绝经后心肌梗死患者雌激素和一氧化氮变化及其相关性

INTRODUCTIONThereisthedifferenceinincidenceofcoronaryheartdisease（CHD）betweenmalesandfemales．CHDincidenceisloweramongfemalescomparedwithmales．Ratioofincidencebetweenfemalesandmaleswas１：３－４．Forfemales，onsetageis１０yearslessthanmen．PostmenopausalincidenceofCHDincreasesdramatically，andis２．７timescomparedtothepremenospausalwhichissimilarorexceedthatofmen．CHDincidenceislowerforwomenreceivingestrogenreplacementtherapythanforthosereceivingnoreplacementthera－py．Itsuggested…     

绝经后心肌梗死患者性激素与脂代谢的关系

目的:探讨绝经后心肌梗死患者性激素与脂代谢之间的关系。方法:利用放免法、免疫酶法、酶法分别检测绝经后心肌梗死组(30例)和绝经后对照组(30例)血中雌二醇、孕酮、睾酮、脂蛋白(a)、三酰甘油、总胆固醇、高密度脂蛋白胆固醇(highdensitylipoproteinchoesterol,HDL-C)、低密度脂蛋白胆固醇(lowdensitylipoproteinchoesterol,LDL-C)水平。结果:绝经后心肌梗死组雌二醇、雌二醇/孕酮、雌二醇/睾酮、HDL-C水平显著比绝经后对照组低(t=4.834,P<0.01;t=2.760,2.539,P<0.05),脂蛋白(a)、LDL-C、三酰甘油、总胆固醇水平犤(21.31±17.93)mg/L,(2.98±1.04),(1.63±1.44),(4.23±0.94)mmol/L犦明显比绝经后对照组高犤(13.52±13.04)mg/L,(2.15±1.19),(1.13±0.55),(3.50±1.36)mmol/L犦(t=2.279～2.884,P<0.05),雌二醇与脂蛋白(a)、LDL-C均呈负相关(r=-0.373,P<0.05;r=-0.635,P<0.01),与HDL-C呈正相关(r=0.378,P<0.05)。结论:绝经后心肌梗死患者存在明显的以雌二醇水平不足为主的性激素紊乱和脂代谢异常,脂代谢异常和血中雌二醇水平不足密切相关;血中雌二醇水平不足促进脂代谢异常,可能是绝经后妇女心肌梗死发生的重要原因之一。     

女性血清抵抗素水平与急性心肌梗死发病及预后的相关性

目的研究绝经后女性急性心肌梗死患者血清抵抗素水平的变化,探讨血清抵抗素水平与急性心肌梗死发病和预后的关系。方法入选2005年3⁸月住院的绝经后女性患者67例,其中急性心肌梗死患者30例,非冠心病患者37例。收集所有患者的临床资料,包括病史、身高、体重、血压、空腹血糖、血脂、纤维蛋白原、白细胞计数、高敏C反应蛋白等。以酶联免疫吸附法测定血清抵抗素、空腹胰岛素水平,计算定量胰岛素敏感性检测指数QUICKI,并以胰岛素抵抗的体内稳定状态模式评估法(HOMA-IR)来评价胰岛素抵抗。于出院时和出院后连续8年对所有患者进行临床随访,记录主要心脏不良事件发生情况,包括心绞痛、心肌梗死、心力衰竭、再次血运重建及死亡。结果急性心肌梗死组患者血清抵抗素水平为5.04(1.208月住院的绝经后女性患者67例,其中急性心肌梗死患者30例,非冠心病患者37例。收集所有患者的临床资料,包括病史、身高、体重、血压、空腹血糖、血脂、纤维蛋白原、白细胞计数、高敏C反应蛋白等。以酶联免疫吸附法测定血清抵抗素、空腹胰岛素水平,计算定量胰岛素敏感性检测指数QUICKI,并以胰岛素抵抗的体内稳定状态模式评估法(HOMA-IR)来评价胰岛素抵抗。于出院时和出院后连续8年对所有患者进行临床随访,记录主要心脏不良事件发生情况,包括心绞痛、心肌梗死、心力衰竭、再次血运重建及死亡。结果急性心肌梗死组患者血清抵抗素水平为5.04(1.20¹2.45)μg/L,显著高于对照组1.57(0.3212.45)μg/L,显著高于对照组1.57(0.32³.55)μg/L(P<0.05)。血清抵抗素水平与白细胞计数、高敏C反应蛋白呈正相关(r分别为0.459和0.344,P均<0.05)。8年随访结果显示,对照组均未发生不良事件;急性心肌梗死患者血清抵抗素水平高于7.4μg/L者,主要心脏不良事件发生率明显高于血清抵抗素水平低于7.4μg/L者(61.5%vs.23.5%,P=0.035)。结论绝经后女性急性心肌梗死患者血清抵抗素水平显著升高。在绝经后女性急性心肌梗死患者中血清抵抗素水平显著升高组患者主要心脏不良事件发生率显著增加。血清抵抗素在急性心肌梗死患者中升高可能与体内炎症激活有关。     

