Haines C, Chung T, Chang A, Masarei J, Tomlinson B, Wong E
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories.
Arch Intern Med. 1996 Apr 22;156(8):866-72.
Lp(a) lipoprotein level is an independent risk factor for premature coronary artery disease and cerebrovascular accident. Concentrations of this lipoprotein tend to increase after menopause.
To determine whether oral estrogen was effective in lowering concentrations of Lp(a) lipoprotein in postmenopausal women.
A double-blind, placebo-controlled, cross-over study was conducted during a 12-month period in 100 postmenopausal women who had undergone hysterectomy. They were randomized into two groups: group 1 received oral estradiol, 2 mg/d, for the first 6 months and placebo for the second, and group 2 received these treatments in the reverse order. After completion of the crossover study, the effect of prolonged administration of oral estradiol was examined by placing all patients on active treatment and repeating the lipoprotein measurements approximately 12 months later.
No significant differences were noted between the two groups at the commencement of the study (median concentration of Lp[a] lipoprotein, 10.78 mg/dL [range, 2.2 to 108.5 mg/dL] in group 1 and 12.74 mg/dL [range, 0.8 to 98.1 mg/dL] in group 2). Crossover analysis showed a 9.62% reduction in values of Lp(a) lipoprotein with estradiol treatment compared with placebo during 12 months of treatment (P < .001). With prolonged treatment, the median concentration of Lp(a) lipoprotein for those in group 1 decreased from 8.12 mg/dL (range, 1.05 to 57.4 mg/dL) to 5.77 mg/dL (range, 0.84 to 75.39 mg/dL) (P < .001). In group 2, the median concentration decreased from 8.19 mg/dL (range, 2.52 to 99.82 mg/dL) to 7.07 mg/dL (range, 0.70 to 48.79 mg/dL), but this difference was not significant (P = .63).
The results of this study confirm the beneficial effect of oral estradiol on the basic lipoprotein pattern and demonstrate that this treatment is effective in reducing concentrations of Lp(a) lipoprotein in postmenopausal women.
脂蛋白(a)[Lp(a)]水平是早发性冠状动脉疾病和脑血管意外的独立危险因素。绝经后这种脂蛋白的浓度往往会升高。
确定口服雌激素对降低绝经后女性Lp(a)脂蛋白浓度是否有效。
对100例已行子宫切除术的绝经后女性进行了为期12个月的双盲、安慰剂对照、交叉研究。她们被随机分为两组：第1组在最初6个月接受口服雌二醇，2mg/d，后6个月接受安慰剂；第2组接受相反顺序的治疗。交叉研究完成后，通过让所有患者接受积极治疗并在大约12个月后重复脂蛋白测量，来检验长期口服雌二醇的效果。
研究开始时两组之间未观察到显著差异（第1组Lp(a)脂蛋白的中位浓度为10.78mg/dL[范围，2.2至108.5mg/dL]，第2组为12.74mg/dL[范围，0.8至98.1mg/dL]）。交叉分析显示，在12个月的治疗期间，与安慰剂相比，雌二醇治疗使Lp(a)脂蛋白值降低了9.62%（P<0.001）。随着治疗时间延长，第1组患者Lp(a)脂蛋白的中位浓度从8.12mg/dL（范围，1.05至57.4mg/dL）降至5.77mg/dL（范围，0.84至75.39mg/dL）（P<0.001）。在第2组中，中位浓度从8.19mg/dL（范围，2.52至99.82mg/dL）降至7.07mg/dL（范围，0.70至48.79mg/dL），但这种差异不显著（P=0.63）。
本研究结果证实了口服雌二醇对基础脂蛋白模式的有益作用，并表明该治疗对降低绝经后女性Lp(a)脂蛋白浓度有效。
