύǴύᙴᖏ‫׉‬٠ό‫ـش‬ǶȠ໳ࡆϣ࿶ન ୢǷ΢ђϺ੿ፕȡύග‫ډ‬ǺȨζηΎྃ๝਻౰ǴᏁ‫׳‬ᎳߏǹΒΎԶϺ࣢ ԿǴҺે೯Ǵϼፂે౰ǴД٣аਔΠǴࡺԖηǹΟΎ๝਻ѳ֡Ǵࡺ੿Уғ ԶߏཱུǹѤΎโମ୲ǴᎳߏཱུǴ‫ي‬ᡏ౰֧ǹϖΎ໚ܴે૰Ǵय़‫ۈ‬ขǴᎳ‫ۈ‬ ቝǹϤΎΟ໚ે૰‫ܭ‬΢Ǵय़ࣣขǴᎳ‫ۈ‬қǹΎΎҺે຀Ǵϼፂે૰ϿǴϺ ࣢ᆃǴӦၰό೯Ǵࡺ‫׎‬ᚯԶคηΨǶȩҗԜё‫ޕ‬Ǵ๝೯ၸፂǵҺΒેᆅ౛ ζ‫ޑ܄‬Д࿶ᆶғ෗ǴԶ‫ځ‬ύΎΎࡰ‫ޑ‬൩ࢂζ‫܄‬εऊӧѤΜΐྃѰѓǴ๝਻ ᅌ૰ǴռணȐፂҺȑᐒૈ૰ଏǴ਻Ոςၨа߻຀ϿǹတΠࠟᡏȐϺ࣢ȑϩ ‫ݜ‬ધ໶࢏ᆃǴԶ٬Д࿶ଶЗȐӦၰό೯ȑǶΨӢတΠࠟᡏϩ‫ݜ‬ધ໶ǴЇว ӚᏔ‫᠌۔‬๜фૈѨ‫ܭ‬ѳᑽȐ഍໚όፓȑǴԶౢғ‫׳‬ԃයӚᅿᖏ‫ރੱ׉‬Ƕ ӧύᙴ‫ڂ‬ᝤύନ໳ࡆϣ࿶ύᜢ‫ܭ‬ζ‫ޑ܄‬ғ෗ғ౛౜ຝԖ૶ၩѦǴќѦ ӵπ᛾‫ྗݯ‬ᛣρǺȨζаՈࣁЬǴΎΎ߾‫ړ‬ኧςಖǴಖ߾࿶Н๊ǴҺፂે ຀૰ǴϺ࣢๊ǴӦၰό೯Զคη‫خ‬ǶȩπᙴᏢᆜҞρǺȨ஁ζϺ࣢ςၸ යǴ࿶ેόϬǴ‫܈‬ΟǵѤД΋ՉǴ‫܈‬΋ДӆԿǶȩ֡ග‫ډ‬ζ‫܄‬ऊӧϖΜྃ ߻ࡕ཮य़ᖏ࿶යધ໶ǵռணό௨ռ‫ޑ‬౜ຝǶԶπߎ჆ाౣǷᚇੰે᛾ ጇρǺȨ஁Γ᠌ᔿǴ഻ൿ໾టনǴຝӵઓᡫ‫܌‬բǴኧЖ՜ǴҒ૛εව෯Ь ϐǶȩπᙴ‫ے‬Ѹ᠐ρǺȨ଼‫ב‬ϐচǴॿೢϐЈǴЈ๝όҬǴЈόΠҬ‫ܭ‬ ๝ǴᐜО໶‫ځ‬ઓܴǴ๝ό΢Ҭ‫ܭ‬ЈǴᆒ਻‫ڰ‬ԶόҔǶȩπҡ࠻઎ᒵρǺ Ȩ‫ᦼ۽‬ό൦฻᛾ǴЈՈϿΨǴЈઓ࡝்ǴԜ‫ط‬๝ϐ຀ǴԶЈ਻ϐ১ΨǶȩ ߾ග‫஁ډ‬ζᆶ‫׳‬ԃයԖᜢ‫ޑ‬ᆒઓੱ‫ރ‬Ƕ. 3.

(8) ᆕӝа΢‫܌‬ॊǴ‫׳‬ԃයੱংဂȐclimacteric syndromeȑ ᔈឦ‫ ܭ‬Ȩ࿶ᘐ ߻ࡕፏੱȩ‫ޑ‬ጄᛑǴӧђжᙴᝤคൂᐱ૶ၩǴΨคԜੰӜǴՠ‫ރੱځ‬தණ ‫ـ‬ӧȨԃԴՈ஝ȩȨԃԴ࿶ᘐൺٰȩȨ᠌ចȩȨԭӝੰȩ฻ੰ᛾ύǶ၀ੰ ᖏ‫׉‬٠ό‫ـش‬Ǵ‫ܭ‬ϤΜԃж໒‫ۈ‬Ǵӧ௲‫׷‬ύ൩Ԗ૸ፕǶ1964 ԃύ୯অु ӄ୯ଯ฻ᙴᛰଣਠ௲‫׷‬ਔωஒ๊࿶߻ࡕӚᜪੱ‫ރ‬ӧȠύᙴ஁ࣽᏢȡύӈࣁ Ȩ ࿶ᘐ߻ࡕፏੱ ȩ೭΋ੰӜ3Ƕ ύᙴᇡࣁȨ๝຀ȩࢂᏤठ‫׳‬ԃය‫ޑ‬ਥҁচӢǴ๝Ьғ෗ǵᙒᆒǶ‫׳‬ԃ ය஁ζ๝਻ᅌ૰ǵؑҺે຀ǵᆒ਻ό‫ى‬Ǵ‫׎‬ԋ഍໚ॿ຀ǴόૈᔶᎦྕྦ‫ځ‬ Ѭ᠌๜Ǵࡺр౜Д࿶ધ໶ǵዊ዗ǵԠрǵྠᔿܰࡗǵѨ઀ӭფǵᓐཀྵԸ ሳǵဈጣล೬ǴΞᆒઓ‫׭‬ᢠǴֿᓎߡ▋Ǵဎ๞஥Π฻ǴࣗԿр౜‫׳‬ԃයᆒ ઓੰ3,4,5Ζ ύᙴ‫ޑ‬ᒣ᛾ፕ‫ݯ‬аံ๝༤ᆒࣁЬा‫ݯ‬ᕍ‫߾ݤ‬Ǵᒣ᛾ᘜયϩࣁ‫ط‬๝഍຀ ࠠǵ๠๝໚຀ࠠǵ๝഍໚ॿ຀ࠠǵ๝഍຀‫ط‬ᢠࠠǵЈՈό‫ࠠى‬Ƕ੾ཀྵԸ ሳǵ੗዗Ԡрǵय़आዊ዗฻Ոᆅ๤ᕭੱ‫ރ‬Ǵࢂ഍຀О‫ࣗܮ‬Կ഍຀໚ϗ‫܌‬ ठǹྠᔿܰࡗǵ‫׭‬ᢠኁཆǵЈௌѨ઀฻ᆒઓઓ࿶ੱ‫ރ‬ǴᆶЈǵ‫᠌ٿط‬๜‫ޑ‬ ѨፓԖᜢǹԿ‫ܭ‬഍ၰଳᔴ‫؟‬዗ǵဈลङภǵମ፦౧᚞฻ୢᚒǴ߾ᆶ๝‫ޑ‬഍ ໚ѨፓԖᜢ6,7Ƕ ‫ݯ‬ᕍ΢߾аȨ‫ڰ‬๝ȩࣁЬǶՠҗ‫ܭ‬Ȩ‫ط‬๝ӕྍȩϐࡺǴᖏ‫ރੱ׉‬ҭԖ ‫਻ط‬ᢠ่‫߄ޑ‬౜ǴӢԜ‫ݯ‬ᕍ΢ΨाԵቾȨፓ‫ط‬౛਻ȩ‫ޑ‬Б‫ݤ‬Ƕ٩஻‫ޣ‬όӕ ‫ޑ‬᛾ࠠǴதҔ೮ᇿණǵϤ‫ښ‬Ӧ໳ΤǵϺЦံЈϏǵѰᘜΤǵਦߕΖ݄Τ‫܈‬ ѓᘜΤ฻БᏊу‫ݯٰښ‬ᕍ8,9Ƕ. 4.

(9) ಃΒ࿯ ‫׳‬ԃයੱংဂ‫ੰޑ‬౛ᐒᙯ Ȩଶ࿶ȩࢂ஁ζғ‫ڮ‬຾ำύѸฅวғ‫ޑ‬ғ౛ၸำǴଶ࿶ගҢռணфૈ ૰ଏǴғ෗ૈΚಖЗǶռணфૈ૰ଏࢂᅌ຾‫ޑ܄‬Ǵ‫׳‬ԃයΏࢂ஁ζҗғ‫ػ‬ ԃស຾Εߚғ‫ػ‬ԃស‫ޑ‬ၸ෠ਔයǴԜਔռண೴ᅌ෧Ͽ‫಻܄‬ᅟᆾȐхࡴሟᐟ નȐestrogenȑǵ໳ᡏનȐprogesteroneȑǵ໢ᐟનȐandrogenȑȑ‫ޑ‬ౢ ғ Ǵ ಖ ठ ғ ౛ ΢ ‫ ޑ‬Д ࿶ ֹ ӄ ಖ З Ƕ Ш ࣚ ፁ ғ ಔ ᙃ Ȑ World Health Organization, WHOȑӧ 1981 ԃჹଶ࿶‫ۓޑ‬ကࣁ΋ԃϣคД࿶ٰዊ‫ޑ‬௃ ‫׎‬Ǵஒଶ࿶‫ޑ‬ၸำϩࣁΟঁ໘ࢤǴϩձࣁଶ࿶߻යȐpremenopauseȑǵଶ ࿶ ύ ය Ȑ perimenopause ȑ ǵ ଶ ࿶ ࡕ ය Ȑ postmenopause ȑ 10 Ƕ ଶ ࿶ ߻ ය Ȑpremenopauseȑࢂࡰ஁ζӧଶ࿶а߻ǴۘԖғ෗ૈΚ‫ޑ‬೭ࢤᅐߏਔයǴ Ԝਔ஁ζ‫ޑ‬Д࿶ຼය‫ک‬а۳‫ޑ‬Д࿶ࠠᄊ٠คόӕǹଶ࿶ύය Ȑperimenopauseȑࢂࡰଶ࿶ϐ߻ϣϩ‫ݜ‬ǵғ౛Ꮲǵᖏ‫׉‬੝ቻᡉҢջஒଶ࿶ ໒‫ۈ‬Ǵ‫ډޔ‬ଶ࿶ϐࡕ΋ԃ‫ޑ‬ਔ໔ǹଶ࿶ࡕයȐpost-menopauseȑ߾ࢂଶ࿶ ᅈ΋ԃϐࡕᆉଆǴҭջԾฅଶ࿶ΜΒঁДࡕ΋‫ډޔ‬ԝΫ‫ޑ‬ၸำ11Ƕ ଶ࿶٩‫ځ‬όӕ‫ޑ‬চӢёϩࣁΟᅿᜪࠠǺ΋ǵԾว‫܄‬ଶ࿶Ȑnatural menopauseȑǴࢂҗ‫ܭ‬ԃស‫ޑ‬ቚуǴռணфૈԾฅԴϯ‫܌‬೷ԋ‫ޑ‬ଶ࿶Ȑ٠ ௨ନᚶѫǵ‫ݜ‬٢฻௃‫׎‬ȑǶΒǵЋೌЇଆ‫ޑ‬ଶ࿶Ȑsurgical menopauseȑǴ ࢂࡰД࿶ϐύᘐΏҗ‫ܭ‬Ћೌᄔନη৐Ϸ΋ᜐ‫ޑ‬ռணǴ‫ࢂ܈‬ᄔନ‫ٿ‬ᜐռணǵ ᄔନ‫܈‬੮Πη৐‫܌‬೷ԋ‫ޑ‬Д࿶ಖЗǶќԖ΋ᅿԐว‫܄‬ଶ࿶Ȑpremature menopauseȑǴࢂࡰϿኧ஁ζӧѤΜྃа߻ଶ࿶Ǵ‫ځ‬ଶ࿶ᐒᙯҞ߻ۘόܴ ዴǶ ռணфૈ෧ଏǴᡏϣ‫಻܄‬ᅟᆾᐚࡋΠफ़ࢂЇଆ‫׳‬ԃයੱংဂ‫ޑ‬Ьाচ ӢǶռணфૈ૰ଏࡕǴΠຎЫȐhypothalamusȑ— တΠࠟᡏȐpituitary glandȑ-- ռணȐovaryȑື‫ޑ‬ѳᑽѨፓǴቹៜઓ࿶ύኰϷЍଛΠ‫ޑ‬Ӛ᠌Ꮤ фૈǶሟᐟન‫ڙ‬ᡏȐestrogen receptorȑନғ෗Ꮤ‫۔‬ѦǴቶ‫ݱ‬Ӹӧ‫ܭ‬ӄ‫ي‬೚ ӭಔᙃϷᏔ‫۔‬ύǴӵ٢‫܊‬ǵҜጥǵ߷‫ે୏ރ‬ǵЬ୏ેǵ‫ط‬ǵ๝ǵମᓝǵિ ެಔᙃǵ‫سֿݜ‬಍ϷύኰǴຼൎઓ࿶ϡ‫ک‬ઓ࿶ಒझǶࡺ྽ᡏϣሟᐟનНѳ Πफ़ࡕǴ‫ځ‬Ҟ኱ಔᙃ‫ک‬Ꮤ‫۔‬ёౢғфૈ‫ک‬ಔᙃ‫׎‬ᄊᏢ‫ޑ‬ᡂϯǴவԶр౜΋. 5.