绝经期妇女抑郁和焦虑症状与绝经年限及雌激素水平的关系

目的:分析绝经期妇女抑郁和焦虑的临床特征,寻求进行干预的可能性。方法:109例绝经期妇女在体检时接受了Zung编制的抑郁自评量表(SDS)和焦虑自评量表(SAS)的测评,并与她们的绝经年限及雌激素水平进行比较。结果:109例受试者中SDS标准分≥50分者67例(61.5%),标准分均值为(46.84±10.96)分,明显高于正常人常模(41.88±8.55,t=2.586,P<0.02)。SAS标准分≥50分者69例(63.3%),标准分均值(44.62±10.31),明显高于正常人常模(40.06±10.52,t=2.347,P<0.05)。109例受试者按绝经年限分组后,≤3年组的SDS和SAS标准分明显高于3～8年和>8年组(t=2.196～2.365,P均<0.05)。在按雌激素不同浓度分组比较中,低雌二醇组(<100pmol/L,68例)的SDS和SAS标准分明显高于雌二醇组(≥100pmol/L,41例)(t=2.218和2.156,P均<0.05),而高睾酮组(≥30mmol/L)、高促卵泡素组(≥30μg/L)和高促黄体生成素组(≥40μg/L)的SDS和SAS标准分明显高于浓度低各组(t=2.197～2.295,P均<0.05)。结论:绝经期妇女的抑郁和焦虑情绪表现的与绝经年限和雌激素水平密切相关。     

雌激素水平与绝经后妇女腱鞘炎的相关性研究

目的 探讨雌激素水平与绝经后妇女腱鞘炎的关系.方法 选取74例绝经妇女,其中32例为腱鞘炎患者(A组),42例同期健康体检的绝经妇女为对照组(B组);42例正常行经的健康体检妇女为正常对照组(C组).均进行雌激素水平测定,并进行相关性分析.结果 A组与B组之间,雌激素(E2)水平分别为(89.7066±126.7458)pmol/L和(45.6768±30.6342)pmol/L,差异无统计学意义(P>0.05);A组与C组雌激素水平分别为(89.7066±126.7458)pmol/L和(626.7384±361.5348)pmol/L,差异有统计学意义(P<0.01).结论 绝经后妇女腱鞘炎发病与雌激素水平变化无明显关系.     

绝经后妇女雌激素水平与腹主动脉粥样硬化的关系

目的:研究绝经后妇女雌激素水平与腹主动脉钙化的关系,寻求干预动脉粥样硬化的可能性。方法:使用渡边弘美计算方法,收集了137例绝经后妇女腹部CT扫描中3126帧图像资料,测量腹主动脉钙化体积,并与患者近期的血雌二醇(estradiol,E2)、睾酮(testosterone,T)、促卵泡激素(follicle-stimulatinghormone,FSH)、促黄体生成素(follicle-luteinizinghormone,FLH)比较。结果:137例绝经后妇女中,63例CT图像上出现腹主动脉钙化,钙化率(incidencesofcalcifiedlesion,ICL)为45.9%,平均每位患者的平均钙化体积(meancalcifiedvolume,MCV)为(0.68±0.32)cm3。按绝经年限分组后,6～15年组和>16年组的ICL和MCV均明显大于绝经年限<5年组(ICL依次为50.8%,65.7%和21.4%;χ2分别为7.856和13.669,P分别为<0.02和0.01)。63例有钙化者按钙化体积分组后,体积大组(≥1.5cm3,21例)和体积小组(<1.5cm3,35例)的E2和T均明显低于无钙化组(74例),而前者的FSH和LH则明显高于后者(t=2.047～2.407,P均<0.05)。结论:绝经后妇女雌激素水平与动脉粥样硬化的发生和进展密切相关。     

