Kessler C M, Szymanski L M, Shamsipour Z, Muesing R A, Miller V T, LaRosa J C
Division of Hematology-Oncology, George Washington University Medical Center, Washington, DC, USA.
Obstet Gynecol. 1997 Mar;89(3):326-31. doi: 10.1016/S0029-7844(96)00530-3.
To examine the relationship of estrogen-induced changes in lipids and lipoproteins with alterations in the coagulation system.
Coagulation and lipid indices were measured in 31 postmenopausal women, ages 40-60 years, after a 3-month course of 0.625-mg conjugated equine estrogen. We analyzed changes in variables from baseline to 3 months using t tests for paired samples or the Wilcoxon matched-pairs signed-rank test.
Unopposed estrogen replacement therapy produced statistically significant decreases in antithrombin-III antigen (P = .006) and activity (P = .001) and total protein S (P = .003) and a significant increase in protein C antigen (P = .017). C4b-binding protein also decreased significantly from baseline to 3 months (P < .001). Mean fibrinogen level decreased by 18.2 mg/dL, not a statistically significant change (P = .213). Estrogen produced the expected statistically significant changes in lipids and lipoproteins. Several correlations between changes in lipids and lipoproteins and coagulation indices were statistically significant. Protein C antigen and activity changes correlated directly with high-density lipoprotein cholesterol changes (r = .52, P < or = .005; r = .38, P < or = .05; respectively), and protein C antigen also correlated directly with increases in apoprotein A-I (r = .54, P < or = .005). Triglyceride changes correlated directly with changes in protein C antigen (r = .36, P < or = .05) and activity (r = .49, P < or = .005) and inversely with C4b-binding protein (r = -.58, P < or = .01). Apoprotein B was correlated with free protein S (r = .48, P < or = .01).
Although several estrogen-induced changes may decrease atherosclerotic potential and hypercoagulability, others may promote coagulability. These divergent effects may be manipulated pharmacologically by other estrogen compounds or by the addition of various progestins.
研究雌激素诱导的脂质和脂蛋白变化与凝血系统改变之间的关系。
对31名年龄在40至60岁之间的绝经后女性进行了为期3个月的0.625毫克结合马雌激素治疗，测量其凝血和脂质指标。我们使用配对样本t检验或Wilcoxon配对符号秩检验分析了从基线到3个月变量的变化。
单纯雌激素替代疗法使抗凝血酶III抗原（P = 0.006）、活性（P = 0.001）以及总蛋白S（P = 0.003）显著降低，蛋白C抗原显著升高（P = 0.017）。从基线到3个月，C4b结合蛋白也显著降低（P < 0.001）。纤维蛋白原平均水平下降了18.2毫克/分升，差异无统计学意义（P = 0.213）。雌激素使脂质和脂蛋白发生了预期的具有统计学意义的变化。脂质和脂蛋白变化与凝血指标之间的几种相关性具有统计学意义。蛋白C抗原和活性变化与高密度脂蛋白胆固醇变化直接相关（r = 0.52，P ≤ 0.005；r = 0.38，P ≤ 0.05），蛋白C抗原也与载脂蛋白A-I的增加直接相关（r = 0.54，P ≤ 0.005）。甘油三酯变化与蛋白C抗原（r = 0.36，P ≤ 0.05）和活性（r = 0.49，P ≤ 0.005）直接相关，与C4b结合蛋白呈负相关（r = -0.58，P ≤ 0.01）。载脂蛋白B与游离蛋白S相关（r = 0.48，P ≤ 0.01）。
虽然雌激素诱导的几种变化可能会降低动脉粥样硬化风险和高凝性，但其他变化可能会促进凝血。这些不同的作用可以通过其他雌激素化合物或添加各种孕激素进行药理学调控。