(10) ‫س‬ӈ‫ރੱޑ‬Ǵ಍ᆀȨ‫׳‬ԃයምᛖȩǴ‫܈‬ᆀȨ‫׳‬ԃයੱংဂȐclimacteric syndromeȑȩ1,12,13Ƕ ‫׳‬ԃයੱংဂ‫ޑ‬ᖏ‫߄׉‬౜Ǻ 1. Д࿶‫ׯ‬ᡂǺ߄౜ࣁД࿶ᓎวǵД࿶ีวǵόೕ߾η৐рՈϷഈ࿶Ƕ 2. Ոᆅ๤ᕭੱ‫ރ‬Ȑvasomotor syndromeȑǺ߄౜ࣁ዗ዊआϷ‫ڹ‬ԠǴ‫ځ‬ ੝ᗺࢂϸᙟр౜อኩ‫ޑ‬य़೽‫ک‬ᓍ೽ҜጥତତวआϷว዗ǴᝩϐрԠǴғ౛ ‫܄‬ଶ࿶‫ޣ‬วғ౗ຬၸ 50%Ƕ 3. ઓ࿶ᆒઓੱ‫ރ‬Ǻ‫׳‬ԃය஁ζ۳۳ᐟ୏ܰࡗǴขቾόӼ‫܈‬௃ᆣեပǵ ‫׭‬ᢠჲ៿ǴόૈԾ‫ך‬௓‫ڋ‬Ƕ 4. ‫ ֿ ݜ‬ғ ෗ ၰ ੱ ‫ ރ‬Ȑ urogenital syndrome ȑ Ǻ ᆶ ᡏ ϣ ሟ ᐟ ન Ȑestrogenȑᆶ‫܄ت‬નȐandrogenȑΠफ़ԖᜢǴ߄౜ੱ‫ࣁރ‬഍ၰଳᔴǵ‫ڈ‬ ภǵ഍ၰϩ‫ނݜ‬ቚӭ‫ک‬གࢉǴаϷ഍ၰǵѦ഍ཝ᝚Ǵ‫܄‬Ҭภǵ‫܄‬Ҭࡕр Ոǵֿᓎǵֿ࡚ǵֿѨ࿣‫ک‬ϸᙟֿၡགࢉ12Ƕ 5. ମ፦౧᚞ੱȐosteoporosisȑǺሟᐟન‫ڀ‬Ԗߥៈମ᝜֖ໆ‫ޑ‬բҔǴࢂ ஁ζ΋ғᆢ࡭ମ᝜֖ໆ‫ޑ‬ᜢᗖᐟનǴ‫׳‬ԃයऊ 25%஁ζ஻Ԗମ፦౧᚞ǴЬ ा߄౜ࣁੵภǵᎪङ‫ک‬ମ‫ש‬Ƕ. 6.

(11) ಃΟ࿯ ዗ዊआ ӧ ‫ ׳‬ԃ ය ੱ ং ဂ ፏ ӭ ੱ ‫ ރ‬ύ Ǵ ന ੝ ձ Ъ ܴ ᡉ ‫ ࢂ ޑ‬዗ ዊ आ Ȑ hot flushȑǶ‫׳‬ԃය஁ζँฅ‫ي‬ᡏག᝺΋ިច዗۳ᖍ೽ǵᓍ೽ǵૅ೽ፂǴ൳ࣾ ដ൩੃ଏǴᒿ๱ԖЈௌǵหԠǴӧоϺΨளඤ൳ԛ ՊǶε೽ҽ໒‫ۈ‬р౜ ‫ܭ‬΢ъ‫܈ي‬ङ೽Ǵϐࡕ۳΢‫܈‬۳Π߄౜ǴԖਔ཮р౜ӧӄ‫ي‬Ƕ΋૓዗ዊआ р౜‫ޑ‬ਔ໔ԾΟΜࣾԿϤΜϩដό฻Ǵѳ֡ࣁΟԿѤϩដǶ߻ӂΜϩத ‫ـ‬Ǵՠε೽ҽ‫஁ޑ‬ζ֡ᜤаඔॊǶԶЪ೭ᅿੱ‫ރ‬Ψёૈӧᅵ᝺ਔр౜Ǵр ౜ਔ෧Ͽ‫ז‬ೲ୏౳ය‫ޑ‬ᅵ઀ǴᘋΓమფǴቹៜғࢲࠔ፦14Ƕ዗ዊआࣁՈᆅ ๤ᕭੱ‫ރ‬Ȑvasomotor syndromeȑϐ΋ǴऊԖ 75%~80%ϖΜྃа΢‫஁ޑ‬ζ මԖၸԜ࿶ᡍǴЪᆶଶ࿶‫ރ‬ᄊԖᜢǺଶ࿶߻යȐpremenopauseȑ஁ζԖ 14~51%ԖԜੱ‫ރ‬Ǵଶ࿶ύයȐperimenopauseȑ஁ζԖ 35~50%ǴԶଶ࿶ࡕ යȐpostmenopauseȑ஁ζ߾ଯၲ 30~80%15Ƕ዗ዊआ‫ޑ‬౰Չ౗ӄШࣚ٠ό ΋ኬǴ࣬ၨ‫ܭ‬ኻऍӚ୯Ǵ٥ࢪ஁ζ‫׳ځ‬ԃය዗ዊआੱ‫ރ‬౰Չ౗ၨեǴΨ೚ ᆶᅿ௼‫ک‬໯१ЎϯԖᜢᖄ1Ƕ ዗ዊआวғ‫ޑ‬চӢҞ߻٠όΜϩమཱǴёૈࢂΠຎЫྕࡋፓ࿯ᐒ‫ڋ‬ౢ ғ υ ᘋ ‫ ܌‬ठ Ǵ ‫ ځ‬ύ ੋ Ϸ ೚ ӭ Ӣ ન Ǵ х ࡴ ಻ ᅟ ᆾ ញ ‫ ܫ‬Ӣ η Ȑ hormone releasing factors ȑ ǵ ߦ ‫ ܄‬ဏ ᐟ ન Ȑ gonadotrophins ȑ Ϸ ઓ ࿶ ᡏ న Ȑneurohumoralsȑ฻Ƕёૈ౛ፕࣁᡏϣሟᐟનȐestrogenȑ෧ϿǴᏤठΠ ຎ Ы ϣ ‫ ޑ‬တ ϣ ଢ଼ Ȑ endorphin ȑ ᐚ ࡋ Π फ़ Ǵ ߦ ٬ ཥ ๝ ΢ ဏ ન ȐnorepinephrineȑϷՈమનȐserotoninȑϩ‫ݜ‬Ǵफ़եྕࡋፓ࿯ਡ‫ޑ‬೛‫ۓ‬ ᗺǴ‫ڈ‬ᐟό፾྽‫ޑ‬ᡏ዗ණѨǶҗԜё‫ޕ‬ሟᐟન‫ת‬ᄽ،‫فޑ܄ۓ‬ՅǴԶ٬Ҕ ሟᐟનٰ‫ݯ‬ᕍ዗ዊआԖ‫ځ‬ᖏ‫ޑ׉‬ሽॶ13Ƕ ᆶ‫ځ‬Ѭዊआ‫ݩރޑ‬КၨଆٰǴ‫׳‬ԃය஁ζ‫ޑ‬዗ዊआ‫ځ‬ғ౛ᡂϯӧ‫ຼܭ‬ ᜐՈࢬቚуǵЈၢуೲǴ੝ձࢂҜጥႝߔ‫ޑ‬෧Ͽࣁ‫ځ‬ख़ा੝ቻ1Ƕ਻ংԖ ёૈࣁቹៜ዗ዊआวғᓎ౗‫ޑ‬ख़ाӢηǶ዗ዊआёаวғӧ΋Ϻύ‫ޑ‬ҺՖ ਔ໔ǴЪ཮೏΋٤௃‫܌ݩ‬ᇨวǴӵᓿּǵᓸΚǵँฅ‫ׯࡋྕޑ‬ᡂǵଚᆒǵ ‫ڜ‬ଢ଼Ӣ‫܈‬ҺՖ዗໯Ƕ዗ዊआวғ‫ޑ‬ᓎ౗ӢΓԶ౦Ǵε೽ҽ‫׳ޑ‬ԃය஁ζѳ ֚֡ᘋϤঁДԿΒԃǴ೯தӧΟԿϖԃࡕ੃ѨǴՠϝԖ 10%‫஁ޑ‬ζੱ‫࡭ރ‬ ុε‫ܭ‬Μԃ16Ƕ. 7.