巨细胞病毒感染与急性心肌梗死关系的研究

目的探讨巨细胞病毒(cytomegalovirus,CMV))感染与急性心肌梗死(acute myocardial infarction,AMI)之间的关系。方法采用酶联免疫法(ELISA)检测72例AMI患者与79例正常对照组血清中CMV抗体水平,同时检测两组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、可溶性血管细胞间黏附分子-1(sVCAM-1)、超敏C-反应蛋白(hsCRP)水平。结果AMI组巨细胞病素IgG抗体阳性率(61.11%)显著高于对照组(43.04%,P<0.05)。AMI组IL-6(69.08±108.29)、TNF-α(36.79±5.78)、sVCAM-1(30.03±25.86)、hsCRP(23.80±33.44)水平与对照组(22.91±17.37、2.11±3.32、5.53±5.37、2.10±1.79)比较差异有统计学意义(P<0.01)。结论CMV感染可能通过激发和加重冠状动脉内炎症反应,参与动脉粥样硬化、AMI的病理过程。     

绝经期妇女雌激素水平与常见身心症状的相关性

目的:调查唐山地区绝经期妇女常见身心症状严重程度与其绝经年限的关系,并比较不同雌激素水平绝经期妇女身心症状严重程度的差异。方法:选择2001-02/2005-02在唐山市妇幼保健院门诊体检的绝经期妇女267例,年龄42～55岁,平均(53±11)岁;绝经年限1～13年。均自愿接受量表调查测试。绝经年限<3年121例,3～8年67例,>8年79例。高雌二醇组94例(血清雌二醇≥100pmol/L)和低雌二醇组173例(血清雌二醇<100pmol/L);高睾酮组108例(血清睾酮≥30mmol/L)和低睾酮组159例(血清睾酮<30mmol/L);高促卵泡素组163例(血清促卵泡素≥30μg/L)和低促卵泡素组104例(血清促卵泡素<30μg/L);高促黄体生成素组155例(血清促黄体生成素≥40μg/L)和低促黄体生成素组112例(血清促黄体生成素<40μg/L)。①身心症状严重程度调查:采用绝经期妇女常见身心症状调查表该调查表共分14项内容:烦恼;情绪低落;皮肤感觉异常;头晕;注意力不集中;肢体凉;梦多易醒;腰背酸痛;疑病;疲倦乏力;耳鸣;易激动;入睡困难;记忆力减退。每个项目根据无、轻、重评分为0～2分。严重程度总分:14个单项分总和为严重程度总分。严重程度总均分:严重程度总分/14。②实验室指标检测:血清雌二醇、睾酮、促卵泡素和促黄体生成素采用放射免疫分析测定。③组间显著性测定:用t检验完成。结果:绝经期妇女267例均进入结果分析,并完成量表调查。①绝经期妇女267例常见身心症状发生率:最高的为疲倦乏力,占79.8%,情绪低落次之,占78.2%,梦多易醒发生率最低,占24.3%。②绝经年限与常见身心症状程度评分关系:绝经年限<3年组的严重程度平均总分和每项严重程度平均分均明显高于3～8年和>8年组(t=2.210～2.365,P<0.05)。③雌二醇、睾酮浓度与常见身心症状程度评分:低雌二醇组和高睾酮组的严重程度平均总分和每项严重程度平均分明显高于高雌二醇组和低睾酮组(t=2.294～2.879,P<0.05)。④促卵泡素和促黄体生成素浓度与常见身心症状严重程度评分:高促卵泡素组和高促黄体生成素组的严重程度平均总分和每项严重程度平均分均明显高于低促卵泡素组和低促黄体生成素组(t=2.250～2.794,P<0.05)。结论:绝经期妇女身心症状以疲倦乏力最多见;绝经年限短、血清雌二醇浓度低和睾酮、促卵泡素和促黄体生成素浓度高的绝经期妇女身心症状。     

单纯疱疹病毒感染与急性心肌梗死关系的研究

目的 探讨单纯疱疹病毒(HSV)感染与急性心肌梗死之间的关系.方法 采用ELISA方法检测72例急性心肌梗死患者与79例正常对照组血清中HSV-1及HSV-2抗体水平,同时检测两组的IL-6(pg/ml)、TNF-α(pg/ml)、sV-CAM-1(nmol/L)、hsCRP(mg/L)水平;并进行冠心病危险因素调查.结果 急性心肌梗死组HSV-1 IgG抗体阳性率(73.61%)、HSV-2 IgG抗体阳性率(58.33%)显著高于对照组(39.24%,36.71%;P＜0.01,P＜0.05).急性心肌梗死组IL-6(69.08±108.29)、TNF-α(36.79±5.78)、sVCAM-1(30.03±25.86)、hsCRP(23.80±33.44)水平与对照组(22.91±17.37,2.11±3.32,5.53±5.37,2.10±1.79)比较差异有统计学意义(P＜0.01).调整冠心病危险因素前后,HSV-1和HSV-2 IgG抗体阳性率均与急性心肌梗死有相关性(分别HSV-1OR1=4.4,P=0.01;OR2=4.8,P=0.001;OR3=3.5,P=0.012.HSV-2OR1=2.2,P=0.001;OR2=3.5,P=0.006;OR3=3.3,P=0.009).结论 HSV 感染可能通过激发和加重冠状动脉内炎症反应,参与动脉粥样硬化、急性心肌梗死的病理过程.     

