Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada.
Pharmacotherapy. 2010 May;30(5):442-52. doi: 10.1592/phco.30.5.442.
To compare the cardiovascular and metabolic effects of medroxyprogesterone acetate (MPA) with those of conjugated equine estrogen (CEE) as single-hormone therapies in women who underwent hysterectomy with bilateral ovariectomy.
Secondary analysis of a 12-month, double-blind, randomized, parallel-therapy trial.
Four teaching hospitals and one community hospital in Vancouver, Canada.
Thirty-three healthy women who underwent premenopausal hysterectomy with bilateral ovariectomy.
Subjects received either MPA 10 mg/day (18 women) or CEE 0.6 mg/day (15 women) for 12 months, started immediately after hysterectomy with bilateral ovariectomy.
Lipid profiles (high-density lipoprotein cholesterol [HDL], total cholesterol, apolipoprotein B, and triglyceride levels), homeostatic measures (hemoglobin A(1c) and fasting blood glucose level), hormone levels (free and bioavailable testosterone, cortisol, sex hormone-binding globulin [SHBG], and dehydroepiandrosterone sulfate), inflammatory markers (C-reactive protein [CRP] and serum albumin levels), and anthropometric measures (body mass index [BMI], truncal fat, and total body fat) were assessed over the 12-month period. After 12 months, the women assigned to MPA had lesser increases in BMI (p=0.04), triglyceride (p=0.003), HDL (p<0.0005), SHBG (p<0.0005), total testosterone (p=0.003), and CRP values (p=0.01) and higher serum albumin levels (p<0.0005) compared with the women receiving CEE.
Therapy with CEE, but not MPA, after surgical menopause appears to predispose healthy women to low-grade inflammation, as evidenced by its independent associations with elevated CRP and reduced albumin levels. In women treated with MPA, the favorable levels of inflammatory markers, BMI, and triglyceride levels need to be confirmed in larger controlled trials, as progesterone therapy may provide a safe and effective alternative to estrogen for vasomotor symptoms in women with surgical menopause.
比较醋酸甲羟孕酮（MPA）与结合雌激素（CEE）作为单一激素疗法对行子宫切除术伴双侧卵巢切除术的妇女的心血管和代谢影响。
为期 12 个月的双盲、随机、平行治疗试验的二次分析。
加拿大温哥华的 4 所教学医院和 1 所社区医院。
33 名健康的绝经前子宫切除术伴双侧卵巢切除术患者。
受试者在子宫切除术伴双侧卵巢切除术后立即接受 MPA 10 mg/天（18 名女性）或 CEE 0.6 mg/天（15 名女性）治疗 12 个月。
血脂谱（高密度脂蛋白胆固醇[HDL]、总胆固醇、载脂蛋白 B 和甘油三酯水平）、稳态测量（血红蛋白 A1c 和空腹血糖水平）、激素水平（游离和生物可用睾酮、皮质醇、性激素结合球蛋白[SHBG]和脱氢表雄酮硫酸酯）、炎症标志物（C 反应蛋白[CRP]和血清白蛋白水平）和人体测量学指标（体重指数[BMI]、躯干脂肪和全身脂肪）在 12 个月期间进行评估。12 个月后，接受 MPA 治疗的女性 BMI（p=0.04）、甘油三酯（p=0.003）、HDL（p<0.0005）、SHBG（p<0.0005）、总睾酮（p=0.003）和 CRP 值（p=0.01）增加较少，血清白蛋白水平升高（p<0.0005），而接受 CEE 治疗的女性则没有。
手术后绝经后接受 CEE 治疗，而不是 MPA，似乎会使健康女性易患低度炎症，这一点从 CRP 升高和白蛋白水平降低与炎症标志物独立相关就可以证明。在接受 MPA 治疗的女性中，需要在更大的对照试验中进一步证实炎症标志物、BMI 和甘油三酯水平的有利水平，因为孕激素治疗可能为手术绝经后女性的血管舒缩症状提供一种安全有效的雌激素替代疗法。
