替勃龙对围绝经期妇女动脉的保护作用

Tibolone in The Prevevtion of Arteriosclerosis to Postmenopausal Women

目的观察替勃龙治疗对绝经后妇女更年期症状及颈动脉和椎动脉I MT和RI的影响。方法有更年期症状的绝经后妇女138例,随机分为治疗组(替勃龙2.5 mg/d)和对照组。替勃龙治疗前及治疗2 a后询问病史,按改良Kupperman评分,并检测血TC、TG、HDL-C、LDL-C及颈动脉I MT,颈动脉、椎动脉的RI。结果 129例完成观察和治疗。替勃龙治疗2 a后血TC显著降低(P<0.05),LDL-C和Lp(a)极显著降低(P<0.01),HDL-C略有降低(P>0.05)。替勃龙治疗2 a CCA的I MT下降26.7%(P<0.01)。CCA的RI从0.72±0.06下降到0.68±0.06,ICA的RI从0.59±0.05至0.56±0.05,VA的RI从0.66±0.06下降到0.62±0.04(P<0.05)。ECA的RI下降不明显(P>0.05)。结论替勃龙可改善更年期症状,并降低胆固醇、LDL和Lp(a),颈动脉RI,颈动脉内I MT厚度,对动脉粥样硬化有预防作用。

Objective To assess the effect of tibolone treatment on the menopause symptom and the intima-media thickness（IMT） of the common carotid artery（CCA） and the resistive indices（RIs） of the CCA and internal（ICA） and external（ECA） carotid and the vertebral arteries（VAs） in postmenopausal women.Methods According to random number table,138 symptomatic postmenopausal women were devided into experimental（tibolone were used,2.5mg/day） and routine group,inquested and graded according Kupperman method.Fasting blood samples were drawn at baseline and the end of the follow-up period-2 years later for total cholesterol,Lp（a）,LDL and HDL cholesterol,and triglyceride determinations,and also noninvasive measurements of the IMT of the CCA and the RI of the CCA,ICA,ECA,and VA were made with ultrasound.Results 129 subjects were compliant and completed the study.Two years of tibolone treatment significantly decreased total cholesterol（P0.05）,very significantly decreased LDL cholesterol and Lp（a）（P0.01）.The decrease of HDL cholesterol was not significant（P0.05）.It also decreased the IMT of the CCA（mean±SD） by 26.7%（P0.01）.the RI of the CCA（mean±SD） decreased from 0.72±0.06to 0.68±0.06,the RI of the ICA decreased from 0.59± 0.05 to 0.56± 0.05,and the RI of the VA from 0.66±0.06 to 0.62±0.04（P0.05）.The decrease in the RI of the ECA was not significant（P0.05）.Conclusion The present study showed that tibolone treatment improved menopause symptom and decreased total cholesterol/LDL cholesterol/Lp（a）,causes thinning of the IMT of the CCA and improves CCA and ICA blood flows and thus appears to be useful in preventing atherosclerosis.