Nitric oxide synthesis in patients with myocardial infarction

The findings of the author demonstrate that the system of nitric oxide (NO) generation and metabolism is an element of multicomponent response of the organism to myocardial infarction (MI). This response consists in MI patients' systemic ability and, in particular, their peripheral blood mononuclears' ability to produce NO as well as the absence of iNOS activation in peripheral blood of MI patients. It is important for a practitioner to understand that a fall in the urine and plasma concentration of NO metabolism end product reflects low activity of NO generation while NO is a powerful regulatory factor in the cardiovascular system. Thus, low levels of NO and its metabolites in the urine and plasma of MI patients indicate depletion of compensatory coronarodilatating potential and, eventually, poor prognosis. Relevant measurements will provide additional parameters in assessment of body reserves in MI patients and in MI prognosis within the first hours of its onset.     

雌激素受体与绝经后骨质疏松症

检索Pubmed数据库和中国期刊全文数据库文献，总结雌激素受体与绝经后骨质疏松症的关系。雌激素受体以雌激素受体α和雌激素受体β两种亚型广泛存在于人体内。雌激素根据其结合的受体亚型，选择性激活细胞内信号传导途径，表现出多种生物学活性。雌激素对骨吸收的调控作用是通过某些细胞因子的介导和直接对破骨细胞作用完成的。近年来对选择性雌激素受体调节剂对两种不同受体亚型的特异性作用的研究已成为热点。     

The differential association of conjugated equine estrogen and esterified estrogen with activated protein C resistance in postmenopausal women

OBJECTIVES: Clinical trials have demonstrated that oral conjugated equine estrogen (CEE) therapy with or without medroxyprogesterone (MPA) increases venous thrombotic risk but this safety issue has not been investigated for other oral estrogens. Based on observational study findings that esterified estrogen (EE) was not associated with venous thrombotic risk whereas CEE was, we hypothesized that CEE users would be more resistant to activated protein C (APC), a prothrombotic phenotype, than EE users. METHODS: We conducted an observational, cross-sectional study of postmenopausal women 30-89 years old who were controls in a case-control study of venous thrombosis. Use of CEE, EE, and MPA at the time of phlebotomy was determined using computerized pharmacy records. APC resistance was measured in plasma by the endogenous thrombin potential normalized APC sensitivity ratio. Adjusted mean APC resistance values were compared across estrogen type and CEE:EE ratios are presented. RESULTS: There were 119 CEE and 92 EE users at the time of phlebotomy. Compared with EE users, CEE users had APC resistance measures that were 52% higher (1.52; 95% confidence intervals: 1.07-2.17) in adjusted analyses. Restricting to modal dose users (0.625 mg) and stratifying by MPA use did not materially change associations. CONCLUSIONS: CEE use was associated with higher levels of APC resistance when compared with EE use in postmenopausal women. These findings might provide an explanation for the higher risk of venous thromboembolism previously observed with CEE compared with EE use and, if replicated, may have safety implications for women when choosing an estrogen for symptom relief.     

Relation between the duration of cardiac pain and the state of the coronary vessels in patients with acute myocardial infarction

The study compared specific characteristics of cardiac pain syndrome with coronary arteriography findings for 100 patients in acute period of myocardial infarction. The evidence obtained suggests that duration of cardiac pain does not depend on the type of obstruction in the infarction-related coronary artery. Long-standing radiating pain occurred in affected anterior interventricular branch. The pain seems related to total asynergia severity and the lesion of coronary bed. Neuroleptanalgesia induced more continuous anesthesia in patients with infarction-related circumflex branch and anterior coronary artery while its effect reduced in ++multi-vascular affection of the coronary bed. No relapses of pain syndrome were recorded in responders to intracoronary thrombolytic therapy.     

Acute myocardial infarction in women.

