绝经对女性冠心病患者临床特征及危险因素的影响

Effects of menopause on clinical profile and cardiovascular risk factors of women with coronary heart disease

目的探讨绝经对女性冠心病患者临床特征及危险因素的影响。方法选择2009年2月至2011年1月在我院经冠脉造影确诊的未绝经冠心病患者(29例);年龄相匹配的男性患者(31例);绝经后女性冠心病患者(67例),其中绝经时间≤5年者30例,绝经时间>5年者37例;健康绝经者(60例),其中绝经时间≤5年者30例,绝经时间>5年者30例进行对比分析。结果与男性比较,未绝经组糖代谢异常及有冠心病家族史明显高于男性组(P<0.05),且多数具有典型的心绞痛。绝经各组与未绝经组比较随着绝经时间的延长合并高血压者显著升高(P<0.01)。而合并糖代谢异常及有冠心病家族史者下降,同时表现为典型心绞痛者也明显下降(P<0.05)。冠状动脉病变女性以单支病变为主(P<0.05)。绝经后冠心病者较绝经≤5年健康组,雌二醇及孕酮水平均下降明显(P<0.05),随着绝经时间的延长雌二醇下降尤为明显,而绝经后的冠心病组间无差异。结论心血管危险因素、临床特征两性存在差异,绝经对女性冠心病患者心血管危险因素及冠状动脉病变有影响,雌孕激素水平下降可能是其原因之一。

Objective To study the effects of menopause on clinical profile and risk factors of women with coronary heart disease(CHD).Methods Risk factors,clinical symptoms and coronary angiographic characteristics of CHD were investigated retrospectively in the following subjects who came to our hospital between February 2009 and January 2011: 29 premenopausal women with CHD,31 age-matched male patients(control group),67 postmenopausal women with CHD(30 whose menopause lasted 5 years or less and 37 whose menopause lasted more than 5 years),and 60 healthy postmenopausal women(30 whose menopause lasted 5 years or less and 30 whose menopause lasted more than 5 years).Results Compared with the men,abnormal metabolism of sugar and family history of CHD were significantly higher in premenopausal group than in male group(P<0.05),and most of them in premenopausal group had typical angina.Compared with premenopausal group,a significantly increased number of patients in postmenopausal groups had hypertension as menopause prolonged(P<0.01);meanwhile,the number of patients with abnormal metabolism,family history of CHD and typical angina markedly reduced(P<0.05).Coronary artery disease was primarily a single lesion in women(P<0.05).The level of estrogen and progesterone declined after menopause in menopausal CHD groups than in the healthy group with menopause for less than years(P<0.05);progesterone level dropped especially significantly as menopause prolonged.However,no such difference was found between CHD groups after menopause.Conclusion Males and females have different cardiovascular risk factors and clinical profile.Menopause affects cardiovascular risk factors and coronary artery lesions in female CHD patients,and the decline of estrogen and progesterone level is probably one of the causes.