辛伐他汀、雌孕激素替代治疗对绝经后高脂血症妇女血脂和C-反应蛋白的影响

绝经后妇女随着性腺功能的减退,常出现高脂血症,使其患冠心病的危险性增加。雌孕激素替代治疗通过调节血脂代谢,使心血管疾病的发生率下降35%~50%[1]。干预研究表明,羟甲戊二酰辅酶A(HMG-CoA)还原酶抑制剂通过降低高脂血症患者的总胆固醇、低密度脂蛋白,从而减少冠心病的发生。     

雌激素对绝经妇女脂质代谢的影响

本文了绝经后妇女因体内雌激素水平降低，导致血清脂蛋白水平随之发生一些不利于该类妇女心血管系统的变化。雌激素替代治疗后可使绝经后升高的总胆固醇和ＬＤＬ－Ｃ水平降低￣１９％，Ｌｐ（ａ）水平降低１４％￣５０％，减轻或抑制ＬＤＬ的氧化过程并减轻氧化的ＬＤＬ对细胞的毒性作用，还能使降低的ＨＤＬ－Ｃ水平升高９％￣２０％，脂质代谢的这些变化可使绝经后妇女冠心病的发病率和病死率降低。对雌激素给药的途径，单有升与孕     

雌激素替代治疗对绝经后冠心病妇女血脂和胰岛素抵抗的影响

目的 :观察雌激素替代治疗对绝经后冠心病 （CHD）妇女血脂谱和胰岛素抵抗的改善作用。方法 :对确诊为CHD的绝经后妇女 ,口服尼尔雌醇 2 m g/2周 ,治疗 6个月。分别于治疗前后测定血糖、胰岛素 （INS）、性激素结合球蛋白 （SHBG）、促卵泡素 （FSH）、黄体生成素 （L H）、雌二醇 （E2 ）、总胆固醇 （T- CH）、甘油三酯 （TG）、高密度脂蛋白胆固醇 （HDL- C）、低密度脂蛋白胆固醇 （L DL- C）等 ,并计算胰岛素敏感指数 （SI）。结果 :雌激素替代后 ,CHD患者的 FSH,L H,T- CH,TG,L DL- C,INS明显下降 ;而 E2 ,SHBG,HDL- C,SI明显升高。结论 :雌激素替代治疗能改善 CHD患者血脂谱紊乱和胰岛素抵抗     

雌激素替代疗法对绝经后冠心病患者及正常妇女的影响

目的观察雌激素治疗绝经后冠心病患及正常妇女体内血脂、血小板聚集率、氧自由基及纤溶活性变化。方法选５３例绝经后妇女冠心病患为冠心病组,４２例绝经后健康妇女为正常对照组,每组病例再单盲随机分为治疗组和安慰剂组,治疗组予尼尔雌醇（每月４ｍｇ／次）治疗６个月,安慰剂组予安慰剂治疗,观察治疗前后患雌激素水平及血脂各项指标、血小板聚集率、氧自由基和纤溶活性变化。结果冠心病组雌激素水平低于正常对照组（Ｐ＜     

对绝经后妇女冠心病雌激素替代治疗的新认识

长期以来人们相信雌激素对绝经期妇女心血管的保护作用,然而1998年年和2000年先后发表的大型随机循证临床试验HERS和ERA结果令人失望。2000年ACC会议建议患冠心病的绝经期妇女用激素替代疗法作为二级预防是不适宜的,但已经接受激素治疗的妇女继续应用激素还是可取的。     

小剂量尼尔雌醇对绝经后妇女脂蛋白(a)和血脂的调脂疗效

目的 :观察小剂量、长效尼尔雌醇对绝经后妇女脂蛋白 (a)〔 Lp(a)〕和血脂的影响。方法 :选择绝经 2年以上的妇女 54例 ,随机分为治疗组和对照组。治疗组每月服尼尔雌醇 1次 ,每次 2mg。结果 :治疗组 3个月后 HDL- C、apo- AI明显升高 ,LDL- C降低 ,Lp(a)治疗半年后开始下降 ,治疗 9个月后与对照组相比有显著性差异 ,1年后降低仍较显著 ,TC、TG无明显改变。对照组前后无明显改变。结论 :尼尔雌醇副作用轻 ,同时减轻绝经期妇女的更年期综合征症状。对高 Lp(a)、高LDL- C或者低 HDL- C水平的绝经妇女可作为最初单一预防冠心病的药物使用     

雌激素替代疗法对绝经后妇女血管内皮功能的影响

雌激素可抑制妇女冠状动脉粥样硬化性心脏病的发生 ,并可致血管阻力的降低。雌激素产生这些效应的机制不明。而内皮细胞功能障碍 ,即内皮细胞产生和释放一氧化氮 (ＮＯ)、内皮素(ＥＴ)、前列环素 (ＰＧＩ2 )、血栓素 (ＴＸＡ2 )平衡失调 ,被认为是动脉粥样硬化形成的始动因素和中心环节。本研究旨在观察雌激素替代疗法对绝经后妇女血管内皮功能的影响。对象和方法　　 1 对象　　选择门诊未经治疗的绝经 1年以上妇女 10 8例 ,经仔细病史询问及体格检表 1　治疗前后血液生化指标的变化生化指标 ＴＣ(ｍｍｏｌ/Ｌ)ＴＧ(ｍｍｏｌ/Ｌ)ＬＤＬ ｃ…     