Although CHD is the leading cause of death in women, little is known about their response to and recovery from an acute MI. The medical and nursing care offered to women following an MI is based primarily on research studies of men. Few studies have included only women, and those that have compared women and men are limited by sample sizes that are too small for meaningful comparisons and study variables that reflect men's concerns (e.g., specific risk factors or return to work issues). Women's cardiovascular anatomy and physiology differ somewhat from men's. Women average smaller chests, hearts, and coronary artery vessel diameters and different body fat distributions. Their cardiovascular systems are designed to adapt to the extraordinary demands of pregnancy and childbirth and do so by modifying diastolic, rather than systolic, function. Similar physiologic changes are often seen in response to exercise. Women's higher levels of estrogen and progesterone influence lipid metabolism and hormone receptor activity. Thus, diagnostic tests that are based on research with men (e.g., ECGs and exercise stress tests), show more false-positive and false-negative results in women. Additionally, therapeutic interventions (e.g., PTCA and CABG) that were developed for men have been less effective for women. CHD is apparently expressed differently in women. Diabetes mellitus is a strong, independent risk factor for CHD in women and results in a risk similar to that of nondiabetic men. More women present with angina as an initial manifestation of CHD than with MI and rarely have sudden cardiac death. Women experience more complications than men and a higher mortality following acute MI. They derive less benefit from medical or surgical therapy and experience more side effects. Many aspects of women's response to acute MI reflect gender rather than biologic differences. Women's worlds, the sociocultural contexts within which they live, and their activities are qualitatively different from men's. The nursing care offered to women should be based on sound scientific rationale that responds to these unique experiences and concerns.     

Priming effect of misoprostol on estrogen pretreated cervix in postmenopausal women

Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 +/- 0.7 and 3.7 +/- 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 +/- 16.2 seconds for the estrogen group and 61.4 +/- 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women.     

绝经后女性脑梗死患者垂体促性腺激素及性激素变化的研究

目的探讨绝经后女性脑梗死患者血清垂体促性腺激素和性激素的变化特点及意义。方法采用放射免疫法动态测定110例绝经后女性脑梗死患者血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）及睾酮（T）的水平，分析其与病程、病情、梗死部位、梗死灶数量及梗死范围的关系。结果绝经后女性脑梗死患者急性期血清FSH、LH、E，水平下降，T升高，与恢复期及正常对照组比较差异均有显著性（均为P〈0．01）；恢复期与正常对照组比较差异无显著性（P〉0.05）。急性期中、重型组血清FSH、E2、T水平均明显高于轻型组（均为P〈0．05）。结论绝经后女性脑梗死患者急性期存在垂体促性腺激素、性激素水平的紊乱，其随着疾病的恢复逐渐趋于正常，且这种紊乱不受梗死部位、梗死灶数量及梗死范围的影响，而与病情程度密切相关。     

雌激素对绝经后妇女血管内皮功能的作用

1998年3月一1998年7月对20例绝经后妇女服用17-B-雌二醇后测定血管内皮因子的变化,报告如下。l对象与方法1．1对象年龄55－68岁,平均（61＋17）岁。入选标准：①绝经后妇女卵巢切除的患者且停经＞l年;②雌激素＜40Pg／L,促卵泡生成素＞40IU／L;③未接受雌激素或其它激素治疗。并排除先心病、肺心病、风心病、心肌梗死及严重肝、肾功能损害者。1．2方法1．2．1实验设计及用药全组患者入院后常规治疗,口服17卡一雌H醇［诺更宁,诺和诺德（天津）生物技术有限公司提供］前3天,停用一切药物（若有心绞痛发作,可合化硝酸甘油）8：OO…     

雌激素替代治疗对绝经后妇女内皮功能的影响

目的观察雌激素替代治疗(ERT)对绝经后妇女内皮功能的影响。方法绝经组妇女32例每天口服结合雌二醇0.625mg,共两周;同期24名正常月经妇女为对照组。分别采集绝经组妇女服药前后和对照组妇女空腹静脉血标本测雌二醇(E2)、一氧化氮(NO)水平,并采用无创性高分辨超声法检测内皮依赖性血管舒张功能。结果绝经组ERT前血流介导的血管舒张(FMD)、NO及E2明显低于对照组(P<0.05),ERT后显著增加(P<0.05),而硝酸甘油介导的血管舒张(NMD)治疗前后差异无显著性意义;FMD与E2、NO相关(P<0.001),而NMD与NO、E2均无相关性(P>0.05)。结论女性绝经后存在显著的内皮依赖性血管舒张功能异常,进行雌激素替代治疗可明显改善甚至逆转上述变化,该作用可能是雌激素的心血管保护机制之一。