绝经后激素替代治疗期间长期补充维生素D3可能对血脂产生不良影响。

Long-term vitamin D3 supplementation may have adverse effects on serum lipids during postmenopausal hormone replacement therapy.

作者信息

Heikkinen A M, Tuppurainen M T, Niskanen L, Komulainen M, Penttilä I, Saarikoski S

机构信息

Department of Obstetrics and Gynecology, University Hospital of Kuopio, Finland.

出版信息

Eur J Endocrinol. 1997 Nov;137(5):495-502. doi: 10.1530/eje.0.1370495.

DOI:10.1530/eje.0.1370495

PMID:9405029

Abstract

OBJECTIVE

The positive short-term effects of postmenopausal hormone replacement therapy (HRT) on serum lipids are well known, but it has been suggested that they vanish with time. Cholecalciferol (vitamin D3) is widely used to prevent postmenopausal osteoporosis but the influence of vitamin D3 on serum lipids is poorly known. The long-term effects of HRT and vitamin D3 on the concentrations of serum lipids were studied in a population-based prospective 3-year study.

DESIGN AND METHODS

464 women were randomized into four treatment groups: (i) HRT (sequential combination of 2 mg estradiol valerate and 1 mg cyproterone acetate), (ii) Vit D3 (vitamin D3 300 IU/day), (iii) HRT+Vit D3 (both as above), (iv) placebo (calcium lactate 500 mg/day).

RESULTS

320 women completed the study. After three years of treatment, serum concentrations of low density lipoprotein (LDL) cholesterol decreased in the HRT group (10.1%, P<0.001) and the HRT+Vit D3 group (5.9%, P=0.005), increased in the Vit D3 group (4.1%, P=0.035) but remained unchanged in the placebo group. The concentrations of total cholesterol decreased by 5.8% in the HRT group (P<0.001) and by 3.3% in the HRT+Vit D3 group (P=0.023), but did not change in the other two groups. Serum concentrations of high density lipoprotein (HDL) cholesterol decreased in the Vit D3 group (5.2%, P=0.001), HRT+Vit D3 group (3.7%, P=0.046), and the placebo group (4.5%, P=0.006) but did not change significantly in the HRT group. The HDL/LDL ratio increased in the HRT group (10.5%, P=0.006) and decreased in the Vit D3 group (10.5%, P<0.001) whereas no changes occurred in the other two groups. In addition, serum triglycerides increased similarly in all groups (14.0-18.8%, P<0.05-0.001).

CONCLUSIONS

Our results confirm the positive long-term effect of HRT with sequential estradiol valerate and cyproterone acetate on serum lipid concentrations. In addition, the results suggest that vitamin D3 supplementation may have unfavorable effects on lipids in postmenopausal women. Pure vitamin D3 treatment was associated with increased serum LDL cholesterol. Furthermore, the beneficial effects of HRT on serum LDL cholesterol content were reduced when estradiol valerate was combined with vitamin D3. However, the relevance of these associations to cardiovascular morbidity remains to be established.

摘要

目的

绝经后激素替代疗法（HRT）对血脂的短期积极影响众所周知，但有人认为这些影响会随着时间消失。胆钙化醇（维生素D3）广泛用于预防绝经后骨质疏松症，但维生素D3对血脂的影响却鲜为人知。在一项基于人群的前瞻性3年研究中，对HRT和维生素D3对血脂浓度的长期影响进行了研究。

设计与方法

464名女性被随机分为四个治疗组：（i）HRT（2mg戊酸雌二醇和1mg醋酸环丙孕酮的序贯组合），（ii）维生素D3（维生素D3 300IU/天），（iii）HRT+维生素D3（两者如上），（iv）安慰剂（乳酸钙500mg/天）。

结果

320名女性完成了研究。经过三年治疗，HRT组（10.1%，P<0.001）和HRT+维生素D3组（5.9%，P=0.005）的低密度脂蛋白（LDL）胆固醇血清浓度降低，维生素D3组（4.1%，P=0.035）升高，而安慰剂组保持不变。HRT组总胆固醇浓度降低了5.8%（P<0.001），HRT+维生素D3组降低了3.3%（P=0.023），但其他两组没有变化。维生素D3组（5.2%，P=0.001）、HRT+维生素D3组（3.7%，P=0.046）和安慰剂组（4.5%，P=0.006）的高密度脂蛋白（HDL）胆固醇血清浓度降低，而HRT组没有显著变化。HRT组的HDL/LDL比值升高（10.5%，P=0.006），维生素D3组降低（10.5%，P<0.001），而其他两组没有变化。此外，所有组的血清甘油三酯均类似地升高（14.0 - 18.8%，P<0.05 - 0.001）。

结论

我们的结果证实了戊酸雌二醇和醋酸环丙孕酮序贯的HRT对血脂浓度的长期积极影响。此外，结果表明补充维生素D3可能对绝经后女性的血脂有不利影响。单纯维生素D3治疗与血清LDL胆固醇升高有关。此外，戊酸雌二醇与维生素D3联合使用时，HRT对血清LDL胆固醇含量的有益作用降低。然而，这些关联与心血管发病率的相关性仍有待确定。