激素替代疗法与健康绝经后女性动脉生理功能的改善有关。

Hormone replacement therapy is associated with improved arterial physiology in healthy post-menopausal women.

作者信息

McCrohon J A, Adams M R, McCredie R J, Robinson J, Pike A, Abbey M, Keech A C, Celermajer D S

机构信息

Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.

出版信息

Clin Endocrinol (Oxf). 1996 Oct;45(4):435-41. doi: 10.1046/j.1365-2265.1996.8070816.x.

DOI:10.1046/j.1365-2265.1996.8070816.x

PMID:8959082

Abstract

OBJECTIVE

Oestrogen replacement therapy is associated with a marked reduction in coronary event rates in post-menopausal women. As older age is associated with progressive arterial endothelial damage, a key event in atherosclerosis, we assessed whether hormone replacement therapy (HRT) with oestrogen alone, or oestrogen and progesterone combined, is associated with improved endothelial function in healthy women after the menopause.

DESIGN

Using high resolution external vascular ultrasound, brachial artery diameter was measured at rest and in response to reactive hyperaemia, with increased flow causing endothelium-dependent dilatation (flow-mediated dilatation).

PATIENTS

We investigated 135 healthy women; 40 were pre-menopausal (mean +/- SD age/26 +/- 6 years, group 1), 40 were post-menopausal and had never taken HRT (aged 58 +/- 3 years; group 2) and 55 were age-matched post-menopausal women who had taken HRT for > or = 2 years, from within 2 years of the menopause (aged 57 +/- 4 years; group 3). In group 3, 40 women were on combined oestrogen and progesterone and 15 on oestrogen-only HRT.

RESULTS

In group 2, flow-mediated dilatation was significantly reduced compared with group 1 (4.4 +/- 3.4 vs 9.6 +/- 3.6%, P < 0.001), consistent with a decline in arterial endothelial function after the menopause. In group 3, however, flow-mediated dilatation was significantly better than group 2 (6.2 +/- 3.3 vs 4.4 +/- 3.4%, P = 0.01), suggesting a protective effect of HRT. Flow-mediated dilatation was similar in women taking oestrogen alone and in those on combined HRT (5.5 +/- 2.8 vs 6.5 +/- 3.4%, P = 0.40).

CONCLUSIONS

Long-term HRT is associated with improved arterial endothelial function in healthy post-menopausal women. This benefit was observed in both the combined hormone replacement and unopposed oestrogen therapy groups. This may explain some of the apparent cardioprotective effect of HRT after the menopause.

摘要

目的

雌激素替代疗法与绝经后女性冠状动脉事件发生率显著降低相关。随着年龄增长与动脉内皮渐进性损伤相关，而动脉内皮损伤是动脉粥样硬化的关键事件，我们评估了单独使用雌激素或雌激素与孕激素联合的激素替代疗法（HRT）是否与绝经后健康女性内皮功能改善相关。

设计

使用高分辨率体外血管超声，在静息状态下以及反应性充血时测量肱动脉直径，反应性充血时血流增加导致内皮依赖性扩张（血流介导的扩张）。

患者

我们研究了135名健康女性；40名处于绝经前（平均±标准差年龄/26±6岁，第1组），40名绝经后且从未接受过HRT（年龄58±3岁；第2组），55名年龄匹配的绝经后女性，她们在绝经后2年内接受HRT≥2年（年龄57±4岁；第3组）。在第3组中，40名女性接受雌激素与孕激素联合治疗，15名接受单纯雌激素HRT。

结果

与第1组相比，第2组中血流介导的扩张显著降低（4.4±3.4对9.6±3.6%，P<0.001），这与绝经后动脉内皮功能下降一致。然而，在第3组中，血流介导的扩张显著优于第2组（6.2±3.3对4.4±3.4%，P = 0.01），提示HRT具有保护作用。单独使用雌激素的女性与接受联合HRT的女性的血流介导的扩张相似（5.5±2.8对6.5±3.4%，P = 0.40）。