雌孕激素替代治疗与绝经后老年女性结肠直肠癌间关系

妇女健康创议(WHI)研究证实，绝经后女性接受雌孕激素替代治疗将弊大于利，尽管雌孕激素替代治疗可能与绝经后女性罹患结肠直肠癌风险降低有关。本文意就接受雌孕激素替代治疗与绝经后老年女性新发结肠直肠癌危险以及肿瘤相关特征间关系进行了分析。     

雌激素替代治疗对绝经后妇女冠心病血糖、血脂等的影响

目的：探讨雌激素对血糖、血胰岛素及血脂的影响。方法：对绝经后女性冠心病（CHD）60例，正常对照组30例做75g糖耐量试验，测空腹、餐后1．2小时血糖，血胰岛素（INS）及血脂（ISI），计算胰岛素敏感指数。CHD 组给予利维受（每片含7－甲异炔诺酮2.5mg）治疗12周，然后重复上述各项目检测。结果：与对照组相比，CHD组血糖、INS及ISI均有显性差异（P＜0．001）。利维爱治疗后，血糖、INS、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B较治疗前降低，而ISI、高密度脂蛋白胆固醇、载脂蛋白A水平升高，治疗前、后有显性差异（P＜0．001）。结论：雌激素替代治疗可以降低绝经后CHD患的血糖、INS水平，降低胰岛素抵抗（IR），纠正脂质代谢紊乱。     

雌激素替代治疗对绝经妇女血脂血压及体质量指数影响

目的探讨尼尔雌醇联合小剂量安宫黄体酮(MPA)替代治疗对绝经妇女血脂、血压及体质量指数的影响. 方法 78例45～56岁的绝经妇女随机分为治疗组及对照组,观察时间1年,其中56例资料完整,治疗组29例,对照组27例.治疗组每15d服尼尔雌醇2mg,每月服MPA 4mg×10d,对照组服安慰剂,所有入选者分别于服药前、服药后3月、6月、12月检测血脂、血压及体质量指数. 结果服药3月后血HDL-C(1.74±0.45)mmol·L-1、Apo AⅠ(1.37±0.29)mmol·L-1、TG(1.79±0.38)mmol·L-1明显升高,LDL-C(2.57±0.63)mmol·L-1显著降低,持续用药6月后舒张压(73.87±7.81)mmHg明显降低,治疗组与用药前及对照组比较差异有显著性意义(P＜0.05). 结论尼尔雌醇加小剂量MPA对绝经妇女心血管系统有保护作用.     

雌激素替代疗法对绝经后妇女血清血管 紧张素转化酶及血脂代谢的影响

目的　探讨雌激素替代疗法 (ERT)对绝经后妇女血清血管紧张素转化酶 (ACE)含量及血脂代谢的影响。方法　测定 30例健康绝经后妇女应用ERT(治疗组 )前及应用ERT 14周后血清ACE、雌二醇 (E2 )及血清甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、脂蛋白 (a) [Lp(a) ]含量 ,并与 30例健康绝经后妇女应用安慰剂 (对照组 )进行对照。结果　对照组应用安慰剂前后 ,ACE及血脂各项含量无变化 ;治疗组应用ERT后 ,ACE含量明显降低且与E2 呈负相关 ,血清TC、LDL C及Lp(a)含量降低 ,HDL C含量升高 ,TG无变化。结论　绝经后妇女补充雌激素 ,可通过降低血清ACE水平及改善血脂代谢共同发挥对心血管系统的保护作用。     

雌激素替代治疗对绝经后女性血脂代谢及血浆内皮素的影响

目的 探讨雌激素替代治疗(ERT)对绝经妇女血脂及血浆内皮素的影响。方法 选择自然停经妇女60例,其中30例用ERT,另30例用安慰剂治疗30天。治疗前后均检测促卵泡激素(FSH)、雌二醇(E_2)、孕酮(P)、睾酮(T)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及血浆内皮素-1(ET-1)。结果 ERT组妇女血清E_2水平较治疗前明显升高,P、T水平无明显变化,TC、TG及LDL-C下降,HDL-C升高,ET-1水平显著下降;安慰剂组妇女上述指标均无显著变化。线性相关分析显示:绝经妇女E_2与TC、TG、LDL-C及ET-1负相关,与HDL-C正相关;TC与ET-1明显正相关。结论 ERT能改善绝经妇女血脂代谢和降低其血浆内皮素-1水平。两者相互促进和补充,从而发挥心血管保护作用。     

Effect of estrogen-progestin replacement therapy on plasma lipids and lipoproteins in postmenopausal women

