绝经后女性冠心病患者内源性女性激素分泌异常及其对一氧化氮合成的影响

目的观察绝经后女性冠心病患者内源性女性激素分泌的异常变化及其对一氧化氮合成的影响,探讨造成雌、孕激素联用的性激素替代疗法失败的可能原因。方法筛选绝经后女性冠心病患者100例及年龄、绝经年限和体质指数具可比性的健康绝经后女性100例,采用放射免疫法测定血清雌二醇和孕酮的水平,采用化学比色法测定血清一氧化氮水平及一氧化氮合酶活性,并对雌二醇、孕酮及雌二醇/孕酮与血清一氧化氮及一氧化氮合酶的关系进行相关分析。结果绝经后女性冠心病患者与健康绝经后女性相比,雌二醇水平下降(121±32比156±31 pmol/L),孕酮水平上升(5.67±1.60比3.14±1.10 nmol/L),雌二醇/孕酮明显降低(27.9±26.5比52.4±37.8),相关分析显示雌二醇、雌二醇/孕酮与血清一氧化氮和一氧化氮合酶活性呈正相关关系,血清孕酮水平与一氧化氮和一氧化氮合酶活性呈负相关关系。结论绝经后女性冠心病患者雌激素水平降低,孕激素水平升高,雌激素/孕酮比值降低,这种改变对血管内皮功能有不良影响。性激素替代疗法时雌激素和孕激素剂量搭配不适当孕激素偏高,导致雌/孕激素比偏低可能是其未能有效保护心血管系统的原因之一。

Abnormality in Endogenous Female Sex Hormones Secretion and Its Influence on Nitric Oxide Synthesis in Postmenopausal Women with Coronary Artery Disease

Aim This study sought to evaluate the endogenous female sex hormones secretion abnormality in postmenopausal women with coronary artery disease(CAD)and its influence on nitric oxide synthesis. Methods We assessed the concentration of serum female hormones,estradiol(E₂)and progesterone(P)by using radioimmunoassay and determined serum NO(Nitrite/Nitrate) and the activity of NO synthetic enzyme(NOS)by colorimetry in 100 postmenopausal women with coronary artery disease and 100 healthy postmenopausal women who were enrolled in this study. Results Postmenopausal women with coronary artery disease had significantly lower E₂,higher P levels(121±32 pmol/L vs 156.2±30.6 pmol/L,5.67±1.6 nmol/L vs 3.14±1.1 nmol/L respectively)and lower E₂/P ratio(52.4±26.5 vs 127.9±37.8) than healthy postmenopausal women.The serum NO level and NOS activity were lower in women with CAD than in healthy women.The serum E₂ level and E₂/P ratio were positive correlative with NO level and NOS activity,whereas,the serum P level was passive relative with NO level and NOS activity. Conclusions Compared with healthy postmenopausal women,women with CAD have lower estrogen,higher progesterone levels and significantly lower E₂/P ratio.This endogenous female hormones imbalance do adverse effect on the vascular endothelial function.