(12) ዗ዊआᗨόࢂठ‫ރੱڮ‬Ǵՠᝄख़‫཮ޣ‬٬‫ځ‬ғࢲࠔ፦Πफ़Ǵቹៜπբǵ ВதғࢲǴఁ΢ӢᅵόӳԶᏤठੲ॰ǵ‫ݙ‬ཀΚΠफ़ǵኁᢠǴΨ཮υᘋৎ৥ ғࢲϷՔߧᜢ߯Ƕ΋૓ё٬ҔВ૶Ϸୢ‫ٰڔ‬ຑ՗዗ዊआ‫ޑ‬ำࡋǴВ૶ύ૶ ၩ‫؂‬В዗ዊआวғ‫ޑ‬ᓎ౗Ϸ‫؂‬ԛ‫ޑ‬ำࡋǴԶࡕёᙯϯࣁϩኧբࣁКၨǶ዗ ዊआ‫ޑ‬ำࡋ߾٩аΠ‫ۓ‬က15Ǻ ᇸ༾ȐmildȑǺε೽ҽਔ໔዗ዊआ໻ག‫ډ‬ว዗ՠคрԠǶ ύ฻ȐmoderateȑǺε೽ҽਔ໔዗ዊआག‫ډ‬ว዗٠рԠǴՠό‫ى‬аύ Зࢲ୏‫ޑ‬຾ՉǶ ᝄख़ȐsevereȑǺε೽ҽਔ໔዗ዊआόՠག‫ډ‬ว዗ЪрԠǴӕਔሡଶ З҅ӧ຾Չ‫୏ࢲޑ‬Ƕ ಻ᅟᆾᕍ‫ݤ‬Ҟ߻ϝࣁ‫ׯ‬๓‫׳‬ԃයੱংဂϐന٫ҔᛰǴ੝ձࢂଞჹύࡋ ‫܈‬ख़ࡋ‫ޑ‬Ոᆅ๤ᕭੱ‫ރ‬Ȑ֖዗ዊआȑǴӄౚςຬၸኧί࿤஁ζௗ‫ڙ‬ၸ‫҅܈‬ ӧௗ‫಻ڙ‬ᅟᆾᕍ‫ݤ‬Ƕη৐҂Ϫନ‫ޣ‬ሡӝ‫ٳ‬٬ҔሟᐟનϷ໳ᡏન‫ݯ‬ᕍǴη৐ ς Ϫ ନ ‫ ߾ ޣ‬໻ ٬ Ҕ ሟ ᐟ ન ‫ ݯ‬ᕍ Ǵ ऍ ୯ ᖏ ‫ ׉‬ϣ ϩ ‫ ݜ‬Ꮲ ཮ Ȑ American Association of Clinical Endocrinologists Ǵ AACE ȑ Ǵ ऍ ୯ ஁ ౢ ࣽ Ꮲ ଣ ȐAmerican College of Obstetrician and GynecologistsǴACOGȑϷчऍ‫׳‬ԃ යᏢ཮ȐNorth American Menopause SocietyǴNAMSȑ֡ࡌ᝼٬ҔനեԖ ਏᏊໆϷϖԃϐϣ‫ޑ‬อය٬ҔǶёᒧҔ‫ޑ‬Ꮚࠠхࡴαܺǵ࿶Ҝ֎ԏǵ഍ၰ ٬ҔϷ‫ݙ‬৔Ǵ‫ځ‬த‫ޑـ‬ୋբҔࣁ٢‫܊‬ᅍภϷ഍ၰрՈ15,16Ƕ 2002 ԃ஁ζፁғीฝȐthe Women's Health InitiativeǴWHIȑӧJAMA ᚇᇞ΢ว߄ፕЎࡰр٬Ҕestrogenᆶprogestin‫಻ޑ‬ᅟᆾඹжᕍ‫ݤ‬όՠ཮Ꮴठ ٢ᕎǴ‫཮׳‬ቚуЈՈᆅ੯ੰ‫ޑ‬วғ౗ǴӢԜ᏾ঁᖏ‫׉‬၂ᡍᆙ࡚ഷଶ17Ƕନ Αऍ୯஁ζԋࣁᡋψϐചѦǴ‫ځ‬д୯ৎ஁ζΨᜤаॴխǶѠ᡼Ӧ୔࿶൞ᡏ εစൔᏤࡕǴ‫׳‬ԃය஁ζჹ‫಻ܭ‬ᅟᆾᕍ‫ݤ‬ௗ‫ࡋڙ‬εࣁफ़ե18ǶӢԜǴᜢ‫ܭ‬ ߚ಻ᅟᆾᛰ‫ݯނ‬ᕍ‫׳‬ԃය஁ζ዗ዊआᛰ‫زࣴޑނ‬В੻ቚуǶନΑ಻ᅟᆾᕍ ‫ݤ‬ѦǴ‫ځ‬дࣴ‫ز‬ύ‫಻ߚޑ‬ᅟᆾᛰ‫ݯނ‬ᕍхࡴ19Ǻ 1. Gabapentin (ឦneuroendocrine agents)Ǻᗨςჴᡍ᛾ჴёफ़ե 20-30% ‫ޑ‬዗ዊआᓎ౗Ϸᝄख़ࡋǴՠӢᓐཀྵǵੲ॰ǵ༐ᅵ฻ୋբҔεԶ٬ੰ ஻όᜫཀᝩុܺҔ20Ƕ. 8.

(13) 2. ᒧ ᏷ ‫ ܄‬Ո మ ન ӣ ԏ ‫ ڋ ׭‬Ꮚ Ȑ selective serotonin and noradrenalinereuptake inhibitors ȑ Ǻ ឦ ‫ ל‬ኁ ᢠ ᛰ ‫ ޑ‬΋ ᅿ Ǵ х ֖ venlafaxine ǵ paroxetineϷfluoxetineǴ ё‫ׯ‬๓ 50~60%‫ޑ‬዗ዊआǴҞ߻ऍ୯१ࠔᆶ ᛰࠔᆅ౛ֽȐFood and Drug AdministrationǴFDAȑۘ҂ਡ঑‫ݯځ‬ᕍ ‫׳‬ԃය዗ዊआ‫ޑ‬፾ᔈੱǴҞ߻໻ࡌ᝼Ҕ‫ܭ‬ค‫ݤ‬٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ‫஁ޑ‬ ζǴӵ٢ᕎ‫܈‬η৐ϣጢᕎ஻‫ޣ‬฻21,22Ƕ 3. ౦໳✉๧‫ނڗ‬Ȑisoflavone extractsȑǺ΋૓๧‫ڗ‬Ծε‫ل‬Ȑsoy beansȑ ‫܈‬आ޸रጴȐred cloverȑǶᗨԖ࣬ᜢࣴ‫ࡰز‬рё‫ׯ‬๓‫׳‬ԃය஁ζ዗ ዊआϷ‫ڹ‬Ԡ‫ޑ‬௃‫׎‬Ǵՠࣴ‫ز‬ᡉҢҭԖࡐம‫ޑ‬ӼኃᏊբҔǴࡺჹ‫ׯܭ‬ ๓‫׳‬ԃයੱ‫ޑރ‬ਏ݀όܴᡉ21ǶҞ߻ϝឦ‫଼ߥܭ‬१ࠔǴόёૈֹӄ‫ڗ‬ ж੿҅‫಻ޑ‬ᅟᆾǴჹ‫ރੱܭ‬ᇸ༾‫ޣ‬ёаᡣᡏϣ಻ᅟᆾȨ጗फ़ȩǴ෧ ᇸੱ‫ރ‬Ǵՠੱ‫ރ‬ᝄख़‫ׯޑޣ‬๓௃‫߾ݩ‬Ԗज़ǶҞ߻Γᜪอය‫ߏ܈‬ය٬ Ҕۘ҂ԖୋբҔൔᏤ22ǶӢ౦໳✉ϝ཮բҔӧሟᐟન‫ڙ‬ᡏ΢ǴࡺԖ٢ ᕎ‫܈‬η৐ϣጢᕎੰў‫஁ޑ‬ζόࡌ᝼٬ҔǶ 4. ໵ϲഞȐBlack cohoshȑǺЬाቹៜύኰઓ࿶‫س‬಍‫ޑ‬ՈమનԶߚ಻ᅟ ᆾᐚࡋǴᙴᏢࣴ‫ز‬᛾ჴคշỜ጗஁ζ‫׳‬ԃයό፾ 23 ǴЪჹ‫᠌ط‬Ԗ্ 24. Ƕ. 5. ᆢд‫ڮ‬FǴՠࢂցӼӄ‫܈‬ԖਏϝલЮ‫ޑ୼ى‬᛾Ᏽ25Ƕ Կ‫ܭ‬ଞ‫ء‬ȐacupunctureȑǴᙴᏢࣴ‫ࡰز‬рค‫ׯݤ‬๓዗ዊआ‫ޑ‬ᓎ౗Ϸᝄ ख़ࡋ26Ƕ‫ځ‬Ѭ૛ᛰᜪӵξᛰǵ྽ᘜǵД‫ـ‬૛‫ݨ‬ǵΓ⭂ǵҒ૛Ϸύᛰ٠όࡌ ᝼٬ҔǴӢલЮԖਏ‫ޑ‬ჴᡍ่݀16Ƕ ᕴϐǴࣽᏢࣴ‫ࡌ่݀ز‬᝼྽‫׳‬ԃය஁ζӢ዗ዊआԶ‫؃‬ບਔǴ‫܌‬Ԗ஁ ζӃ‫ׯ‬ᡂғࢲࠠᄊǴӵफ़եᡏϣਡЈྕࡋǵೕࡓၮ୏ǵ෧ᇸᡏख़ǵ‫ྟי‬ǵ ‫ܫ‬᚞‫מ‬ѯ฻Ǵё٬ੱ‫ރ‬෧጗Ƕऩੰ஻໻Ԗᇸ༾዗ዊआੱ‫ރ‬ਔё٬Ҕ౦໳✉ ๧‫ނڗ‬ǵ໵ϲഞ‫܈‬ᆢд‫ڮ‬EǹԶჹ‫ܭ‬ύ฻Ϸᝄख़‫ޑ‬஻‫߾ޣ‬٬Ҕӄ‫಻܄ي‬ᅟ ᆾ‫ݯ‬ᕍǴሡ٬ҔനեԖਏᏊໆϷλ‫ܭ‬ϖԃ‫ޑ‬อය٬ҔǶऩੰ஻ค‫ݤ‬٬Ҕ಻ ᅟᆾ‫ݯ‬ᕍ‫ޣ‬Ǵӆ٬Ҕgabapentinǵvenlafaxineǵparoxetine‫܈‬fluoxetineٰ‫ׯ‬ ๓‫ځ‬዗ዊआੱ‫ރ‬15,16ǶȐ߄ 2.1ȑ. 9.

(14) ߄ 2.1. ዗ዊआ‫ࡌޑ‬᝼‫ݯ‬ᕍᄔाȐаACOG & NAMSࡌ᝼ࣁ୷ᘵȑ16. ! ஁ζӢ዗ዊआ‫؃‬ບ!. ੱ‫ރ‬ຑ՗Ǻ!࡭ុਔ໔ǵᝄख़ࡋǵߦ຾Ӣηǵ! Ӄӂǵӝ‫ੱੰٳ‬ǵՔᒿᛰ‫ނ‬Ƕ!. ᇸ༾Ȑmildȑ: ε೽ҽਔ໔዗ዊआ໻ག‫ډ‬ว዗ՠคрԠǶ ύ฻Ȑmoderateȑ: ε೽ҽਔ໔዗ዊआག‫ډ‬ว዗٠рԠǴՠό‫ى‬а ύЗࢲ୏‫ޑ‬຾ՉǶ ᝄख़Ȑsevereȑ: ε೽ҽਔ໔዗ዊआόՠག‫ډ‬ว዗ЪрԠǴӕਔሡଶ З҅ӧ຾Չ‫୏ࢲޑ‬Ƕ. ೀ࿼Ǻ - ‫ׯ‬ᡂғࢲࠠᄊǶ - ߚೀБҔᛰȐӵ౦໳✉๧‫ނڗ‬ǵ໵ϲഞ‫܈‬ᆢд‫ ڮ‬EȑǶ - ӄ‫֖܄ي‬ሟᐟન಻ᅟᆾ‫ݯ‬ᕍϝࣁύ฻Ϸᝄख़዗ዊआੱ‫ރ‬Ъค࿣‫ג‬ ੱ஻‫ޑޣ‬኱ྗ‫ݯ‬ᕍǴሡ٬ҔനեԖਏᏊໆϷλ‫ܭ‬ϖԃ‫ޑ‬อය٬ҔǶ - ऩੰ஻ค‫ݤ‬٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ‫ޣ‬Ǵ٬Ҕ gabapentinǵvenlafaxineǵ paroxetine ‫ ܈‬fluoxetineȐሡค࿣‫ޣੱג‬ȑǶ ໳ᡏનȐߏය٬Ҕჹ٢ᕎੰў‫ޑޣ‬Ӽӄ‫܄‬҂‫ޕ‬ȑǶ Clonidine ‫ ک‬MethyldopaǺ໻ԖύࡋᕍਏЪࢥ‫ࣗ܄‬ଯǶ. ࡭ុຑ՗Ǻ ‫؂‬ԃሡຑ՗‫ݯ‬ᕍ‫ޑ‬Ѹा‫܄‬Ǵ੝ձࢂ٬Ҕӄ‫֖܄ي‬ሟᐟન಻ᅟᆾ‫ݯ‬ᕍ ‫ځ܈‬Ѭᛰ‫ݯނ‬ᕍǶ. 10.

