绝经后女性冠心病与非冠心病患者雌激素水平与凝血及纤溶功能分析(英文)

Analysis of estrogen level, coagulation and fibrinolysis function in women with or without coronary artery disease after menopause

背景:绝经后女性冠心病发病率及死亡率升高多认为与雌激素降低有关,但确切机制不明。目的:探讨绝经后女性冠心病与非冠心病患者血中内源性雌激素水平与凝血及纤溶功能的变化。设计:以诊断为依据,非随机对照试验。地点、对象和方法:选择2001-09/2002-05,以因胸闷痛收住本院的正常绝经≥1年的妇女为研究对象。纳入标准:均为绝经后妇女;2周内未用抗凝剂;未服用免疫抑制剂、雌激素。排除标准:肝、肾、内分泌、神经及生殖系统疾病。根据冠状动脉造影结果,将62例绝经后的妇女分为冠心病(32例)与非冠心病(30例)两组。清晨空腹取静脉血,抽提血浆和血清后测定雌二醇、孕酮、促卵泡刺激素和促黄体生成素,凝血系统的纤维蛋白原、血管性血友病因子抗原(vonWille-brandfactorantigen,vWF:Ag)及纤溶系统的组织纤溶酶原激活剂(tissueplasminogenactivator,tPA)、纤溶酶原激活剂抑制物-1(plasminogenactivatorinhibitor-1,PAI-1)和D-二聚体等。主要观察指标:两组患者凝血及纤溶系统指标比较及雌激素水平。结果:冠心病组血中雌二醇犤(39.97±9.73)ng/L犦,孕酮犤(6.42±1.14)nmol/L犦明显低于非冠心病组犤(64.92±9.77)犦ng/L,(7.01±0.85)nmol/L(t=10.6860,2.3960,P<0.01,0.05);冠心病组患者凝血系统的纤维蛋白原,vWF:Ag,

BACKGROUND:It is mostly considered that the higher morbidity and mortality of coronary artery disease(CAD) in postmenopausal women is related to a lower level of estrogen,but the pathogenesis is not definite. OBJECTIVE:To observe the changes of endogenous estrogen level,coagulation and fibrinolysis function in the blood in women with or without CAD after menopause.DESIGN:Non randomly controlled study based on diagnosis.SETTING,PARTICIPANTS and INTERVENTIONS:The subjects were the normal postmenopa usal women(menopause period exceed 1 year),complaining chest pain or discomfort, from September 2001 to May 2002.Inclusive criteria:All subjects selected in the study were postmenopausal women.They had not taken anticoagulant within 2 weeks and never administrated immune inhibitor and estrogen.Exclusive criteria:Patien ts with disturbances in liver,kidney,endocrine,neural and reproductive organs we re excluded.According to the results of coronary angiographies,the 62 women were divided into CAD group(n=32) and non CAD group(n=30).Fasting blood in vein was taken in the morning;and the plasma and the serum were extracted immediately,fo r testing the level of estradiol,progesterone,follicle stimulating hormone and l uteinizing hormone,fibrinogen and von Willebrand factor antigen(vWF:Ag) of coag ulation system,tissue plasminogen activator(tPA),plasminogen activator inhibitor 1(PAI 1) and D dimer of fibrinolytic system etc.MAIN OUTCOME MEASURES:Indexes of coagulation and fibrinolysis system were test ed,and estrogen level of the patients was measured in two groups. RESULTS:The levels of estradiol[(39.97±9.73) ng/L]and progesterone[(6.42±1.1 4) nmol/L] in the CAD group were significantly lower than those[(64.92±9.77) ng /L,(7.01±0.85) nmol/L] in the non CAD group(t=10.686 0,2.396 0,P< 0.01,0.05) r espectively;the levels of fibrinogen,vWF:Ag,PAI 1 and D dimer in the coagula tion system in CAD group were significantly higher than those in the non CAD gr oup(t=2.337 7 -4.356 0,P< 0.05);the tPA level of fibrinolytic system in CAD gro up was lower than that in the non CAD group(t=2.4307,P< 0.05). CONCLUSION:The level of estradiol is obviously lower,the function of coagulati on system is strengthened and the function of fibrinolysis system is reduced sig nificantly in menopausal women of the CAD group than those of menopausal women i n the non CAD group.