激素替代治疗对绝经后高血压患者凝血纤溶系统的影响

Effects of Tibolone replacement therapy on coagulation and fibrinolysis of postmenopausal women with hypertension

目的 观察激素替代治疗 (HRT)对绝经后高血压妇女血压及凝血纤溶平衡的影响。方法 选择绝经后轻、中度高血压妇女 5 0例 (绝经后高血压组 ) ,随机均分为降压治疗亚组和联合治疗亚组。降压治疗亚组给予福辛普利 10mg/d或加吲达帕安 2 .5mg/d ;联合治疗亚组的降压治疗同前组 ,同时选择 7 甲基异炔诺酮 (替勃龙 ) 2 .5mg/d接受HRT治疗。两组平均治疗 9个月。观察血压、凝血纤溶及抗凝指标的变化。另设绝经后正常血压妇女 2 2例作为对照组。结果 与对照组比较 ,绝经后高血压组 11脱氢血栓烷B2 (11DHTXB2 )增高 5倍 ,前列腺素E2 (PGE2 )增高 1.5倍 (P值均 <0 .0 1) ,蛋白C活性 (PC :A)明显下降 (P <0 .0 5 ) ,组织型纤溶酶原激活剂抗原 (tPA :Ag)增高 (P <0 .0 1) ,组织型纤溶酶原激活剂 (tPA) /纤溶酶原激活剂抑制因子 1(PAI 1)比值上升 (P <0 .0 1)。提示绝经后高血压患者有明显的凝血倾向。降压治疗亚组治疗后血压明显下降 ,凝血纤溶平衡无明显变化。联合治疗亚组治疗后血压明显下降 ,11DHTXB2 下降 4 4 % ,PGE2 上升 34% ,活化的凝血因子FⅦ (FⅦ :C)下降 15 % ,PC、抗凝血酶 (AT)、组织因子途径抑制物 (TFPI)无明显变化 ,纤溶酶原 (PLG)增加12 % ,tPA、PAI 1分别下降 2 9%和 4 % ,D 二聚体 (D D)

Objective To observe the effect of hypotensive therapy plus Tibolone (HRT) on blood pressure, coagulation factors and fibrinolytic components of postmenopausal women with hypertension.Methods 50 subjects were chosen and randomly divided into antihypertensive group and antihypertensive plus HRT group (combination group). Fosinopril (10 mg/d) or fosinopril (10 mg/d) plus indapamide (2.5 mg/d) was taken in either group. Tibolone (2.5 mg/d) was given as HRT. All subjects were treated for 9 months. Factors of coagulation and fibrinolysis and antithrombin (11DHXB 2, PGE 2, FⅦ:C, PLG:A, FDP:A, FDP, D-D, tPA:AG, PAI-1:AG, AT:A, PC:A, TFPI) were evaluated. 22 subjects with normotensive postmenopausal women were selected as control group.Results 11DHTXB 2 and PGE 2 were five folds and one and half folds higher in hypertensive postmenopausal group respectively than those in the control group. PC:A decreased significantly, but tPA:Ag and the ratio of tPA/PAI-1 increased (P<0.01). It indicated that hypercoagulability was present in postmenopausal women with hypertension. After treatment, the blood pressure decreased significantly and no change in coagulation and fibrinolytic system was seen in antihypertensive group. In the combination group, the blood pressure decreased significantly also. 11DHTXB 2 and FⅦ decreased by 44% and 15% respectively, whereas PGE 2 increased by 34%. PC, AT and TFPI showed no difference. In addition, TPA, PAI-1, D-D and FDP were reduced by 29%, 4%, 31% and 28%, respectively. PLG increased by 12%. Hypercoagulability was improved significantly in antihypertensive plus HRT group.Conclusion It shows that hypercoagulability is pronounced in postmenopausal women with hypertension. The hypotensive therapy has no negative impact on coagulation and fibrinolytic system. Tibolone (HRT) can significantly improve the hypercoagulability. It seems that Tibolone may be beneficial in decreasing the risk of cardiovascular events.