经皮雌激素替代疗法：对心血管疾病止血危险因素的有益作用。

Transdermal estrogen replacement therapy: beneficial effects on hemostatic risk factors for cardiovascular disease.

作者信息

Lindoff C, Peterson F, Lecander I, Martinsson G, Astedt B

机构信息

Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden.

出版信息

Maturitas. 1996 May;24(1-2):43-50. doi: 10.1016/0378-5122(95)01000-9.

DOI:10.1016/0378-5122(95)01000-9

PMID:8794433

Abstract

OBJECTIVES

To assess the effect of estrogen replacement therapy on hemostatic risk factors for cardiovascular disease (CVD) in postmenopausal women during 2 years of treatment.

METHODS

In an open prospective study, patients (n = 42) were investigated before and during 2 years of treatment, and compared to an untreated postmenopausal control group (n = 18) followed during the same period, healthy premenopausal women (n = 20) being included as a reference group for premenopausal values. The patients underwent treatment with transdermal 17 beta-estradiol (E2) (50 micrograms/24 h), oral medroxyprogesterone acetate (5 mg/day) being added for 12 days every second month.

RESULTS

After 2 years of treatment there was a significant increase in t-PA antigen (P = 0.01) and a significant decrease in F VII antigen (P = 0.01). PAI-1 antigen concentrations decreased slightly. Fibrinogen concentrations were already significantly decreased at 3-month follow-up (P = 0.01), and were still low after 2 years. By contrast, at 2-year follow-up the postmenopausal control group manifested significant increases in F VII and PAI-1 antigen and slight increases in fibrinogen, which resulted in significant differences between patients and controls. Regression analysis showed the increase in the serum estradiol concentrations to be inversely correlated to the decreases in the plasma concentrations of F VII antigen (r = -0.34, P = 0.001) and fibrinogen (r = -0.35, P = 0.001). There were no changes in AT III or protein C in any group.

CONCLUSIONS

The increase in serum estradiol concentrations due to replacement therapy did not adversely affect the studied components of the fibrinolytic and protein C defense system against thrombosis, and resulted in beneficial decreases in F VII antigen and fibrinogen. These findings may help to explain the beneficial effects of estrogen replacement therapy in terms of protection from cardiovascular disease.

摘要

目的

评估雌激素替代疗法对绝经后女性在2年治疗期间心血管疾病（CVD）止血危险因素的影响。

方法

在一项开放性前瞻性研究中，对患者（n = 42）在治疗前及治疗2年期间进行调查，并与同期未治疗的绝经后对照组（n = 18）进行比较，纳入健康的绝经前女性（n = 20）作为绝经前数值的参考组。患者接受经皮17β - 雌二醇（E2）（50微克/24小时）治疗，每两个月添加口服醋酸甲羟孕酮（5毫克/天），共12天。

结果

治疗2年后，组织型纤溶酶原激活物（t - PA）抗原显著增加（P = 0.01），凝血因子VII（F VII）抗原显著降低（P = 0.01）。纤溶酶原激活物抑制剂 - 1（PAI - 1）抗原浓度略有下降。纤维蛋白原浓度在3个月随访时已显著降低（P = 0.01），2年后仍较低。相比之下，在2年随访时，绝经后对照组的F VII和PAI - 1抗原显著增加，纤维蛋白原略有增加，这导致患者与对照组之间存在显著差异。回归分析显示血清雌二醇浓度的增加与F VII抗原血浆浓度的降低（r = -0.34，P = 0.001）和纤维蛋白原的降低（r = -0.35，P = 0.001）呈负相关。任何组的抗凝血酶III（AT III）或蛋白C均无变化。