绝经后冠心病患者及正常妇女尼尔雌醇替代治疗的观察

Estradiol replacement therapy in post-menopausal women with or without coronary artery disease

目的 拟探讨雌激素 (E)对心血管保护作用部分是通过诱导血管内皮一氧化氮 (NO)释放增加而介导的。方法 选 4 8例绝经妇女冠心病患者为观察组 ,3 6例绝经后健康妇女作为对照组 ,以上二组中的患者随机分为干预组和安慰剂组 ,分别予以尼尔雌醇 (每月 2mg/次 )或安慰剂 (每月 2片 /次 )治疗 6个月 ,观察对象均分别于 0、3、6个月末时抽血测血清雌激素水平 (E2 )、血清NO、血清低密度脂蛋白 胆固醇 (LDL C)水平。结果 ( 1)冠心病组的血清E2 水平低于正常对照组 (P <0 0 1) ;( 2 )经过尼尔雌醇 6个月干预治疗后 :绝经后妇女是否患有冠心病血清E2 水平均逐渐上升 (P <0 0 1或P <0 0 5 ) ;血清NO含量显著增高 (P <0 0 1) ,且冠心病组较对照组更明显 (P <0 0 5 ) ;各组血清LDL C水平明显下降 (P <0 0 5 ) ;( 3 )经过 6个月治疗血清E2 水平与血清NO含量呈正相关 (r =0 664 3 ,P <0 0 0 5 ) ,与血清LDL C水平呈显著负相关 (r=- 0 73 3 4,P <0 0 1)。结论 尼尔雌醇替代治疗有利于绝经后正常妇女及冠心病妇女的心血管保护作用。提示了雌激素替代治疗可通过诱导内皮释放NO而介导的。

Objective To study the protective mechanism of estrogen action Methods Randomized placebo controlled trial was conducted in forty eight post menopausal women with coronary artery disease (CAD) and thirty six normal menopausal women by receiving nilestriol replacement therapy or placebo treatment for six months Serum estradiol (E 2), nitric oxide (NO) and low density lipoprotein cholesterol (LDL C) levels were measured at 0,3 rd and 6th month of treatment Results (1) E 2 level in the CAD group was lower than that in the normal group ( P <0 01) (2) After nilestriol treatment: (a) E 2 level was significantly higher than baseline ( P <0 01 in the CAD group, P <0 05) in the normal group); (b) NO level, being lower in the post menopausal women, was significantly increased ( P <0 01), NO level in the CAD group increased much higher than that in the normal group ( P <0 05); (c) LDL C level was decreased ( P <0 05) (3) There was a significant positive correlation between E 2 level and NO (NO 2/NO 3) level ( r =0 664 3, P <0 005) while a significant negative correlation between E 2 level and LDL C level ( r =-0 733 4, P <0 01) after six months treatment Conclusions Estrogen replacement therapy is beneficial to post menopausal women with or without CAD The cardioprotective effect of estrogen replacement therapy seems to be due to the beneficial effect of estrogen induced increasing release of NO