健康成年女性内生雌激素的变化与脂类代谢关系的探讨

Study on the Cyclic Fluctuation of Serum Lipid and Apolipoprotein Levels During Menstrual Cycle in Healthy Child-Bearing Age Women

目的：研究健康成年女性内生雌激素的变化对脂类代谢的影响，为雌激素替代治疗（ERT）提供参考。方法：选择健康体检育龄妇女387例，年龄（21～50）岁，测定雌激素（E2）、孕激素（P）、载脂蛋白A-Ⅰ（apoA-Ⅰ）、载脂蛋白B（apoB）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、甘油三酯（TG）、脂蛋白a[LP（a）]。并从中选取40例自愿者作月经周期中自体早排卵期（EF）和黄体期（LUT）对照。结果：月经周期中雌激素的周期性波动，会影响到脂类代谢，选取EF、LUT作配对比较，发现内生雌激素水平对apoA-Ⅰ、apoB、apoA-Ⅰ／apoB、HDL-C、LDL-C、LDL-C／HDL-C、TC、TC／HDL-C、TG有影响，对LP（a）无影响，其中LDL-C、LDL-C／HDL-C、TC／HDL-C水平在LUT均比EF明显低（P〈0．05）。结论：健康成年女性月经周期中内生雌激素的波动对脂类代谢有影响，虽然对于多数脂类影响不显著，但对在绝经期前女性进行脂类检测和药物治疗监测时，对测定结果处于临界水平的标本，需将其考虑为重要影响因素之一，不注意这些波动可能会影响治疗和诊断。随年龄增长呈周期性变化的雌激素水平有下降趋势，脂类：TC、TG、LDL-C、apoB随年龄增长有增长趋势，作为心血管疾病的危险因素之一，是一个较长的渐进过程。

Objective To study the influence of changes of endogenous estrogen levels during menstrual cycle on the serum lipid and apolipoprotein levels. Methods Serum E2, P （with immunoassay） and apoA-Ⅰ , apoB, HDL, LDL, total cholesterol, TG, Lp （a） （with biochemistry） levels were determined in 387 healthy child -bearing age women, among which these levels were determined twice （once in early follicular phase and once in luteal phase） in 40 volunteers. Results With the exception of Lp（ a）, there were fluctuations of lipids and related apolipoproteins levels with the cyclic changes of estrogen levels （ higher in luteal phase than early follicular phase）, HDL levds were higher during luteal phase and LDL, LDL/HDL, total cholesterol/HDL levels were significantly lower during luteal phase than those during early follicular phase （P 〈 0.05）. Conclusion Changes of endogenous estrogen levels during normal menstrual cycle did have effects on the test results of lipid profile and should be taken into consideration in borderline ca- ses. The 387 individuals involved in this study covered a wide range of age difference （21 - 50） and the results demonstrated a general tendency of decrease of estrogen level with increase of several cardio - vascular related risk factors （ total cholesterol, TG, LDL, apoB） levels as a gradual aging process.