绝经后女性冠心病性激素与冠状动脉病变关系探讨

Relationship of Sex Hormones and Morphology of Coronary Lesion in Post - menopausal Women with Coronary Artery Disease

目的研究绝经后妇女性激素水平失衡与冠状动脉病变的关系。方法选取121例行双源CT（DSCT）冠状动脉成像的绝经后女性住院病人为研究对象，分为冠心病（coronary heart disease，CHD）组70例和非冠心病组51例。按照DSCT结果对冠状动脉狭窄病变程度进行定量Gensim评分，计算冠脉病变支数；缺血相关病变根据Ambrose分类方法分为两组：简单病变和复杂病变；同时测定血清雌二醇（E2）、睾酮（T）、孕酮（P）含量，血脂。结果①冠心痛组和非冠．心病组比较，E2、HDL—C低于非冠心病组，有显著差异（P〈0．05），LDL—C、TG、TC、T、T／E2高于非冠心病组，有显著差异（P〈005），P、P／E2无明显差异（P〉0．05）。②冠状动脉病变积分与性激素及性激素比值无明显相关性（P〉0．05）。③不同冠状动脉病变支数的患者，性激素及性激素比值比较，差异无统计学意义（P〉0．05）。④复杂病变与简单病变之间比较，E2水平降低，T、P、T／E2、P／E2水平增加，但无显著性差异（P〉005）。⑤多因素分析结果显示T／E2、LDL—C是冠心病复杂病变发生的独立危险因素；线性相关分析表明T／E2与TC、LDL—C呈正相关，与HDL—C呈负相关。结论①性激素比值与冠状动脉病变支数及狭窄程度无关；与病变类型有关。②T／E2是女性冠心病复杂病变发生的独立危险因素，性激素水平失衡可能通过血脂代谢紊乱导致冠状动脉粥样硬化病理生理改变及斑块不稳定性的发生。

Objective To study the relationship between the ratios of sex hormones and morphology of coronary lesion in post - menopausal women . Methods 121 cases of post - menopausal hospital patients underwent dual sourse CT were selected . They were divided into 2 groups , CHD group 70 cases and non -CHD group 51 cases . According to the result of DSCT, coronary lesion score and diseased vessel numbers were calculated. Ischemic-related coronary lesions were classified as ＂simple lesion＂ and ＂complex lesion＂ according to the criteria proposed by Ambrose method. Serum estradiol（E2）, testoserone（T）, prolaction（P） and lipid wear measured on an empty stomach. Results @ The level of serum E2of CHD group is 29.14±4.88 pmol/1 , and it is predominant higher than the level of non - CHD group which is 32. 46 ±6.19 pmol/1 ;As for smoking, the non- CDH group is predominant lower than that of CHD group. @ There are no significant difference between the ratios of sex hormones and coronary lesion score. （2）The ratios of sex hormones showed little difference among different diseased vessel numbers. （2）Between simple lesion and complex lesion,E2 was lower, T, P, T/E2, P/E2 were higher, though there are significant difference. （5） Logistic regression analysis indicated that T/E2, LDL-C were significantly independent disk factors of complex lesion. Correlation analysis showed that there are a significant positive correlation between T/E2 and TC, LDL-C, while a negative correlation existed T/E~ and HDL-C. Conclusions The ratios of sex hormones correlate with the classification of coronary , but not with diseased vessel numbers or severity of coronary artety lesions. T/E2 is one of the independent risk factors of complex lesion. There is a close correlation between imbalance sex hormones , which results in the onset of pathophisiological changes of coronary atherosclerosis and unstable plaque.