在绝经后的妇女中,雌激素治疗与孕激素和内皮依赖的血管扩张相结合
M Gerhard1, B W Walsh, A Tawakol
1Department of Medicine, Obstetrics and Gynecology , Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Circulation
|September 22, 1998
概括
雌激素替代疗法可以改善绝经后妇女的血管功能. 添加孕激素不会阻断雌激素对内皮功能或胆固醇水平的益处.
科学领域:
- 心血管科学 心血管科学
- 内分泌学 在内分泌学.
- 妇女健康 妇女健康
背景情况:
- 流行病学研究表明,雌激素替代疗法 (ERT) 可以减少绝经后妇女的心血管事件.
- 雌激素的心血管保护可能源于改善的内皮功能和血管扩张.
- 孕激素对雌激素血管效应的影响尚不清楚.
研究的目的:
- 研究通过皮肤的雌激素,有或没有微化孕激素,对绝经后妇女内皮依赖血管扩张的作用.
- 为了确定孕激素是否会减弱雌激素对血管的有益作用.
主要方法:
- 一个安慰剂受控的交叉试验,涉及17名患有轻度高胆固醇血症的绝经后妇女.
- 高分辨率B模式超声波测量了手臂动脉直径.
- 通过反应性高血压评估的内皮依赖血管扩张;使用酸甘评估的内皮独立血管扩张.
主要成果:
- 雌激素显著改善了内皮依赖的血管扩张 (11.1%的变化与安慰剂的4.7%相比,P<0.001).
- 孕激素并没有显著减轻这种改善;联合治疗显示9.6%的血管扩张 (P=NS与单独的雌激素相比).
- 雌激素,有或没有孕激素,适度降低了总和LDL胆固醇 (P<0.001与安慰剂相比).
结论:
- 微化孕激素不会减少雌激素对内皮依赖血管扩张的积极影响.
- 激素替代疗法的血管保护性益处可能超出降脂效应.
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