(15) ಃΟക ‫׷‬਑ᆶБ‫ݤ‬ ಃ΋࿯ʳ ᖏ‫׉‬၂ᡍ೛ी 3.1.1 ၂ᡍ೛ी ҁ၂ᡍ೛ी௦ੰᐕӣྉኳԄǴаܺҔ಻ᅟᆾ‫ݯ‬ᕍ߻ࡕ‫ޑ‬ሟᐟનલЮԾ ‫ך‬ຑ՗߄Ȑ߄ 3.1ȑᕴϩϷ዗ዊआൂ໨ϩኧᑔᔠрǴ຾Ε಍ीϩ‫܌ޑ݋‬Ԗ ੰ஻բࣁ҆ဂᡏǶӆаܺᛰࡕ዗ዊआൂ໨ϩኧ҂‫ׯ‬๓‫ޣ‬Ǵ୔ϩрคਏಔ‫ک‬ ԖਏಔࡕǴКၨϩ‫݋‬а‫פ‬рԾ᝺዗ዊआੱ‫ރ‬҂‫ׯ‬๓‫࣬ޑ‬ᜢӒᓀӢηǶ ӧҁ၂ᡍύǴ዗ዊआ‫ۓޑ‬ကࣁȨሟᐟનલЮԾ‫ך‬ຑ՗߄ȩ‫ځ‬ύϐȨ዗ ዊआȩൂ໨ϩኧၲ 2 ϩ‫ ܈‬2 ϩа΢Ƕӧҁ၂ᡍύǴ዗ዊआ‫ݯ‬ᕍคਏ‫ۓޑ‬က ࣁܺҔ಻ᅟᆾ‫ݯ‬ᕍΟঁДࡕȨሟᐟનલЮԾ‫ך‬ຑ՗߄ȩ‫ځ‬ύϐȨ዗ዊआȩ ൂ໨ϩኧϝၲ 2 ϩ‫ ܈‬2 ϩа΢Ƕ ёૈ‫࣬ޑ‬ᜢӒᓀӢηхࡴǺੰ஻ܺҔ಻ᅟᆾ‫ݯ‬ᕍ߻‫ޑ‬ମࣧ๚ϣບϷη ৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ε஁ࣽຬॣ‫ݢ‬ᔠ่ࢗ݀Ϸη৐ϣጢࠆࡋǵ٢‫܊‬ቹႽᏢᔠ ࢗ ่ ݀ Ε Ո మ ύ Ո િ ެ Ȑ Ο ለ Ғ ‫ ݨ‬િ triglyceride ǵ ᕴ ᖌ ‫ ڰ‬ᎇ total cholesterol ȑǵ‫ޜ‬ဎՈᑗॶȐglucose-ACȑǵᎽЧ✉ለᙯữ䁙ȐALTȑǵ Ꮍ૛ᎉለᙯữ䁙ȐASTȑǵ ᘠ‫ڈݰ‬ᐟનȐFSHȑǵߦ໳ᡏᐟનȐLHȑǵ ሟΒᎇȐE2/EstradiolȑϷᖏ‫׉‬΢‫׳‬ԃයੱংဂ‫ׯ‬๓‫ޑ‬ำࡋȐ٬Ҕሟᐟનલ ЮԾ‫ך‬ຑ՗߄ȑǶ. 11.

(16) ߄ 3.1 ሟᐟનલЮੱ‫ރ‬Ծ‫ך‬ຑ՗߄21 0 = ؒԖ ! ! ຑϩВය! !. 1 = ᇸ༾. 2 = ύ฻. 3 = ᝄख़. !. !. !. !. !. आ! !. !. !. !. !. !. ᓐ ! ཀྵ ! ౳ ! ޸! !. !. !. !. !. !. ᓐ!!!!!!!!ภ! !. !. !. !. !. !. ኪ!!!!!!!!ច! !. !. !. !. !. !. ௃ ! ᆣ ! ‫ ! ׭‬ᢠ! !. !. !. !. !. !. Ѩ ! ပ ! ག ! ᝺! !. !. !. !. !. !. ᆒ ! ઓ ! ᆙ ! ஭! !. !. !. !. !. !. Ѩ!!!!!!!!઀! !. !. !. !. !. !. ౦ ! த ! ੲ ! ॰! !. !. !. !. !. !. ङ!!!!!!!!ภ! !. !. !. !. !. !. ᜢ ! ࿯ ! ለ ! ภ! !. !. !. !. !. !. Լ ! Ժ ! ለ ! ภ! !. !. !. !. !. !. य़ ! Л ! ቚ ! ӭ! !. !. !. !. !. !. Ҝ ጥ ౦ த ଳ ᔿ! !. !. !. !. !. !. ‫ ! ܄‬ኅ ! ෧ ! ե! !. !. !. !. !. !. ‫ ܄‬ག ‫ ࡋ ڙ‬फ़ ե! !. !. !. !. !. !. ഍ ! ၰ ! ଳ ! ᔿ! !. !. !. !. !. !. Չ ‫ ܊‬ਔ ག ภ ཱ! !. !. !. !. !. !. ᕴ ! ! ᑈ ! ! ϩ! !. !. !. !. !. !. ໨Ҟ! ዗. ዊ. ! а΢‫ޑ‬ຑϩीᆉ߄Ǵёаᔅշ‫ی‬Ծ‫ך‬ຑ՗ࢂցલЮሟᐟનǶ΋૓Զ‫ق‬Ǵᕴ ᑈϩӵຬၸ 26 ϩǴཱུёૈᡉҢሟᐟન‫ޑ‬ϩ‫ݜ‬ό‫ى‬ǶӵԖҺՖᅪୢǴፎᒌ ၌‫஁ޑی‬ౢࣽᙴғǶ!. 12.

(17) 3.1.2 Γᡏ၂ᡍ‫ہ‬঩཮ȐIRBȑቩࢗ ! ! ਲ༜ᄪ҇ᙴଣคΓᡏ၂ᡍ‫ہ‬঩཮‫ޑ‬ጓ‫ڋ‬ǴӢ‫׳‬ԃයੱংဂȐICD ዸǺ 627.2ȑឦ‫ٯ‬Չᖏ‫׉‬ບᘐ‫ݯک‬ᕍǴЪҁ၂ᡍ೛ी௦ੰ‫ٯ‬ӣྉኳԄǴࡺ࿶᛿ ଣߏӀᗋӕཀࡕ୺ՉǶȐߕᒵ΋ȑ 3.1.3 ၂ᡍਔ໔Ϸᕉნ ! ! ҁ၂ᡍӣྉҗ 2008 ԃ 1 Д 1 ВଆԿ 2008 ԃ 12 Д 31 ВЗǴӢ‫׳‬ԃය ੱংဂԿਲ༜ᄪ҇ᙴଣ஁ౢࣽ൩ᙴੰ஻‫ੰޑ‬ᐕၗ਑Ȑ֖ႝηੰᐕϷરҁੰ ᐕȑǶ 3.1.4 ჹຝ ȐAȑયΕచҹȐinclusion criteriaȑǺ 1. 45~70 ྃଶ࿶ຬၸ΋ԃϐ஁ζǶ 2. ߃ԛ൩ບਔԖܴᡉ‫׳‬ԃයੱ‫ރ‬Ъ҂ௗ‫ڙ‬ၸ಻ᅟᆾᕍ‫ޣݤ‬Ȑሟᐟન લЮੱ‫ރ‬Ծ‫ך‬ຑ՗ɪ15 ϩǴ‫ځ‬ύ዗ዊआൂ໨ϩኧሡၲ 2 ϩ‫ ܈‬2 ϩ а΢ȑǶ 3. ᛝ࿿‫ڙ‬၂‫ޣ‬ӕཀਜ‫ޣ‬Ƕ ȐBȑ௨ନచҹȐexclusion criteriaȑǺ 1.. <45 ྃ‫>܈‬70 ྃζ‫܄‬Ƕ. 2.. ᕎੱ஻‫ޣ‬Ȑ࿶‫ݯ‬ᘰϐη৐ᓍচՏᕎ஻‫ޣ‬ନѦȑǶ. 3.. Ԗ٢ᕎৎ௼ў‫܈‬٢‫܊‬᝻ບԖဍ༧‫ޣ‬Ƕ. 4.. ຬॣ‫ݢ‬ෳໆη৐ϣጢࠆࡋ>16mm ‫ޣ‬Ƕ. 5.. ϝး࿼η৐ϣᗉѫᏔ‫ޣ‬Ƕ. 6.. ు೽ᓉેՈਵǵՈਵ‫܄‬੯ੰǵတՈᆅཀѦ‫܈‬Ӄ߻٬ҔሟᐟનǴ මԖ೭٤ੰў‫ޣ‬Ƕ. 7.. όܴੰӢ‫܌‬Їଆ‫ޑ‬ғ෗Ꮤό҅தрՈ‫ޣ‬Ƕ. 8.. ς‫܈ޕ‬ᚶᅪᚶѫ‫ޣ‬Ƕ. 9.. 㞓๋ࠗ፦؈๱ੰ஻‫ޣ‬Ƕ. 10. ࡚ᄌ‫ੰط܄‬஻‫܈ޣ‬ම஻‫ੰط‬ǴЪ‫طځ‬фૈۘ҂ࡠൺ҅த‫ޣ‬. 13.

(18) Ȑ Ꮍ Ч ✉ ለ ᙯ ữ 䁙 ALT >40U/L, ‫ ܈‬Ꮍ ૛ ᎉ ለ ᙯ ữ 䁙 AST >40U/LȑǶ 11. ܴᡉ๝фૈ౦த‫ޣ‬Ƕ (Ոమֿનේ BUN >23mg/dL, ‫܈‬Լὢለ Creatinine >1.7mg/dL)Ƕ 12. ᆒઓ੯ੰ҂‫ؼ‬ӳ௓‫ޣڋ‬Ƕ 13. ଚ᠅‫܈‬ᛰ‫ނ‬ԋ᠅‫ޣ‬Ƕ 14. ჹ಻ᅟᆾ‫ݯ‬ᕍҔᛰԋҽၸ௵‫ޣ‬Ƕ 15. όᜫཀᛝ࿿ӕཀਜ‫ޣ‬Ƕ. 14.

(19) ಃΒ࿯ ‫׷‬਑ᆶБ‫ݤ‬ ӣྉԾᜫୖᆶ‫ڙޑ‬၂‫ ܭޣ‬2008 ԃ 1 Д 1 ВଆԿ 2008 ԃ 12 Д 31 В ЗǴӧਲ༜ᄪ҇ᙴଣ൩ບ‫ੰޑ‬ᐕǴ٠ϩ‫݋‬Ӣ‫׳‬ԃයੱংဂԶௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ ᕍቹៜ‫ځ‬ԋਏ‫࣬ޑ‬ᜢӢηǶ‫܌‬ሡӣྉ‫ੰޑ‬ᐕϣ৒хࡴǺ 1. ମࣧ๚ϣບϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ƕ 2. ࿶഍ၰ/ဎ೽ຬॣ‫ݢ‬ᔠ่ࢗ݀Ƕ 3. ٢‫܊‬᝻ບϷຬॣ‫ݢ‬ᔠ่ࢗ݀Ƕ 4. ᓉે‫ܜ‬ՈᔠᡍॶǴ֖ՈమύᎽЧ✉ለᙯữ䁙 (ALT)ǵᎽ૛ᎉለᙯữ䁙 (AST)ǵΟለҒ‫ݨ‬િ (triglyceride)ǵᕴᖌ‫ڰ‬ᎇ (total cholesterol)ǵᘠ‫ڈݰ‬ ᐟન(FSH)ǵߦ໳ᡏᐟન (LH)ǵ ሟΒᎇ (E2/Estradiol)Ƕ 5. ሟᐟનલЮੱ‫ރ‬Ծ‫ך‬ຑ՗߄༤ቪ่݀Ƕ !. 15.

(20) ಃΟ࿯!၂ᡍ‫؁‬ᡯᆶБ‫!ݤ‬ ! ၂ᡍჹຝǺ5681 ྃଶ࿶ຬၸ΋ԃϐ஁ζ! ບᘐǺ‫׳‬ԃයੱংဂȐJDE ዸǺ738/3ȑ! ߃ԛ൩ບਔԖܴᡉ‫׳‬ԃයੱ‫ރ‬Ъ҂ௗ‫ڙ‬ၸ಻ᅟᆾᕍ‫ޣݤ‬ȐሟᐟનલЮ ੱ‫ރ‬Ծ‫ך‬ຑ՗߄ɪ26 ϩǴ‫ځ‬ύ዗ዊआൂ໨ϩኧሡၲ 3 ϩ‫ ܈‬3 ϩа΢ȑ!. ӣྉ 2008 ԃ 1 Д 1 ВଆԿ 2008 ԃ 12 Д 31 ВЗǴӧਲ༜ᄪ҇ᙴଣ൩ ບ‫ੰޑ‬ᐕǶϣ৒хࡴǺ 1. ମࣧ๚ϣບϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ƕ 2. ࿶഍ၰ/ဎ೽ຬॣ‫ݢ‬ᔠ่ࢗ݀Ƕ 3. ٢‫܊‬᝻ບϷຬॣ‫ݢ‬ᔠ่ࢗ݀Ƕ 4. ᓉે‫ܜ‬ՈᔠᡍॶǴ֖ՈమύᎽЧ✉ለᙯữ䁙 (ALT)ǵᎽ૛ᎉለᙯữ 䁙 (AST)ǵΟለҒ‫ݨ‬િ (triglyceride)ǵᕴᖌ‫ڰ‬ᎇ (total cholesterol)ǵᘠ ‫ڈݰ‬ᐟન(FSH)ǵߦ໳ᡏᐟન(LH)ǵሟΒᎇ(E2/Estradiol)Ƕ 5. ሟᐟનલЮੱ‫ރ‬Ծ‫ך‬ຑ՗߄༤ቪ่݀Ƕ. 1.‫ݯ‬ᕍคਏϐ‫ۓ‬ကǺ ܺҔ಻ᅟᆾ‫ݯ‬ᕍΟঁДࡕȨሟᐟનલЮԾ‫ך‬ຑ՗ ߄ȩ‫ځ‬ύϐȨ዗ዊआȩൂ໨ϩኧϝၲ 3 ϩ‫ ܈‬2 ϩа΢Ƕ 2. ϩࣁԖਏಔϷคਏಔǴ຾Չ࣬ᜢӒᓀӢηϐϩ‫݋‬Ƕ. 16.

