Seeger Harald, Mueck Alfred O
Department of Endocrinology and Menopause, University Women's Hospital, Tuebingen, Germany.
Gynecol Endocrinol. 2007 Oct;23 Suppl 1:2-8. doi: 10.1080/09513590701584998.
Estrogens exert beneficial effects on the vascular system, while progestogens generally have a negative impact (e.g. vasoconstrictor effects on the arterial system). In contrast, dydrogesterone appears to be largely neutral in terms of biochemical markers and indirect clinical endpoints, such as blood pressure, that act as surrogate markers for vascular function. Studies on lipid and carbohydrate metabolism, which can also influence vascular function, demonstrate that the addition of dydrogesterone intensifies rather than attenuates beneficial estrogenic effects. Dydrogesterone also has largely neutral effects on hemostasis. Since there are relatively few data available on clinical parameters such as blood flow measurements, especially in women with pre-existing cardiovascular diseases, increased risks cannot be excluded for a combination of estrogen replacement with dydrogesterone. Further studies should focus on this open question since dydrogesterone, with its largely neutral properties, might be a suitable option, including for older women already at increased cardiovascular risk.
雌激素对血管系统有有益作用，而孕激素通常有负面影响（如对动脉系统的血管收缩作用）。相比之下，炔诺孕酮在生化指标和间接临床终点（如血压，作为血管功能的替代指标）方面似乎基本呈中性。关于脂质和碳水化合物代谢（也可影响血管功能）的研究表明，添加炔诺孕酮会增强而非减弱雌激素的有益作用。炔诺孕酮对止血也基本呈中性作用。由于关于诸如血流测量等临床参数的数据相对较少，尤其是在已有心血管疾病的女性中，不能排除雌激素替代与炔诺孕酮联合使用会增加风险。鉴于炔诺孕酮基本呈中性的特性，可能是一个合适的选择，包括对于已经有较高心血管风险的老年女性，因此进一步的研究应聚焦于这个未解决的问题。
