Os Ingrid, Os Audun, Sandset Per Morten, Bølling Silje, Seljeflot Ingebjorg, Djurovic Srdjan, Westheim Arne
Department of Internal Medicine, Ullevål University Hospital, Oslo, Norway.
Cardiology. 2002;98(1-2):6-12. doi: 10.1159/000064667.
The objective was to evaluate the effect of hormone replacement therapy (HRT) on plasma homocysteine levels in postmenopausal women with coronary artery disease (CAD) and to investigate associations of homocysteine to other cardiovascular risk factors.
The women in this single-center, controlled, and randomized study were examined at baseline, and after 3 and 12 months, after they had been recruited consecutively from patients referred for investigational coronary angiography. All analyses were performed examiner blind. They were randomized to HRT consisting of transdermal application of continuous 17beta-estradiol with cyclic medroxyprogesterone acetate (MPA) tablets for 14 days every 3rd month, or to a control group.
After 3 months of unopposed 17beta-estradiol, no significant effect on homocysteine was observed compared to the control group. The absolute decrease of 5% in median plasma homocysteine levels after 12-month HRT did not reach statistical significance. Plasma homocysteine seemed slightly higher in women with three- or four-vessel disease, but the difference was not significant. With increasing homocysteine levels, free tissue factor pathway inhibitor (TFPI) antigen increased, whereas E-selectin decreased. In women with diabetes or elevated blood glucose >6.0 mmol/l, plasma homocysteine was correlated to body mass index, C-peptide and insulin as well as age.
Transdermal application of 17beta-estradiol and sequential MPA do not affect plasma homocysteine in women with established CAD. Plasma homocysteine is stable in women with CAD over time, and unless special intervention is undertaken, repetitive measurements are not necessary in this particular group of high-risk individuals. The circulating anticoagulant TEPI is related to plasma homocysteine.
评估激素替代疗法（HRT）对绝经后冠心病（CAD）女性血浆同型半胱氨酸水平的影响，并研究同型半胱氨酸与其他心血管危险因素之间的关联。
在这项单中心、对照、随机研究中，从因冠状动脉造影检查而转诊的患者中连续招募女性，在基线时以及3个月和12个月后进行检查。所有分析均在检查者不知情的情况下进行。她们被随机分为接受HRT组，即每3个月经皮连续应用17β-雌二醇并周期性服用醋酸甲羟孕酮（MPA）片14天，或分为对照组。
在单独使用17β-雌二醇3个月后，与对照组相比，未观察到对同型半胱氨酸有显著影响。HRT治疗12个月后，血浆同型半胱氨酸水平中位数绝对下降5%，未达到统计学显著性。三支或四支血管病变的女性血浆同型半胱氨酸似乎略高，但差异不显著。随着同型半胱氨酸水平升高，游离组织因子途径抑制物（TFPI）抗原增加，而E-选择素减少。在患有糖尿病或血糖>6.0 mmol/l的女性中，血浆同型半胱氨酸与体重指数、C肽、胰岛素以及年龄相关。
经皮应用17β-雌二醇和序贯MPA对已患CAD的女性血浆同型半胱氨酸无影响。CAD女性的血浆同型半胱氨酸随时间稳定，除非进行特殊干预，在这一特定高危人群中无需重复测量。循环抗凝剂TEPI与血浆同型半胱氨酸相关。
