炎症に敏感なタンパク質に対する閉経後のホルモンの効果:閉経後のエストロゲン/プロゲステン介入 (PEPI) 研究
M Cushman1, C Legault, E Barrett-Connor
1Departments of Medicine, and Biochemistry, University of Vermont, Burlington, VT 05446, USA. mcushman@salus.uvm.edu
Circulation
|August 18, 1999
まとめ
閉経後のホルモン療法は,炎症マーカーであるC反応性タンパク質を有意に増加させ,同時に溶性Eセレクチンも減少させた. 炎症因子に対するこれらのホルモンの影響は,心血管疾患のリスクをさらに調査する必要があります.
科学分野:
- エンドクリノロジー エンドクリノロジー
- 心血管医学は,心臓血管医学である.
- 炎症の研究 炎症の研究
背景:
- 観察研究は,閉経後のホルモン療法 (HT) が健康な女性における冠動脈イベントを減らす可能性があることを示唆しています.
- しかし,臨床試験のサブグループ分析では,既存の冠動脈疾患を有する女性のHT初期に心血管疾患のリスクが増加することが示されました.
- 炎症因子は血管疾患の予測因子として知られており,HTに対する反応を重要な研究分野にしています.
研究 の 目的:
- 特定の炎症に敏感な要因に対する閉経後のホルモン療法の影響を調査する.
- 異なるホルモン製剤がこれらのマーカーに異なる影響を及ぼすかどうかを判断する.
- 炎症に関連する心血管疾患のリスク因子に対するホルモン療法の持続効果を評価する.
主な方法:
- この研究では,閉経後のエストロゲン/プロゲステン介入 (PEPI) 試験の365人の参加者のデータを分析し,ランダム化され,プラセボ対照試験を行った.
- 4つの炎症感受性因子 (C反応性タンパク質,溶解性Eセレクチン,フォン・ウィレブランド因子抗原,因子VIIIc) は,ベースライン,12ヶ月,および36ヶ月で測定されました.
- 参加者はプラセボまたは4種類のホルモン剤のいずれかを投与された.
主要な成果:
- テストされたすべてのホルモン製剤は,プラセボと比較してC反応性タンパク質 (CRP) の濃度を85%大幅に増加させた.
- 溶性Eセレクチン (sEセレクチン) の濃度は,プラセボと比較して18%減少した.
- ヴォン・ウィレブランド因子や因子VIIIcのレベルに有意な影響は認められず,活性治療群の間で差異は認められなかった.
結論:
- 閉経後のホルモンは,炎症を誘発するマーカーであるC反応性タンパク質を急速に上昇させ,早期の悪性心血管効果を説明する可能性がある.
- ホルモン療法は,溶性Eセレクチン濃度を下げることで,抗炎症効果を示した.
- PEPI試験は臨床エンドポイント評価のために設計されていないため,これらのホルモン誘発の炎症変化と臨床心血管疾患のリスクを関連付けるためにさらなる研究が必要です.
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