经皮雌激素治疗对手术绝经妇女围绝经症状和辅助性T细胞1和2平衡的影响

Effects of transdermal estrogen therapy on perimenopausal symptoms and Th1 and Th2 balance in surgically menopausal women

目的:研究经皮雌二醇(E2)凝胶对手术绝经妇女围绝经症状和T淋巴细胞分泌辅助性T细胞1(Th1)和辅助性T细胞2(Th2)型细胞因子的影响。方法:研究对象为手术绝经组,使用经皮E2凝胶(17β-E2,0.75 mg/d)3个月,用药前、后分别取外周静脉血分离T淋巴细胞,检测T淋巴细胞分泌干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)水平和IFN-γ/IL-4比值,检测外周血E2和卵泡刺激素(FSH)水平,评估围绝经症状和生存质量。生育年龄组检测外周血E2和FSH水平及T淋巴细胞分泌IFN-γ、IL-4水平和IFN-γ/IL-4比值。手术绝经组用药前、后进行自身比较,另以生育年龄组作为参考对象。结果:手术绝经组用经皮雌激素治疗(ET)后,E2水平较用药前明显升高(P<0.05);FSH水平较用药前有下降趋势,但差异无统计学意义(P>0.05);围绝经症状和生存质量均得到显著改善(P<0.01)。手术绝经组用ET前T淋巴细胞分泌IFN-γ和IL-4的水平均明显低于生育年龄组(P<0.05和P<0.01),IFN-γ/IL-4水平明显高于生育年龄组(P<0.01),呈现出Th1优势。手术绝经组用ET后IFN-γ较用药前显著下降(P<0.01),IL-4较用药前显著上升(P<0.01),IFN-γ/IL-4的水平较用药前显著下降(P<0.01),与生育年龄组无明显差异,显示了Th1/Th2趋于平衡。结论:经皮雌激素治疗能显著改善手术绝经妇女的围绝经症状,同时能使手术绝经妇女的Th1/Th2趋于平衡。

Objective： To investigate the effect of transdermal estradiol （E2） gel on perimenopausal symptoms and T helper （Th） 1 and Th2 type cytokines secreting by T lymphocytes in surgically menopausal women. Methods： The women were distributed into two groups： surgically menopause group （menopause group） and reproductive age group （young group）. Surgically menopausal women had taken transdermal E2 gel （0.75 mg/d 17β- E2） for 3 months. Before and after estrogen therapy （ET）, the serum levels of E2 and follicle stimulating hormone （FSH） were measured, the menopausal complaints and quality of life were evaluated, and the levels of IFN-γ and IL-4 secreting by T lymphocytes and the ratio of IFN-γ to IL-4 were examined. In young group, the serum levels of E2 and FSH were measured, and the levels of IFN-γ and IL-4 and the ratio of IFN-γ to IL-4 were examined. Before and after ET, the results of menopause group with young group were compared. Results： After ET, the serum E2 level of menopause group was significantly increased （P〈0.05）, and the serum FSH level was decreased, but the difference was not significant; the menopausal complaints and quality of life were significantly improved （P〈0.01）. Before ET, the levels of IFN-γ and IL-4 in menopause group were significantly lower than those in young group （P〈0.05 and P〈0.01）, the ratio of IFN-γ to IL-4 was exetremly higher than that in young group （P〈0.01）, which suggested a Thl polarization. After ET, the level of IFN-γ in menopause group was significantly decreased （P〈 0.01）, the level of IL-4 was significantly increased （P〈0.01）; the ratio of IFN-γ to IL-4 was exetremly decreased （P〈0.01）, which had no significant difference between the two groups. Conclusion： Low dose transdermal ET can relieve perimenopausal symptoms and act to improve the balance of Th1/Th2 type cytokines.