Virtanen I, Polo-Kantola P, Erkkola R, Polo O, Ekholm E
Department of Obstetrics and Gynaecology, University of Turku, Finland.
Br J Obstet Gynaecol. 1999 Feb;106(2):155-64. doi: 10.1111/j.1471-0528.1999.tb08216.x.
To study whether oestrogen replacement therapy has an effect on autonomic haemodynamic control in postmenopausal women.
A placebo-controlled, prospective, randomised, double-blind cross-over trial.
Fourteen healthy postmenopausal women who had had a hysterectomy, of whom 12 were double-blind.
At the end of each treatment period we conducted autonomic nervous system tests: the Valsalva manoeuvre, the deep breathing test, study at rest and the active orthostatic test. Baroreflex sensitivity was evaluated non-invasively from the Valsalva manoeuvre. Heart rate variability was assessed in time and frequency domains during supine rest and standing. Serum oestradiol was also measured and the previous two weeks' symptoms were assessed.
Autonomic nervous function was mostly normal for age and unchanged by oestrogen. Vasomotor symptoms were not associated with autonomic dysfunction. Baroreflex sensitivity was 13.3 ms/mmHg (SD 7.4 ms/mmHg) with placebo and 10.5 ms/mmHg (SD 5.4 ms/mmHg) with oestrogen (P = 0.052). This was mostly due to a fall in three of the highest indices. In the orthostatic test the 30 s blood pressure overshoot in two women exceeded the normal 90% confidence interval upper limit, making the mean response strong, especially in the symptomatic group (n = 7). Oestrogen attenuated this overshoot.
Oestrogen did not have a consistent effect on the autonomic nervous system. Oestrogen attenuated a highly sensitive baroreflex and a strong 30 s blood pressure rise in the orthostatic test. This minor effect of oestrogen could be due to the fact that, in general, women with menopausal symptoms do not have impaired autonomic haemodynamic control. The effect of oestrogen in women with autonomic nervous system dysfunction remains to be studied.
研究雌激素替代疗法对绝经后女性自主血流动力学控制是否有影响。
一项安慰剂对照、前瞻性、随机、双盲交叉试验。
14名已行子宫切除术的健康绝经后女性，其中12名进行双盲试验。
在每个治疗期结束时，我们进行了自主神经系统测试：瓦尔萨尔瓦动作、深呼吸试验、静息状态研究和主动直立试验。通过瓦尔萨尔瓦动作无创评估压力反射敏感性。在仰卧休息和站立期间，从时域和频域评估心率变异性。还测量了血清雌二醇，并评估了前两周的症状。
自主神经功能在年龄方面大多正常，且不受雌激素影响。血管舒缩症状与自主神经功能障碍无关。安慰剂组压力反射敏感性为13.3毫秒/毫米汞柱（标准差7.4毫秒/毫米汞柱），雌激素组为10.5毫秒/毫米汞柱（标准差5.4毫秒/毫米汞柱）（P = 0.052）。这主要是由于三个最高指标下降。在直立试验中，两名女性30秒血压过冲超过正常90%置信区间上限，使平均反应强烈，尤其是在有症状组（n = 7）。雌激素减弱了这种过冲。
雌激素对自主神经系统没有一致的影响。雌激素减弱了直立试验中高度敏感的压力反射和30秒强烈的血压上升。雌激素的这种轻微作用可能是因为一般来说，有绝经症状的女性自主血流动力学控制没有受损。雌激素对自主神经系统功能障碍女性的影响仍有待研究。