(21) ಃѤ࿯!಍ीϩ‫!݋‬ ! ࣴ‫่݀ز‬Ǵ٬Ҕ SPSS ಍ी೬ᡏ(SPSS for Windows, release 8.0, SPSS Inc, Chicago, IL, USA) Ǵٰ຾Չ಍ीϩ‫݋‬Ǵа p < 0.05 ࣁၲ಍ीᏢ΢ᡉ๱ ཀကǶ‫܌‬Ҕ‫ޑ‬಍ीБ‫ݤ‬ӵΠǺ 1. ‫܌‬Ԗᡂ໨֡ࣁᜪձᡂ໨Ǵхࡴԃស (45-54 and 55 ྃ)ǵౢԛ(1-2 and 3)ǵ‫ي‬ᡏ፦ໆࡰኧ (17-25 and 25.1 kg/m2) ǵওဎౢੰўǵη৐Ϫ ନੰўǵମࣧ๚ᔠࢗϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ǵ஁ౢࣽຬॣ‫ݢ‬ᔠ่ࢗ ݀ǵ಻ᅟᆾೀБᛰ‫ނ‬ǵՈమύᕴᖌ‫ڰ‬ᎇ (total cholesterol >200 mg/dl )ǵ Ο ለ Ғ ‫ ݨ‬િ (triglyceride >170 mg/dl) ǵ ‫ ޜ‬ဎ Ո ᑗ ॶ (glucose-AC >100 mg/dl)ǵᎽЧ✉ለᙯữ䁙 (ALT >40 U/L) ϷᎽ૛ᎉለᙯữ䁙 (AST >45 U/L). ᔠᡍ่݀฻Ƕ 2. аьБᔠ‫ۓ‬ȐChi-square testȑٰᔠᡍᜪձᡂ໨ϐ໔‫ޑ‬ᜢ߯Ƕ 3. ྽ଷ೛ьБᔠ‫ۓ‬೏ၴङਔȐҭࡰ྽‫ځ‬ύ΋ಒ਱‫ޑ‬යࡑॶλ‫ ܭ‬1Ǵ‫܈‬ ࢂຬၸ 20%‫ޑ‬ಒ਱යࡑॶλ‫ ܭ‬5ȑǴ٬Ҕ Fisher’s exact test ٰ຾Չᔠ ‫ۓ‬Ƕ 4. ٬Ҕᛥӓථ଑ᘜȐLogistic regressionȑϷയᆉКȐodds ratioǴ95%ߞ. ᒘ୔໔ȑǴٰ௖૸ௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍࡕ‫ځ‬዗ዊआ౜ຝ҂‫ׯ‬๓၀ಔᆶ࣬ ᜢᡂ໨ϐ໔‫ޑ‬ᜢ߯Ƕ. 17.

(22) ಃѤക ่݀ Ծ 2008 ԃ 1 Д 1 ВଆԿ 2008 ԃ 12 Д 31 ВЗǴӅԖ 120 Տଶ࿶஁ζ ຾Εҁ၂ᡍǴ‫ځ‬ύԖ 6 ՏӧܺҔ಻ᅟᆾ‫ݯ‬ᕍΟঁДࡕ‫ځ‬዗ዊआੱ‫ރ‬҂ܴᡉ ‫ׯ‬๓Ȑคਏಔ!<!6/120 = 5%ȑǴ‫ځ‬ύԖ 114 ՏӧܺҔ಻ᅟᆾ‫ݯ‬ᕍΟঁД ࡕ‫ځ‬዗ዊआੱ‫ރ‬Ԗܴᡉ‫ׯ‬๓ȐԖਏಔ!<!114/120 = 95%ȑǶ٠ϩ‫݋‬Ԗਏಔ ᆶคਏಔ໔‫ޑ‬ৡ౦Ǵ‫פ‬р‫ݯ‬ᕍคਏёૈӒᓀӢηǴ‫่݀ځ‬ӵΠǺ! ! 4.1 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬ᖏ‫୷׉‬ҁၗ਑ ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬ᖏ‫୷׉‬ҁၗ਑Ǵ௖૸Αԃសǵౢԛǵ‫ي‬ᡏ፦ໆ ࡰኧǵওဎౢўϷη৐Ϫନў฻໨ҞǴ‫ځ‬ύѝԖԃសБय़ၲ಍ीᏢ΢‫ޑ‬ৡ ౦Ȑp = 0.014ȑǴ‫ځ‬Ѭ໨Ҟ߾คȐ߄ 4.1ȑǶ ߄ 4.1 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬ᖏ‫୷׉‬ҁၗ਑ ᡂ. ໨. Ԗਏಔ (n = 114). คਏಔ (n = 6). No. (%). No. (%). P ॶ 0.014+. ԃសȐྃȑ 45 — 54. 34 (29.8). 5 (83.3). Њ 55. 80 (70.2). 1 (16.7) 1+. ౢԛ 1—2 Њ3. 49 (43). 3 (50). 65 (57). 3 (50). 2. 1+. ‫ي‬ᡏ፦ໆࡰኧ (kg/m ) 17 — 25. 54 (47.4). 3 (50). Њ 25.1. 60 (52.6). 3 (50). ওဎౢў. 17 (14.9). 0 (0). 0.5931+. η৐Ϫନў. 36 (32.5). 0 (0). 0.1751+. * ьБᔠ‫ۓ‬ȐChi-square testȑǴ + Fisher’s exact test. 18.

(23) 4.2 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬ମࣧ๚ᔠࢗϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬ମࣧ๚ᔠࢗϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ǵ‫ځ‬ύѝԖ η৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ၲ಍ीᏢ΢‫ޑ‬ৡ౦Ȑp = 0.015ȑȐ߄ 4.2ȑǶ ߄ 4.2 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬ମࣧ๚ᔠࢗϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ ᡂ. ໨. Ԗਏಔ (n = 114). คਏಔ (n = 6). No. (%). No. (%) 0.0941+. ମࣧ๚ᔠࢗ ҅த ό҅த. P ॶ. 105 (92.1). 4 (66.7). 9 (7.9. 2 (33.3) 0.015+. η৐ᓍ‫ܓ‬Тᔠࢗ ҅த. 79 (69.3). 1 (16.7). ว‫܈ݹ‬๺ᕭ. 35 (30.7). 5 (83.3). ! * ьБᔠ‫ۓ‬ȐChi-square testȑǴ + Fisher’s exact test!. 19.

(24) 4.3 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫಻ޑ‬ᅟᆾೀБᛰ‫ނ‬ ӧҁଣ‫׳ޑ‬ԃය಻ᅟᆾೀБαܺҔᛰӅԖ PremarinȐConjugated estrogen 0.625mgȑǵEstromonȐConjugated estrogen 0.625mgȑǵEdiol ȐConjugated estrogen 0.3mgȑȐа΢ࣁሟᐟનൂБᇙᏊȑᆶ Premelleǵ DivinaǵSevinaǵClimenǵProgylutonȐа΢ࣁሟᐟનᆶ໳ᡏનӝ‫ٳ‬ ᇙᏊȑǶќԖ Oestogelࣁ࿶Ҝ֎ԏሟᐟનൂБᇙᏊǶࣁ٬η৐ϣጢόӢ ൂᐱ٬ҔሟᐟનԶᏤठቚғ‫܈‬ൾ‫ੰ܄‬ᡂǴη৐҂Ϫନ‫׳ޑ‬ԃයੰ஻ନ٬Ҕ ሟᐟનᇙᏊ෧Ͽ‫׳‬ԃයό፾ѦǴќ๏ϒ໳ᡏનᇙᏊ ProveraȐProgestin 5mgȑߥៈη৐ϣጢǶϩ‫݋‬Ԗਏಔᆶคਏಔ‫಻ޑ‬ᅟᆾೀБᛰ‫ނ‬Ǵ಍ी่݀ և౜‫ٿ‬ಔคܴᡉ಍ीᏢ΢‫ޑ‬ৡ౦Ȑ߄ 4.3ȑǶ ! ߄ 5/4!!ϩ‫݋‬Ԗਏಔᆶคਏಔ‫಻ޑ‬ᅟᆾೀБᛰ‫!ނ‬ ᡂ. ໨. Ԗਏಔ (n = 114). คਏಔ (n = 6). No. (%). No. (%) 1+. ಻ᅟᆾೀБᛰ‫ނ‬ Conjugated estrogen 0.625mg. 65 (57). 4 (66.7). 7 (6.1). 0 (0). +/- progestin 5mg Conjugated estrogen 0.3mg +/- progestin 5mg Divina, Sevina, Climen,. 30 (26.3). 2 (33.3). 12 (10.5). 0 (0). or Progyluton Oestrogel +/- Provera. P ॶ. ! * ьБᔠ‫ۓ‬ȐChi-square testȑǴ + Fisher’s exact test!. 20.

(25) 4.4 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫஁ޑ‬ౢࣽຬॣ‫ݢ‬ᔠ่ࢗ݀ ϩ‫݋‬Ԗਏಔᆶคਏಔ‫஁ޑ‬ౢࣽຬॣ‫ݢ‬ᔠ่ࢗ݀Ǵ಍ी่݀և౜‫ٿ‬ಔค ܴᡉ಍ीᏢ΢‫ޑ‬ৡ౦Ȑ߄ 4.4ȑǶ ߄ 4.4 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫஁ޑ‬ౢࣽຬॣ‫ݢ‬ᔠ่ࢗ݀ ᡂ. ໨. Ԗਏಔ (n = 114). คਏಔ (n = 6). No. (%). No. (%). P ॶ 0.163+. ຬॣ‫ݢ‬ᔠࢗ ҅த. 98 (86). 5 (83.3). η৐౦த. 14 (12.3). 0 (0). ߕឦᏔ౦த. 2 (1.8). 1 (16.7). * ьБᔠ‫ۓ‬ȐChi-square testȑǴ + Fisher’s exact test. 21.

(26) 4.5 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬Ոమғϯॶᔠᡍ่݀ ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬Ոమύᕴᖌ‫ڰ‬ᎇǵΟለҒ‫ݨ‬િǵ‫ޜ‬ဎՈᑗॶǵ ᎽЧ✉ለᙯữ䁙ϷᎽ૛ᎉለᙯữ䁙ᔠᡍ่݀Ǵ಍ी่݀և౜‫ٿ‬ಔคܴᡉ಍ ीᏢ΢‫ޑ‬ৡ౦Ȑ߄ 4.5ȑǶ ! ߄ 4.5 ϩ‫݋‬Ԗਏಔᆶคਏಔ‫ޑ‬Ոమύᕴᖌ‫ڰ‬ᎇǵΟለҒ‫ݨ‬િǵ‫ޜ‬ဎՈᑗ ॶǵᎽЧ✉ለᙯữ䁙ϷᎽ૛ᎉለᙯữ䁙ᔠᡍ่݀ ᡂ. ໨. P ॶ. Ԗਏಔ (n = 55). คਏಔ (n = 3). No. (%). No. (%). ᕴᖌ‫ڰ‬ᎇ >200 mg/dl. 19 (34.5). 1 (33.3). 1+. ΟለҒ‫ݨ‬િ >170 mg/dl. 10 (18.2). 1 (33.3). 0.474+. ‫ޜ‬ဎՈᑗॶ >100 mg/dl. 11 (20). 1 (33.3). 0.508+. ᎽЧ✉ለᙯữ䁙 >40 U/L. 1 (1.8). 1 (33.3). 0.102+. Ꮍ૛ᎉለᙯữ䁙 >45 U/L. 2 (3.6). 1 (33.3). 0.150+. * ьБᔠ‫ۓ‬ȐChi-square testȑǴ + Fisher’s exact test. ! ! ! ! ! ! ! ! ! ! ! ! ! !. 22.

