绝经后女性的血小板反应性和血栓形成倾向。

Platelet reactivity and thrombogenicity in postmenopausal women.

机构信息

Sinai Center for Thrombosis Research, Baltimore, MD, USA.

出版信息

Menopause. 2013 Jan;20(1):57-63. doi: 10.1097/gme.0b013e31825ebafd.

DOI:10.1097/gme.0b013e31825ebafd

PMID:22968255

Abstract

OBJECTIVE

Age-adjusted incidence of cardiovascular disease, including myocardial infarction, is significantly lower in premenopausal women than in men, which is thought to be caused by the cardioprotective effects of estrogen. However, there is a consistent increase in the incidence of coronary artery disease in postmenopausal women in comparison with premenopausal women. The protective benefit of hormone therapy has not been observed in postmenopausal women. It is unknown whether measures of platelet reactivity and clot strength contribute to the disproportionate incidence of cardiovascular disease between premenopausal and postmenopausal women.

METHODS

Fifty healthy volunteers, including 25 premenopausal women and 25 postmenopausal women, aged between 40 and 65 years were enrolled. Total estradiol and follicle-stimulating hormone levels were measured for confirmation of menopausal state and comparison testing. Platelet reactivity was assessed using light transmission aggregometry and P-selectin, and glycoprotein IIb/IIIa receptor expression was assessed using flow cytometry. Thrombelastography was used to measure clot strength, clotting time, and fibrinogen activity. Serum cholesterol, C-reactive protein, complete blood count, and comprehensive metabolic panel were also measured.

RESULTS

Platelet reactivity did not differ among menopausal states or hormone levels. Clotting time was increased in postmenopausal women (6.6 ± 2.0 vs. 7.8 ± 1.2 min, P = 0.013) and significantly correlated with estradiol levels (r = 0.68, P < 0.001). A significantly higher low-density lipoprotein cholesterol level was observed in postmenopausal women (P = 0.05). Mean C-reactive protein levels were numerically higher in the postmenopausal group.

CONCLUSIONS

The thrombotic risk profile between premenopausal and postmenopausal women is similar. However, improved management of cholesterol may be of clinical benefit. Large-scale studies are required to validate these findings.

摘要

目的

与男性相比，绝经前女性的心血管疾病（包括心肌梗死）发病率经年龄校正后明显较低，这被认为是雌激素的心脏保护作用所致。然而，与绝经前女性相比，绝经后女性的冠状动脉疾病发病率持续增加。激素治疗的保护益处并未在绝经后女性中观察到。血小板反应性和血栓强度的测量指标是否导致绝经前和绝经后女性心血管疾病发病率的不成比例尚不清楚。

方法

纳入了 50 名健康志愿者，包括 25 名绝经前女性和 25 名绝经后女性，年龄在 40 至 65 岁之间。测量总雌二醇和卵泡刺激素水平以确认绝经状态并进行比较检测。使用透光比浊法和 P-选择素评估血小板反应性，使用流式细胞术评估糖蛋白 IIb/IIIa 受体表达。使用血栓弹性描记术测量血栓强度、凝血时间和纤维蛋白原活性。还测量了血清胆固醇、C 反应蛋白、全血细胞计数和综合代谢谱。

结果

血小板反应性在绝经状态或激素水平之间没有差异。凝血时间在绝经后女性中增加（6.6 ± 2.0 对 7.8 ± 1.2 分钟，P = 0.013），与雌二醇水平显著相关（r = 0.68，P < 0.001）。绝经后女性的低密度脂蛋白胆固醇水平明显升高（P = 0.05）。后绝经组的平均 C 反应蛋白水平略高。