Turpin G
Service d'Endocrinologie-Métabolisme, Hôpital de la Pitié, Paris.
Ann Cardiol Angeiol (Paris). 1994 Mar;43(3):177-80.
Menopausal hormone replacement therapy is a physiological rather than a pharmacological approach. Large numbers of cohort studies have now clearly shown that relative coronary risk increases at the menopause in the absence of treatment, in particular regarding an early menopause, and decreases by approximately 50% with replacement therapy, provided the latter is based upon physiological estrogens (all studies on the other side of the Atlantic have involved equine conjugated estrogens). Micronized 17 beta estradiol and in the form of its valerate per os, and percutaneous or transdermal 17 beta estradiol are also available in France. There are beneficial effects on cholesterol fractions, and all the more so if the estrogen is given orally rather than percutaneously or transdermally: decrease in total cholesterol by decrease in the atherogenic fraction LDL-C and apoprotein B, increase in anti-atherogenic fraction HDL2-C and apoprotein A1. There is also a significant fall in lipoprotein (a), a particularly atherogenic lipoprotein if its plasma level exceeds 0.30 g/l and also thrombogenic because of decreased fibrinolysis. Increases in triglycerides are seen only when estrogens are taken orally.
更年期激素替代疗法是一种生理性而非药理学方法。大量队列研究现已明确表明，在未接受治疗的情况下，更年期时相对冠状动脉风险会增加，尤其是对于过早绝经的情况；而如果采用替代疗法，且后者基于生理性雌激素（大西洋彼岸的所有研究均使用结合马雌激素），则风险会降低约50%。在法国，也可获得微粒化17β-雌二醇及其戊酸酯口服制剂、经皮或透皮17β-雌二醇。对胆固醇组分有有益影响，若口服雌激素而非经皮或透皮给药，这种影响更明显：通过降低致动脉粥样硬化组分低密度脂蛋白胆固醇（LDL-C）和载脂蛋白B使总胆固醇降低，通过增加抗动脉粥样硬化组分高密度脂蛋白2胆固醇（HDL2-C）和载脂蛋白A1。脂蛋白（a）也会显著下降，脂蛋白（a）是一种特别致动脉粥样硬化的脂蛋白，如果其血浆水平超过0.30 g/l，并且由于纤维蛋白溶解减少还具有促血栓形成作用。仅在口服雌激素时会出现甘油三酯升高。
