促性腺激素和性激素对 QT 间期持续时间的复杂影响。

Complex Influence of Gonadotropins and Sex Steroid Hormones on QT Interval Duration.

机构信息

Assistance Publique-Hôpitaux de Paris (AP-HP) (G.A., L.K., M.L., C.F., C.F.-B., J.-E.S.), Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421, F-75013 Paris, France; Inserm (G.A., L.K., M.L., C.F., C.F.-B., J.-E.S.), CIC-1421 and Unité Mixte de Recherche (UMR), Institute of Cardiometabolism and Nutrition (ICAN) 1166, Sorbonne Universités, F-75013 Paris, France; l'université Pierre et Marie Curie (Paris 06) (G.A., L.K., M.L., C.F., C.F.-B., J.-E.S.), Pitié-Salpêtrière Hospital, IE3M, Department of Endocrinology and Reproductive Medecine, and Centre de Référence des Maladies Endocriniennes Rares de la croissance et Centre des Pathologies gynécologiques Rares, and CIC-1421, F-75013 Paris, France; AP-HP (A.B., P.T.), Pitié-Salpêtrière Hospital (J.-E.S.), Department of Cardiology-Rhythmology Unit, F-75013 Paris, France; and AMPS, LLC (F.B.), New York, New York 10025.

出版信息

J Clin Endocrinol Metab. 2016 Jul;101(7):2776-84. doi: 10.1210/jc.2016-1877. Epub 2016 May 11.

DOI:10.1210/jc.2016-1877

PMID:27167057

Abstract

CONTEXT

QT interval duration is longer in women than in men. Sex steroid hormones have inconsistently been suggested to explain this difference. The implication of gonadotropins has never been studied.

OBJECTIVE

We report here the combined influence of sex steroid hormones and gonadotropins on QT interval duration in healthy subjects and patients with congenital adrenal hyperplasia (CAH) as a model of T and progesterone overexpression.

DESIGN AND PATIENTS

Eighty-four CAH patients (58 women) and 84 healthy subjects matched and paired for sex and age were prospectively included. Circulating concentrations of 17-OH-progesterone, progesterone, T, estradiol, FSH, and LH were measured concomitantly to the recording of a digitized electrocardiogram.

RESULTS

QTcFridericia (QTcF) was shorter in women with CAH than in control women (404 ± 2 vs 413 ± 2.1 milliseconds; P ≤ .001). 17-OH-progesterone, progesterone, the progesterone/estradiol ratio, and total T were higher in women with CAH than in female controls (P < .05), whereas FSH was lower (P ≤ .05). According to multivariable analysis in all women, the progesterone/estradiol ratio (β = -0.33) and FSH levels (β = 0.34) were related to QTcF (r = 0.5; P < .0001), with no influence of CAH or healthy status. QTcF was not different between CAH (404.7 ± 3.7 milliseconds) or healthy men (396 ± 2.8 milliseconds). For men, QTcF (r = 0.48; P < .01) was negatively related to free T (β = -0.29) and positively to FSH levels (β = 0.34).

CONCLUSION

Cardiac repolarization is influenced by complex interactions between sex steroid hormones and gonadotropins, depending on gender. Our results indicate that the progesterone/estradiol ratio in women, T in men, and FSH in both genders are major determinants of ventricular repolarization with opposite effects on QTc interval.

摘要

背景

QT 间期在女性中比男性长。性激素曾被认为可以解释这种差异，但结果并不一致。促性腺激素的影响从未被研究过。

目的

我们在此报告性激素和促性腺激素对健康受试者和先天性肾上腺增生症（CAH）患者 QT 间期的综合影响，CAH 是 T 和孕酮过度表达的模型。

设计和患者

前瞻性纳入 84 例 CAH 患者（58 例女性）和 84 例年龄和性别匹配的健康受试者。同时记录数字化心电图，并测量 17-羟孕酮、孕酮、T、雌二醇、FSH 和 LH 的循环浓度。

结果

CAH 女性的 QTcfreidericia（QTcf）比对照组女性短（404 ± 2 与 413 ± 2.1 毫秒；P ≤.001）。CAH 女性的 17-羟孕酮、孕酮、孕酮/雌二醇比值和总 T 均高于对照组女性（P <.05），而 FSH 较低（P ≤.05）。根据所有女性的多变量分析，孕酮/雌二醇比值（β=-0.33）和 FSH 水平（β=0.34）与 QTcF 相关（r=0.5；P <.0001），与 CAH 或健康状况无关。CAH（404.7 ± 3.7 毫秒）或健康男性（396 ± 2.8 毫秒）的 QTcF 无差异。对于男性，QTcF（r=0.48；P <.01）与游离 T（β=-0.29）呈负相关，与 FSH 水平（β=0.34）呈正相关。