Skobeloff E M, Spivey W H, Silverman R, Eskin B A, Harchelroad F, Alessi T V
Medical College of Pennsylvania, Philadelphia, USA.
Arch Intern Med. 1996 Sep 9;156(16):1837-40.
Seventy-five percent of all adult hospital admissions for asthma are women.
To determine whether a relationship exists between phases of the menstrual cycle and asthma exacerbations in adult females.
Data were analyzed from 182 nonpregnant, adult females with asthma aged 13 years to menopause. Date of presentation, patient age, duration of asthma attack, date of last menstrual period, regular interval between menses, presenting peak expiratory flow rate, and admission and discharge decision were recorded prospectively. Treatment interventions abstracted retrospectively from patient charts included use of oxygen, xanthines, beta-adrenergic agonists, corticosteroids, and magnesium sulfate. The menstrual cycle was divided into 4 phases based on fluctuations in serum estradiol levels. The 4 intervals were preovulatory (days 5-11), periovulatory (days 12-18), postovulatory (days 19-25), and perimenstrual (days 26-4).
Data were analyzed with a goodness-of-fit chi 2. Between June 1991 and May 1992, 182 females (mean +/- SD age, 28.5 +/- 8.0 years) were surveyed. No significant differences were noted for use of oxygen, beta-adrenergic agonists, xanthines, or magnesium among members of the 4 menstrual groups. Intervention with corticosteroids was least in the postovulatory interval (y:n) 0.5:1 and greatest in the preovulatory interval 3.0:1 (alpha = .03) Presentations by menstrual interval were as follows: preovulatory, 36 (20%); periovulatory, 43 (24%); postovulatory, 18 (10%); and perimenstrual, 85 (46%) (alpha < .01).
Asthma presentations are least frequent when serum estradiol levels are at a sustained peak. We observed a 4-fold variation in asthma presentations during the perimenstrual interval, when serum estradiol levels decrease sharply after that prolonged peak. These findings suggest that monthly variations in serum estradiol levels may influence the severity of asthma in adult females.
成年哮喘患者住院病例中75%为女性。
确定成年女性月经周期各阶段与哮喘发作之间是否存在关联。
分析了182名年龄在13岁至绝经的非妊娠成年哮喘女性的数据。前瞻性记录就诊日期、患者年龄、哮喘发作持续时间、末次月经日期、月经周期、就诊时的呼气峰值流速以及入院和出院决定。回顾性从患者病历中提取的治疗干预措施包括使用氧气、黄嘌呤、β-肾上腺素能激动剂、皮质类固醇和硫酸镁。根据血清雌二醇水平的波动将月经周期分为4个阶段。这4个阶段分别为排卵前期（第5 - 11天）、排卵期（第12 - 18天）、排卵后期（第19 - 25天）和月经前期（第26 - 4天）。
采用拟合优度卡方检验进行数据分析。在1991年6月至1992年5月期间，对182名女性（平均年龄±标准差为28.5±8.0岁）进行了调查。4个月经周期组在使用氧气、β-肾上腺素能激动剂、黄嘌呤或镁方面未发现显著差异。皮质类固醇干预在排卵后期最少（使用与未使用比例为）0.5:1，在排卵前期最多为3.0:1（α = 0.03）。按月经周期阶段统计的就诊情况如下：排卵前期，36例（20%）；排卵期，43例（24%）；排卵后期，18例（10%）；月经前期，85例（46%）（α < 0.01）。
当血清雌二醇水平持续处于峰值时，哮喘发作频率最低。我们观察到在月经前期，血清雌二醇水平在那个延长的峰值后急剧下降，哮喘发作频率有4倍的变化。这些发现表明血清雌二醇水平的月度变化可能影响成年女性哮喘的严重程度。