(27) 4.6 ಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓ಔ࣬ᜢӒᓀӢη‫ޑ‬ᛥӓථ଑ᘜϩ‫่݀݋‬ ൂᡂ໨ᛥӓථ଑ᘜϩ‫่݀݋‬ᡉҢԃសϟ‫ ܭ‬45 Կ 54 ྃϷη৐ᓍ‫ܓ‬Тᔠ ่ࢗ݀ࣁว‫܈ݹ‬๺ᕭǴᆶ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓ȐคਏಔȑԖ ᡉ๱Ӧ࣬ᜢ‫܄‬Ƕၨԃᇸ‫ޑ‬ԃសȐϟ‫ ܭ‬45 Կ 54 ྃȑϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ ࣁว‫܈ݹ‬๺ᕭࢂ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓‫ޑ‬ӒᓀӢηȐ OR: 11.7, 95% CI: 1.3 – 104.5, P = 0.027; OR: 11.3, 95% CI: 1.3 – 100.1, P = 0.0296ȑǶӧӭᡂ໨ᛥӓථ଑ᘜϩ‫ॺךࡕ݋‬Ψว౜ԃសϟ‫ ܭ‬45 Կ 54 ྃϷ η৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ࣁว‫܈ݹ‬๺ᕭǴᆶ٬Ҕ಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓ Ԗᡉ๱Ӧ࣬ᜢȐ߄ 4.6ȑǶ ! ߄ 4.6 ಻ᅟᆾ‫ݯ‬ᕍ዗ዊआੱ‫ރ‬҂‫ׯ‬๓ಔ࣬ᜢӒᓀӢη‫ޑ‬ᛥӓථ଑ᘜϩ‫݋‬ ่݀ ٩ᡂ໨. ൂᡂ໨ϩ‫݋‬ odds ratio (95% CI) P ॶ. ӭᡂ໨ϩ‫݋‬ odds ratio (95% CI) P ॶ. ԃសȐྃȑ 45 — 54. 11.7 (1.3 – 104.5) 0.027. 14.0 (1.5 – 132.6). Њ 55. 1. 1. ҅த. 1. 1. ว‫܈ݹ‬๺ᕭ. 11.3 (1.3 – 100.1) 0.0296. 13.5 (1.4 – 127.7). 0.0212. η৐ᓍ‫ܓ‬Тᔠ่ࢗ݀. CI ࡰߞᒘ୔໔Ȑconfidence intervalȑ. 23. 0.0232.

(28) ಃϖക ૸ፕ !!! வҁ၂ᡍ่݀ύǴ‫ॺך‬ว౜ӧੰ஻‫୷ޑ‬ҁၗ਑ύǴคਏಔ‫ޑ‬ԃសၨԖ ਏಔᇸȐp = 0.014; sample power = 68%ȑǴᏵӃ߻Ў᝘ӣ៝Ǵሟᐟનჹ‫ܭ‬ ‫׳‬ԃය‫ޑ‬዗ዊआ౜ຝ‫ת‬ᄽ،‫فޑ܄ۓ‬ՅǴ‫܌‬аёૈӢࣁԃᇸ‫ޣ‬ᡏϣሡၨଯ ‫ޑ‬ሟᐟનᐚࡋωёԖਏ‫ׯ‬๓዗ዊआ13Ǵՠ‫ॺך‬લЮੰ஻ௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍ߻ ‫ޑ‬ሟΒᎇᔠᡍኧᏵٰ᛾ჴ೭ঁଷ೛ǶќѦǴ஁ζ‫ޑ‬዗ዊआ౰Չ౗ᆶԃសԖ ࣬ᜢ‫܄‬15,28Ǵྷ‫ڂ‬΋ߏၲΒΜϖԃ‫ޑ‬ᢀჸࣴ‫ز‬ว౜ӧ 52 Կ 54 ྃਔ‫ځ‬౰Չ ౗ଯၲ 60%29ǴԶ‫ॺך‬ஒԃស‫ޑ‬cut point‫ۓ‬ӧ 54 ྃǴ҅ӳϟ‫ܭ‬౰Չ౗ଯঢ় යǴࡺёှញࣁՖԃសᆶ‫ݯ‬ᕍคਏԖ࣬ᜢ‫܄‬Ƕ ќ௖૸‫ځ‬д࣬ᜢӒᓀӢηхࡴମࣧ๚ᔠࢗϷη৐ᓍ‫ܓ‬Тᔠ่ࢗ݀ǵ಻ ᅟᆾೀБᛰ‫ނ‬Кၨǵ஁ౢࣽຬॣ‫ݢ‬ᔠ่ࢗ݀ϷՈమғϯॶᔠᡍ่݀Ƕ‫ځ‬ύ η৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ԗ಍ीᏢ΢‫ޑ‬ᡉ๱ৡ౦Ȑp = 0.015ȑǴΒಔ࣬Кёว ౜Ԗਏಔ‫ܓޑ‬Т่݀а҅தۚӭȐn = 79, 69.3%ȑǴԶคਏಔ߾аว‫܈ݹ‬ ๺ᕭ‫܄‬ว‫ݹ‬эεӭኧȐn = 5, 83%ȑǶሟᐟનԖ‫ל‬ว‫ݹ‬ϷߥៈՈᆅ‫ޑ‬բҔ 30,31. ǴӢԜǴ዗ዊआ‫ׯ‬๓คਏಔёૈҗ‫ܭ‬ᡏϣሟᐟનΠफ़൯ࡋၨεǴࡺᏤ. ठ‫ݯ‬ᕍ߻‫ܓޑ‬Т่݀εӭࣁว‫܈ݹ‬๺ᕭǴჹ‫಻ܭ‬ᅟᆾ‫ݯ‬ᕍ‫ޑ‬ϸᔈόӵႣ යǶԖਏಔ߾Ӣᡏϣሟᐟનᐚࡋϝᆢ࡭‫לځ‬ว‫ݹ‬բҔǴ‫܌‬а‫ݯ‬ᕍ߻‫ޑ‬η৐ ᓍ‫ܓ‬Т่݀և౜҅த‫ޑ‬К‫ٯ‬ΨၨଯǴ዗ዊआ‫ׯ‬๓‫ޑ‬ำࡋΨၨ౛གྷǴόၸന ӳԖ‫ݯ‬ᕍ߻ࡕ‫ޑ‬ᡏϣሟᐟનᐚࡋКၨբࣁ՘᛾Ƕ ӧ಻ᅟᆾೀБҔᛰБय़Ǵҁ၂ᡍஒ‫܌‬٬Ҕ‫಻ޑ‬ᅟᆾҔᛰϩࣁѤಔǴϩ ձࢂConjugated estrogen 0.625mg +/- progestin 5mgȐ΋૓Ꮚໆሟᐟન+/-࡭ ុ‫܄‬໳ᡏનᇙᏊȑǴ Conjugated estrogen 0.3mg +/- progestin 5mgȐեᏊ ໆ ሟ ᐟ ન +/- ࡭ ុ ‫ ܄‬໳ ᡏ ન ᇙ Ꮚ ȑ Ǵ Divina, Sevina, Climen, or ProgylutonȐሟᐟન+ຼය‫܄‬໳ᡏનᇙᏊȑϷ Oestrogel +/- Provera Ȑ࿶Ҝ֎ԏሟᐟન+/-࡭ុ‫܄‬໳ᡏનᇙᏊȑǶԿ‫ܭ‬ӧೀБ‫ޑ‬ᒧ᏷΢Ӄ٩ੰ ஻‫يޑ‬ᡏ‫ٰݩރ‬،‫ۓ‬αܺᇙᏊ‫ࢂ܈‬࿶ҜᇙᏊǴऩੰ஻Ԗ‫ੰݹط‬ўȐӵBࠠ ‫܈ݹط‬Cࠠ‫ݹط‬஥চ‫ޣ‬ȑ‫܈‬ௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍ߻ՈమᔠᡍᎽЧ✉ለᙯữ䁙 ȐALTȑϷᎽ૛ᎉለᙯữ䁙ȐASTȑॶև౜౦த௃‫ݩ‬ਔȐALT>40 U/L or AST>45 U/LȑǴ‫ॺך‬ሡೀБ࿶Ҝ֎ԏᇙᏊǶӆ‫ޣ‬η৐҂Ϫନ஁ζӧ๏ϒ. 24.

(29) ಻ᅟᆾҔᛰሡу΢໳ᡏનᇙᏊǴٰߥៈη৐ϣጢа෧Ͽቚғ‫܈‬౦தੰᡂ‫ޑ‬ ᐒ཮Ƕ໳ᡏનᇙᏊ๏ᛰёϩ࡭ុ‫܄‬๏ᛰȐ‫؂‬ВܺҔȑ‫ຼ܈‬ය‫܄‬๏ᛰȐ‫؂‬Д ๏ 10 Կ 14 Ϻȑ 32 Ǵຼය‫܄‬๏ᛰ཮Ꮴठ‫ঁ؂‬Д‫ۓޑ‬යрՈȐmonthly menstruation ȑ Ǵ ࡭ ុ ‫ ܄‬๏ ᛰ ߾ ց Ǵ ՠ ҭ ё ૈ ཮ р ౜ ँ ઇ ‫ ܄‬р Ո Ȑbreakthrough bleedingȑ15Ƕӧ๏ᛰ߻‫཮ॺך‬ӛੰ஻ှញ೭‫ޑޣٿ‬ৡ౦Զ ࡕҗੰ஻ԾՉᒧ᏷ҔᛰǴаගଯੰ஻ܺᛰ‫ޑ‬໩ᔈ‫܄‬Ǵၲ‫ډ‬ၨ٫‫ݯޑ‬ᕍਏ ݀Ƕ ќѦǴӧ๏ᛰ೼৩΢ǴёϩࣁαܺᇙᏊȐ֖ Conjugated estrogen 0.625mg +/- progestin 5mg Ǵ Conjugated. estrogen. 0.3mg +/- progestin. 5mg Ǵ Divina, Sevina, Climen, or Progyluton ȑ Ϸ ࿶ Ҝ ֎ ԏ ᇙ Ꮚ Ȑ Oestrogel +/-. Provera ȑ Ƕ ࡕ ‫ ޣ‬ᆶ ߻ ‫ ࣬ ޣ‬К ‫ ޑ ֖ ܌‬ሟ Β ᎇ. ȐestradiolȑӧΓᡏжᖴ೼৩ύёౣၸಃ΋‫؁‬ᡯǴ٬ᡏϣᏱԖၨଯ‫ޑ‬ሟΒ ᎇᐚࡋǶࡺ٬Ҕ࿶Ҝ֎ԏᇙᏊ‫ځޣ‬ᡏϣ‫ޑ‬ሟΟᎇȐestroneȑᆶሟΒᎇ‫ޑ‬К ॶࣁ 1Ǻ1Ǵၨௗ߈ଶ࿶߻‫ރޑ‬ᄊ33ǴՠҞ߻ϝલЮεࠠ߻ᘳ‫ޑ܄‬ᖏ‫׉‬ᚈ‫ޓ‬ ჹྣ၂ᡍٰКၨ๏ᛰ೼৩΢‫ޑ‬ৡ౦34Ƕ୯ϣҗ‫ܭ‬ӄ଼҇நߥᓀ๏б΢‫ޑ‬ज़ ‫ڋ‬Ǵ࿶Ҝ֎ԏᇙᏊ‫ޣ‬ሡԖ‫ੰݹط‬ўȐӵBࠠ‫܈ݹط‬Cࠠ‫ݹط‬ȑ‫܈‬Ոమᔠᡍ ᎽЧ✉ለᙯữ䁙ȐALTȑϷᎽ૛ᎉለᙯữ䁙ȐASTȑॶև౜౦த௃‫ݩ‬Бё ೀБǴࡺ٬ҔαܺᇙᏊϷ࿶Ҝ֎ԏᇙᏊ‫ੰޑ‬஻୷ҁచҹ٠ό΋ठǴ‫ॺך‬ᇡ ࣁКၨ‫ٿ‬ಔ໔‫ޑ‬ৡ౦ࢂؒԖཀက‫ޑ‬Ƕ а۳‫ޑ‬ᢀ‫ۺ‬ύᇡࣁ಻ᅟᆾೀБҔᛰ‫ޑ‬ᏊໆၨεǴᡏϣ‫ޑ‬ሟᐟનᐚࡋ཮ ΢ϲǴੰ஻‫׳ޑ‬ԃයੱংဂ‫ׯ‬๓ਏ݀ၨ٫Ǵ‫܌‬а‫ॺך‬Ⴃය٬Ҕ Conjugated estrogen 0.625mg +/- progestin 5mg ೭ಔᔈ၀཮К Conjugated estrogen 0.3mg +/- progestin 5mg ೭ಔ‫ޑ‬ਏٰ݀ள٫Ǵՠ಍ीी่݀և౜คܴᡉ಍ ीᏢ΢‫ޑ‬ৡ౦ǶҗԜё௢ෳ྽‫׳‬ԃයੰ஻ௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍࡕǴ‫ځ‬዗ዊआੱ ‫ރ‬ϐ‫ׯ‬๓ό‫ـ‬ளᆶᏊໆև౜҅࣬ᜢǶӢԜǴӧೀБ಻ᅟᆾҔᛰ΢ǴᏊໆε λ‫ޑ‬๏ϒᔈԵቾ‫ੰࢂޑ‬஻ҁ‫ރޑي‬ᄊǴӵԃសǵ‫ݯ‬ᕍ߻‫ܓޑ‬Т่݀฻ǴԶ ߚᖏ‫׳ޑ׉‬ԃයੱ‫ރ‬Ƕ চҁ‫ޑ‬၂ᡍ೛ीႣ‫ۓ‬ϩ‫ੰ݋‬஻ௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍ߻‫ޑ‬ᘠ‫ڈݰ‬ᐟન ȐFSHȑǵߦ໳ᡏᐟનȐLHȑϷሟΒᎇȐE2/EstradiolȑǴӢ΢ॊ‫಻ޑ‬ᅟ ᆾӧ஁ζ‫׳‬ԃයр౜ਔԖ੝‫ޑۓ‬ᡂϯ11ǶՠӢ௦ੰᐕӣྉኳԄϷӄ଼҇ந. 25.

