口服雌酮与17β-雌二醇对绝经后女性脂蛋白的不同影响。

Differential effects of oral estrone versus 17 beta-estradiol on lipoproteins in postmenopausal women.

作者信息

Colvin P L, Auerbach B J, Koritnik D R, Hazzard W R, Applebaum-Bowden D

机构信息

Department of Internal Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103.

出版信息

J Clin Endocrinol Metab. 1990 Jun;70(6):1568-73. doi: 10.1210/jcem-70-6-1568.

DOI:10.1210/jcem-70-6-1568

PMID:2347894

Abstract

Toward the definition of optimal postmenopausal estrogen replacement we compared the effects of three graduated doses of two oral estrogens, estrone sulfate and 17 beta-estradiol, on the lipid profiles of two groups of six postmenopausal women. Because of metabolic interconversions equivalent serum concentrations of estrone and estradiol were produced with these regimens. However, differential effects were noted in lipoproteins. 17 beta-Estradiol caused an increase in total plasma cholesterol (from 5.71 +/- 0.36 to 5.99 +/- 0.57 mmol/L, baseline to high dose; P less than 0.02), high density lipoprotein (HDL) cholesterol (from 1.45 +/- 0.15 to 1.78 +/- 0.36 mmol/L; P less than 0.02), HDL2 cholesterol concentration (from 0.41 +/- 0.08 to 0.62 +/- 0.26 mmol/L; P less than 0.01), and triglyceride concentration (from 1.09 +/- 0.29 to 1.24 +/- 0.30 mmol/L; P less than 0.01) without affecting low density lipoprotein (LDL) cholesterol concentration. By contrast, estrone sulfate caused a decrease in total plasma cholesterol (from 6.51 +/- 0.85 to 5.87 +/- 0.41 mmol/L; P less than 0.05) and LDL cholesterol concentration (from 4.34 +/- 0.57 to 3.67 +/- 0.44 mmol/L; P less than 0.01) and an increase in HDL cholesterol (from 1.37 +/- 0.20 to 1.50 +/- 0.26 mmol/L; P less than 0.05) and HDL2 cholesterol concentration (from 0.34 +/- 0.18 to 0.49 +/- 0.18 mmol/L; P less than 0.01), but no change in total triglyceride concentration. We deduce that the differential effect of orally administered estrogens on lipoprotein metabolism in postmenopausal women may be attributed to a first pass effect on hepatic metabolism.

摘要

为了明确绝经后雌激素替代治疗的最佳方案，我们比较了两种口服雌激素（硫酸雌酮和17β - 雌二醇）的三种递增剂量对两组各六名绝经后女性血脂谱的影响。由于代谢转化，这些方案产生了等效血清浓度的雌酮和雌二醇。然而，在脂蛋白方面观察到了不同的影响。17β - 雌二醇使总血浆胆固醇升高（从基线时的5.71±0.36 mmol/L升至高剂量时的5.99±0.57 mmol/L；P＜0.02），高密度脂蛋白（HDL）胆固醇升高（从1.45±0.15 mmol/L升至1.78±0.36 mmol/L；P＜0.02），HDL2胆固醇浓度升高（从0.41±0.08 mmol/L升至0.62±0.26 mmol/L；P＜0.01），甘油三酯浓度升高（从1.09±0.29 mmol/L升至1.24±0.30 mmol/L；P＜0.01），而低密度脂蛋白（LDL）胆固醇浓度未受影响。相比之下，硫酸雌酮使总血浆胆固醇降低（从6.51±0.85 mmol/L降至5.87±0.41 mmol/L；P＜0.05），LDL胆固醇浓度降低（从4.34±0.57 mmol/L降至3.67±0.44 mmol/L；P＜0.01），HDL胆固醇升高（从1.37±0.20 mmol/L升至1.50±0.26 mmol/L；P＜0.05），HDL2胆固醇浓度升高（从0.34±0.18 mmol/L升至0.49±0.18 mmol/L；P＜0.01），但总甘油三酯浓度无变化。我们推断，口服雌激素对绝经后女性脂蛋白代谢的不同影响可能归因于对肝脏代谢的首过效应。