特纳综合征女性患者激素替代治疗对血管内皮功能、动脉僵硬度和心肌变形的影响。

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome.

机构信息

Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center.

2nd Department of Cardiology.

出版信息

J Hypertens. 2021 Oct 1;39(10):2051-2057. doi: 10.1097/HJH.0000000000002903.

DOI:10.1097/HJH.0000000000002903

PMID:34102661

Abstract

OBJECTIVES

Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS.

METHODS

Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group.

RESULTS

Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons).

CONCLUSIONS

HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

摘要

目的

特纳综合征（TS）与心血管风险增加有关。我们研究了激素替代疗法（HRT）是否会影响 TS 女性的内皮功能、动脉僵硬和心肌变形。

方法

25 名 TS 女性在 HRT 的雌激素阶段和 HRT 停止后两个月进行了研究。进行了以下测量：肱动脉血流介导的扩张（FMD）、脉搏波速度（Complior 脉冲波速度）和中心收缩压（cSBP）、颈动脉内膜中层厚度（cIMT）、主动脉（Ao）弹性指数 - 即 Ao 应变、扩张性、僵硬指数和压力应变模量（Ep） - 以及左心室（LV）整体纵向应变（GLS），使用斑点追踪超声心动图。十名年龄和 BMI 相似的健康女性作为对照组。

结果

与对照组相比，接受 HRT 的 TS 女性的 PWV（9.1±2.4 与 7.5±0.5 m/s）、cSBP（130±15 与 121±6 mmHg）、cIMT（0.66±0.06 与 0.55±0.05 mm）、主动脉僵硬指数、Ep 和 LA 应变更高，而 FMD（7.2±4 与 10.5±2.3%）、Ao 应变、Ao 扩张性和 GLS（-18.8±2.7 与 -21.9±1.5%）更低（所有比较均 P<0.05）。HRT 停止两个月后，所有女性的 FMD 均增加（11.7±6 与 7.2±4%），PWV（7.8±1.7 与 9.1±2.4 m/s）和 cSBP（123±14 与 130±15 mmHg）降低。BMI、cIMT 和 GLS 无统计学显著变化（所有比较 P>0.05）。cSBP 的降低百分比与 PWV 的降低百分比相关（r=0.54），与 FMD 的增加百分比呈负相关（r=-0.57；所有比较 P<0.05）。