(30) ߥᓀ‫ޑ‬ज़‫ڋ‬Ǵ‫ॺך‬ค‫ݤ‬ᡣ‫܌‬ԖયΕ‫ੰޑ‬஻Ӄௗ‫಻ڙ‬ᅟᆾॶ‫ܜޑ‬ՈᔠෳǴ‫܌‬ аᏱԖֹ᏾ᔠᡍ่݀ၗ਑‫ੰޑ‬஻ΓኧߚதϿǴค‫ݤ‬ၲ‫ډ‬಍ीϩ‫ޑ݋‬Πज़Ǵ ѝӳ௭కԜёૈӒᓀӢη‫ޑ‬ϩ‫݋‬ǶӕኬӦǴӧՈమғϯᔠᡍॶБय़ǴΨӢ ค‫ֹݤ‬ӄ‫ڗ‬ள 120 Տੰ஻ӧܺᛰ߻‫ޑ‬Ոమύᕴᖌ‫ڰ‬ᎇǵΟለҒ‫ݨ‬િǵ‫ޜ‬ဎ ՈᑗॶǵᎽЧ✉ለᙯữ䁙ϷᎽ૛ᎉለᙯữ䁙‫܌ޑ‬Ԗၗ਑ Ǵࡺ໻൩Ԗֹ᏾ ᔠᡍ่݀‫ੰޑ‬஻ȐԖਏಔ 55 ՏǴคਏಔ 3 Տȑ຾Չϩ‫݋‬Ƕёૈҗ‫ܭ‬ኬҁ ኧၸϿϐࡺǴ‫܌‬аКၨࡕว౜‫ٿ‬ಔคܴᡉ಍ी΢‫ޑ‬ৡ౦Ƕ ‫ޑॺך‬၂ᡍ่݀ᆶ୯ѦЎ᝘ൔᏤ࣬К2Ǵ዗ዊआคਏ‫ޑ‬К‫ٯ‬ऊԖ 3~5% ‫ޑ‬ৡຯǴό‫ޕ‬ၰࢂӢኬҁኧໆϿǴᗋࢂᅿ௼ᆶ҇௃΢‫ޑ‬ৡձǻᏵऍ୯΋ጇ 1995 Կ 1997 ԃ‫ޑ‬ፓࢗ‫زࣴ܄‬Ǵ఼ᇂ 16,065 Տԃសϟ‫ ܭ‬40 Կ 55 ྃ‫ޑ‬όӕ ᅿ ௼ ஁ ζ Ǵ ว ౜ ӧ Ո ᆅ ๤ ᕭ ੱ ‫ ޑ ރ‬౰ Չ ౗ а ߚ ဴ ऍ ୯ Γ Ȑ AfricanAmerican ȑ ന ଯ Ǵ ՞ 45.6% Ǵ ‫ ځ‬ԛ ࣁ Ջ ੤ У ဴ ऍ ୯ Γ Ȑ HispanicAmerican ȑ Ǵ ՞ 35.4% Ǵ Զ ࡕ ٩ ‫ ࣁ ׇ‬ଯ у ઩ Γ Ȑ Caucasians ȑ Ǵ ՞ 31.2% Ǵ ๮ ဴ ऍ ୯ Γ Ȑ Chinese-Americans ȑ Ǵ ՞ 20.5% Ǵ В ဴ ऍ ୯ Γ ȐJapanese-AmericansȑǴ՞ 17.6%Ǵ᛾ჴᅿ௼ዴჴԖ዗ዊआ౰Չ౗Ϸำࡋ ΢‫ޑ‬ৡ౦35ǶԶStudy of Women's Health Across the NationȐSWANȑ‫ࣴޑ‬ ‫่݀ز‬ҭᡉҢ࣬՟‫ޑ‬ᅿ௼ৡ౦37,38Ƕ ӧ٥ࢪǴε‫ࡐࢂل‬දၹ‫ޑ‬१ࠔǴᆶѦ୯࣬ၨǴВதғࢲύ१Ҕε‫ޑل‬ К‫ٯ‬ଯрࣗӭǴӵ‫ل‬ዀϐ‫ܭ‬๮ΓǴ‫⧉ښ‬ϐ‫ܭ‬ВҁΓǶࢂցӢԜӧᡏϣಕᑈ Αၨӭ‫ޑ‬ε‫ل‬౦໳✉Ǵࡺ‫׳‬ԃයਔၨϿ߄౜р዗ዊआੱ‫ګރ‬ǻ ऩࢂԋԃ ࡕω౽҇ԿՋБ୯ৎ‫ޣ‬Ǵ‫ځ‬໯१ಞᄍᜤаֹӄ೏ՋϯǴЪ٥ࢪ໯१ӧՋБ ୯ৎௗ‫ࡋڙ‬ຫٰຫଯǴ१‫׷‬Ψၨ৒ܰ‫ڗ‬ளǶ‫܌‬а዗ዊआੱ‫ޑރ‬ৡ౦ֹӄࢂ ᅿ௼୷Ӣ΢‫ޑ‬όӕǴᗋࢂ໯१Ўϯ՞ၨε‫ޑ‬Ӣનǻ ਥᏵ 2006 ԃStudy of Women's Health Across the NationȐSWANȑᜢ ‫ ܭ‬42 Կ 52 ྃӅ 1,538 Տхࡴߚဴऍ୯ΓȐAfrican Americanȑ, ଯу઩Γ ȐCaucasianȑ, ๮ΓȐChinese ȑϷВҁΓȐJapaneseȑ฻Ӛᅿ௼໔ᆶՈᆅ ๤ᕭੱ‫ൂޑރ‬΋ਡ㧿ለӭࠠ‫܄‬ȐSingle nucleotide polymorphism, SNPsȑ୷ Ӣ ࣴ ‫ ز‬ว ౜ Ǵ Ӛ ᅿ ௼ ໔ ‫ ޑ‬Ո ᆅ ๤ ᕭ ੱ ‫ ރ‬౰ Չ ౗ ᆶ ‫ ܄‬ᐟ ન ж ᖴ 䁙 Ȑ sex steroid-metabolizing enzymeȑϷ‫܄‬ᐟન‫ڙ‬ᡏȐsex steroid receptorȑ໔‫ൂޑ‬ ΋ਡ㧿ለӭࠠ‫܄‬Ԗ࣬ᜢ‫܄‬Ƕ36. 26.

(31) Զќ΋SWAN‫߾่݀زࣴޑ‬ᡉҢǴՈᆅ๤ᕭੱ‫ރ‬ᆶၨଯ‫يޑ‬ᡏ፦ໆࡰ ኧǵ‫ྟܜ‬ўȐՠ౜ς‫ྟי‬ȑǵ࿶߻ੱংဂǵ౜ӸᓸΚᆶԃសԖᜢǴЪԖᅿ ௼΢‫ޑ‬ৡ౦ǹՠᆶ໯१ಞᄍคᡉ๱࣬ᜢ37Ƕ‫ځ‬д‫زࣴޑ‬ൔᏤҭࡰрҗВத ໯१ឪ‫ڗ‬ε‫ل‬ᆶ዗ዊआੱ‫ޑރ‬෧጗٠คܴᡉ࣬ᜢ39,40ǴёૈচӢࣁВத໯ १‫ޑ‬ፓࢗ‫زࣴ܄‬ज़‫܄ڋ‬ၨεǴाၲ‫ډ‬ӵӕᛰ‫ނ‬૓ᆒዴ‫ޑ‬Ꮚໆ๏ϒӧჴՉ΢ ֚ᜤࡋၨଯǴࡺ΋‫ޔ‬ค೭Бय़‫ޑ‬Ў᝘ൔᏤǶ ᗨฅςೀБ಻ᅟᆾ‫ݯ‬ᕍҔᛰǴՠ‫ॺך‬٠คჹуΕ၂ᡍ‫ੰޑ‬஻ज़‫ڋ‬ғࢲ ಞᄍ‫܈‬໯१Ǵς೏዗ዊआ‫֚܌‬ᘋ‫ੰޑ‬஻ࢂցςӧВதғࢲԖ‫ׯ܌‬ᡂȐӵቚ уၮ୏ໆ‫܈‬෧ᇸᡏख़ȑҭ‫ࢂ܈‬໯१΢ቚуε‫ل‬ᜪ१‫ޑނ‬ឪ‫ڗ‬Ǵ‫܌‬а‫ݯ‬ᕍࡕ ‫ޑ‬ԋਏၨЎ᝘ൔᏤ౛གྷǻ೭ёૈሡा຾΋‫؁‬ଞჹੰ஻‫ޑ‬ВதғࢲӆՉፓࢗ ࡕωԖၨޭ‫ޑۓ‬เਢǶ চҁ၂ᡍ೛ी‫׆‬ఈૈуΕύᙴ᛾ࠠ‫ޑ‬ϩᜪа಄ӝύՋᙴ่ӝᖏ‫׉‬၂ᡍ ‫ޑ‬Ҟ‫ޑ‬ǴՠӧჴՉ΢Ԗ‫֚ځ‬ᜤೀǶಃ΋Ǵҁଣ٠คύᙴ೽ߐ‫ޑ‬೛࿼ǴЪҁ ଣ‫஁ޑ‬ౢࣽᙴৣဂ֡คௗ‫ڙ‬ύᙴ‫࣬ޑ‬ᜢ૽ግǴҗ‫଺ٰॺך‬᛾ࠠϩᜪલЮ஑ ཰ᢀᗺǴёૈ཮Ꮴठ၂ᡍ΢‫ޑ‬ᇤৡǶಃΒǵᎃ߈ᙴଣᗨԖύᙴ೽ߐȐߏ۪ इ‫ۺ‬ᙴଣਲ༜ϩଣȑǴՠᆶҁଣϩឦόӕᡏ‫س‬Ǵ࣬ϕЍජ΢Ԗ‫֚܌‬ᜤǶЪ ߏ۪इ‫ۺ‬ᙴଣਲ༜ϩଣᆶҁଣऊԖ 8 Ϧٚ‫ޑ‬ຯᚆǴੰ஻Կ၀ଣ‫؃‬ບҭሡб ຤Ƕࡺ࿶ӭБԵໆ،‫ࡕۓ‬௭కύᙴ᛾ࠠ‫ޑ‬ϩᜪǴΨ ೚ӧ҂ٰ‫ޑ‬၂ᡍύ‫ך‬ ॺૈуΕ‫׳‬ӭύᙴБय़‫ޑ‬ၗ਑Ƕ നࡕ‫ॺך‬ሡ௖૸ sample power ‫ޑ‬೽ҽǶᖏ‫׉‬၂ᡍሡԖ 80%а΢‫ޑ‬ sample power ωԖϦߞΚǴՠҁ၂ᡍ໻Ԗ 68%ǴёૈচӢᗋࢂኬҁኧၸ ϿǶӵૈஒࣴ‫ز‬ਔ໔܎ߏǴࣗԿ៶ࡴӭৎᙴଣӅӕ຾Չࣴ‫ز‬Ǵ࣬ߞёаቚ уኬҁኧǴၲ‫׳ډ‬ଯ‫ޑ‬ϦߞΚǶ. 27.

(32) ಃϤക ่ፕ ಃ΋࿯ʳ่ፕ வа΢‫ޑ‬၂ᡍϩ‫่݀݋‬Ǵ‫ॺך‬ёаள‫ ޕ‬2008 ԃӧਲ༜ᄪ҇ᙴଣӢ‫׳‬ ԃයௗ‫಻ڙ‬ᅟᆾ‫ݯ‬ᕍ‫ੰޑ‬஻ύǴԖ 5%Ծ᝺ࢂӧܺᛰࡕ዗ዊआੱ‫ރ‬٠҂‫ׯ‬ ๓‫ޣ‬ǴԶ࣬ᜢӢηϩ‫ࡕ݋‬ว౜ԃសϷ‫ݯ‬ᕍ߻η৐ᓍ‫ܓ‬Тᔠ่ࢗ݀Ԗᡉ๱‫ޑ‬ ࣬ᜢǶ. ಃΒ࿯ʳ҂ٰ৖ఈ ҁ၂ᡍ௦ੰᐕӣྉኳԄǴឦჴ᛾ᙴᏢ level 3b ‫ޑ‬᛾ᏵȐcase control studyȑǴӢࣴ‫ز‬ჹຝ໻ࣁਲ༜ᄪ҇ᙴଣੰ஻ǴΓኧόӭǴЪ sample power ໻Ԗ 68%Ǵՠϝёᑍ‫׳ـ‬ԃය‫಻ޑ‬ᅟᆾ‫ݯ‬ᕍϝԖ҂ഖӄਏϐೀǶ҂ٰᔕа ҁ၂ᡍҞ‫ࣁޑ‬Ҟ኱೛ीᝄᙣ‫ޑ‬ᒿᐒჹྣᚈ‫ޓ‬၂ᡍǴٰుΕ௖૸዗ዊआੱ‫ރ‬ คਏ‫ޑ‬চӢǴ຾Զ‫ډפ‬ଞჹԜဂੰ஻‫ޑ‬ၨ٫‫ݯ‬ᕍБԄǶќёуΕԖᜢ୷Ӣ Бय़‫زࣴޑ‬Ǵ‫פ‬рԜဂੰ஻‫୷ޑ‬Ӣৡ౦‫܄‬Ǵቚу‫ݯ‬ᕍ΢‫ޑ‬ԋф౗ǶନՋБ ᙴᏢ‫಻ޑ‬ᅟᆾ‫ݯ‬ᕍѦǴќёၮҔ᏾ӝᙴᏢ‫ޑ‬ᢀᗺǴଛӝ΢ύᙴ‫ޑ‬ᒣ᛾ፕ ‫ݯ‬ǵଞ‫ء‬Ϸύ૛ᛰ‫ݯ‬ᕍǴΨ೚ёаࣁஒٰѠ᡼஁ζ‫׳ޑ‬ԃය‫ݯ‬ᕍ஥ٰཥ‫ޑ‬ ᔛӀǶ. 28.

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(34) 14. Ohayon MM. Severe Hot Flashes Are Associated With Chronic Insomnia. Arch Intern Med 2006 Jun: 1262-1268. 15. Umland EM. Treatment strategies for reducing the burden of menopauseassociated vasomotor symptoms. J Manag Care Pharm 2008;14:14-19. 16. Shen W, Stearns V. Treatment strategies for hot flushes. Expert Opin Pharmacother 2009; 10:1133-1144. 17. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321-333. 18. ֆ३ၲǺ಻ᅟᆾ‫ޑ‬᎜ᕏǶϺΠᇻ‫ـ‬р‫ހ‬ϦљǴѠч 2004; pp123-140. 19. Birkhauser MH, Panay N, Archer DF, Barlow D, Burger H, Gambacciani M. Updated practical recommendations for hormone replacement therapy in the peri- and postmenopause. Climacteric 2008 ;11: 108-123. 20. Toulis KA, Tzellos T, Kouvelas D, Goulis DG. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin Ther 2009 ;31 :221-235. 21. Lethaby AE, Brown J, Marjoribanks J, Kronenberg F, Roberts H, Eden J. Phytoestrogens. for. vasomotor. menopausal. symptoms.. Cochrane. Database Syst Rev 2007 Oct 17; CD001395. 22. Song WO, Chun OK, Hwang I, Shin HS, Kim BG, Kim KS, Lee SY, Shin D, Lee SG. Soy isoflavones as safe functional ingredients. J Med Food 2007;10:571-580. 23. Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacol Res 2008; 58:814. 24. Chow EC, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust. 2008 Apr 7;188:420-422.. 30.

(35) 25. Biglia N, Sgandurra P, Peano E, Marenco D, Moggio G, Bounous V, Tomasi Cont N, Ponzone R, Sismondi P. Non-hormonal treatment of hot flushes in breast cancer survivors: gabapentin vs. vitamin E. Climacteric 2009; May 2:1-9. 26. Lee MS, Shin BC, Ernst E. Acupuncture for treating menopausal hot flushes: a systematic review. Climacteric 2009; 12:16-25. 27. Jones MM, Marshall DH, Nordin BEC. Quanititation of menopausal symptomatology and its response to ethinylesteradiol and piperazine oestrone sulphate. Curr Med Res Opin 1977; 4 :12-20. 28. Guthrie JR, Dennerstein L, Taffe JR, Lehert P, Burger HG. Hot flushes during the menopause transition: a longitudinal study in Australian-born women. Menopause 2005; 12:460-467. 29. Rödström K, Bengtsson C, Lissner. L. Milsom I, Sundh V, Björkelund C. A longitudinal study of the treatment of hot flushes: the population study of women in Gothenburg during a quarter of a century. Menopause 2002; 9:156-161. 30. Xing D, Nozell S, Chen YF, Hage F, Oparil S. Estrogen and mechanisms of vascular protection. Arterioscler Thromb Vasc Biol. 2009 Mar;29:289-295. 31. Miller VM, Duckles SP. Vascular actions of estrogens: functional implications. Pharmacol Rev. 2008 Jun;60:210-241. 32. AACE. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocr Pract 2006; 12:315-337. 33. Chetkowski RJ, Meldrum DR, Steingold KA. Biologic effects of transdermal estradiol. N Engl J Med 1986; 314:1615-1620. 34. Nelson HD. Commonly used types of postmenopausal estrogen for treatment of hot flashes: scientific review. JAMA 2004; 291:1610-1620. 35. Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, Salamone L, Stellato R. Relation of demographic and lifestyle factors to symptoms in. 31.

(36) a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000; 152:463-473. 36. Crandall CJ, Crawford SL, Gold EB. Vasomotor symptom prevalence is associated with polymorphisms in sex steroid-metabolizing enzymes and receptors. Am J Med. 2006 Sep;119:S52-60. 37. Gold EB, Block G, Crawford S, Lachance L, FitzGerald G, Miracle H, Sherman S. Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the Study of Women's Health Across the Nation. Am J Epidemiol. 2004 Jun 15;159:1189-99. 38. Green R, Santoro N. Menopausal symptoms and ethnicity: the Study of Women's Health Across the Nation. Womens Health (Lond Engl). 2009 Mar;5:127-33. 39. Zhang Q, Li F, Yu Y, Yu X, Sheng Q, Zhang X. Differential factors associated with hot flashes in Chinese perimenopausal and postmenopausal women. Maturitas. 2009 May 20;63:94-8. 40. Freeman EW, Sherif K. Prevalence of hot flushes and night sweats around the world: a systematic review. Climacteric. 2007 Jun;10:197-214.. 32.

(37) ߕᒵ΋Ǻ. 33.

(38) मЎᄔा Objectives: Hot flush is the leading cause of postmenopausal women to seek for medical intervention in Taiwan. The goal of this study was to analyze the potential risk factors determining no improvements after hormone therapy for postmenopausal women with hot flushes. Methods: We reviewed the postmenopausal women who suffered from moderate to severe hot flushes under hormone therapy from Jan.1, 2008 to Dec.31, 2008 at Taoyuan Veterans Hospital. The evaluations included the result of pelvic examination and Pap smear, gynecologic sonography, serum level of triglyceride, total cholesterol, glucose-AC, ALT and AST before hormone therapy. The definition of “no improvement” is the score of “hot flush” does not decrease after hormone therapy. Results: 6 of the 120 women were not improved in hot flush (5%) after hormone therapy for at least 3 months. Using multivariable logistic regression analyses, the 45 – 54 years-old age and inflammation or atrophy of Pap smear result were significantly associated with no improvements after hormone therapy for postmenopausal women with hot flush. Conclusions: Our results showed that 45 – 54 years-old age and inflammation or atrophy of Pap smear result seem to be associated with no improvements after hormone therapy for postmenopausal women with hot flush. Key words: Hormone therapy • Climacteric syndrome • Hot flush • Postmenopause. 34.

(39) ᖴ ᜏ !!!!ளаஒᏢೌࣴ‫کز‬ᖏ‫׉‬πբ่ӝࣁ΋ࢂ൩᠐ύՋᙴ่ӝࣴ‫܌ز‬നε‫ޑ‬ ԏᛘǴᗨฅѝࢂ΋ঁ໒ᆄǴՠჹаࡕ‫ޑ‬πբࠅࢂεԖշ੻Ƕགᖴഋ௲௤ች ኾӧࣴ‫ز‬೛ीǵ୺ՉϷፕЎቪբ΢‫ࡰޑ‬Ꮴᆶ‫ڐ‬շǴಷ௲௤҉Ϙ‫ࢫک‬௲௤ᝬ ෕ӧፕЎα၂΢‫ࡰޑ‬ᗺǴഋ‫ؙߏ܌‬ӓϷ؇ჩ๩λ‫ڐۆ‬շ‫ ܭ‬2008 ԃ 7 Дୖ ೖ M.D. Anderson Cancer Center ‫ޑ‬᏾ӝᙴᏢ೽ߐǴ‫܌‬ԖύՋᙴ่ӝࣴ‫܌ز‬ ‫ޑ‬ԴৣॺӧΒԃ‫ޑ‬൩Ꮲය໔๏ϒ‫ࡰޑ‬ᏤϷႴᓰǶΨᖴᖴਲ༜ᄪ҇ᙴଣ஁ౢ ࣽπբი໗ȋ‫׵‬ЬҺᙦচǵ၏ཥᙴৣǵշ౛၏٫ᆝλ‫ۆ‬Ϸᎄ჏ฐλ‫ۆ‬ӧ‫ך‬ ൩Ꮲය໔๏ϒπբ΢‫ޑ‬ᔅԆǴ‫׳‬གᖴ‫ך‬ᒃང‫ݿݿޑ‬ǵ༰༰Ϸ‫ॺۂۂ‬ჹ‫ޑך‬ ޭ‫ۓ‬ϷЍ࡭Ƕ! !!!!໻ஒҁፕЎ᝘๏‫ޑך‬ќ΋ъȋ݅Թបᙴৣ‫ک‬ջஒрғ‫ޑ‬λ baby— Alfred.. 35. ໳ඳዝ. ᙣᇞ. 2009. হ.

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