Serum levels of cholesterol (Chol), triglycerides (TG), low-density lipoprotein cholesterol (LDL) high-density lipoprotein cholesterol (HDL), both apolipoproteins A1 and B (Apo A1, Apo B), follicle-stimulating hormone (FSH) luteinizing hormone (LH), estradiol (E2), progesterone (P), testosterone (T) and steroid hormone binding globulin (SHBG) were measured in postmenopausal women, before and after four different estrogen-progestin replacement therapies. Each woman was her own control to avoid genetic or socioeconomic differences. Our results showed that serum E2 and TG significantly increased and serum FSH, LH, LDH, Apo B, and Chol significantly decreased after all treatments. Serum P and T did not significantly change after any of the treatments. HDL, Apo A1 and SHBG significantly increased in the groups treated with medroxiprogesterone acetate (MPA) but not in the group treated with Norgestrel. We conclude that estrogen-progestin replacement therapy in postmenopausal women leads to profound and beneficial changes in plasma lipids and lipoproteins and that treatments with cyclic or continuous MPA could provide greater protection against coronary heart disease (CHD).     

雌激素对绝经后妇女冠心病治疗作用的观察

目的探索雌激素对绝经后妇女冠心病的防治机制及疗效。方法将１０８例绝经１年以上的女性冠心病患者随机分为三组（各３６例），甲组口服结合雌激素（倍美力）０．６２５ｍｇ１／ｄ，乙组口服７甲基异炔诺酮（利维爱）２．５ｍｇ１／ｄ，丙组口服安慰剂１片１／ｄ，于服药前及服药后第３、６个月末检测血脂谱及ＥＣＧ，并记录心绞痛发作情况。结果倍美力治疗后可使胆固醇（ＴＣ）降低１２．８％，甘油三酯（ＴＧ）降低１７．０％，低密度脂蛋白胆固醇（ＬＤＬＣ）降低２９．０％，高密度脂蛋白胆固醇（ＨＤＬＣ）上升１４６％。利维爱治疗后ＴＣ降低８．７％，ＴＧ降低１５．６～３３．８％、ＨＤＬＣ降低１９．７～２８．３％（Ｐ值均＜００１），ＬＤＬＣ无显著变化。倍美力及利维爱治疗第３、６个月后对心绞痛症状的总有效率分别为９０９％、９３５％和８３．３％和９３．１％，对ＥＣＧ缺血性改变的总有效率分别为７６．７％、８２．１％和７８．６％、８１４％，两种药物对妇女冠心病的心肌缺血疗效差异无显著性（Ｐ＞０．０５）。结论雌激素替代治疗可显著改善绝经后妇女冠心病患者的异常血脂及心肌缺血     

The effect of tibolone on the lipoprotein profile of postmenopausal women with type III hyperlipoproteinemia

OBJECTIVE: To investigate the short-term effect of treatment with tibolone on plasma lipid and lipoprotein levels in postmenopausal women with type III hyperlipoproteinemia (HLP). DESIGN AND INTERVENTION: Patients were randomized to receive, in a double-blind cross-over fashion, a fixed dose of tibolone, 2.5 mg once daily or placebo for 8 weeks. The two treatment periods were separated by a wash-out period of 6 weeks. At each visit body weight and blood pressure were determined. Before and after each treatment period, fasting venous blood samples were obtained from the patients for biochemical measurements. SETTING: The Leiden University Medical Center. SUBJECTS: Postmenopausal women with type III HLP (aged < or = 65 years) were recruited from the Lipid Clinics of the Leiden University Medical Center, the Amsterdam Medical Center, the Utrecht Medical Center and the University Hospital Rotterdam. Five out of 25 women with type III HLP were eligible to be included in the study. Four of the five included patients completed the study according to the protocol. One patient was excluded from blinded therapy because total cholesterol levels increased above 20 mmol L(-1). MAIN OUTCOME MEASURES: A significant reduction of plasma triglyceride, total cholesterol, VLDL cholesterol and VLDL triglyceride levels. RESULTS: Plasma triglyceride and total cholesterol levels decreased from 6.82 +/- 3.58 to 2.45 +/- 1.36 mmol L(-1) and from 13.53 +/- 3.64 to 6.61 +/- 2.03 mmol L(-1), respectively (both P < 0.05). The body mass index remained unchanged. The glycated haemoglobin percentage decreased significantly from 5.8 to 5.3%. Treatment with tibolone resulted in a profound reduction in plasma apolipoprotein E, VLDL cholesterol and VLDL triglyceride levels (mean reductions of 66, 77 and 70%, respectively, P < 0.05). CONCLUSIONS: Tibolone is a valuable adjuvant to current therapy in postmenopausal women with type III HLP.     

激素替代治疗与绝经后妇女心血管疾病的关系

在绝经前,女性发生心血管疾病的危险性较低,然而,伴随着更年期的到来,女性心血管疾病的发病率明显升高,激素替代治疗随之成为临床上预防心血管疾病的热点话题.激素替代治疗在预防绝经妇女心血管疾病方面的研究.结果 并不一致,其预防效果在一定程度上取决于接受治疗者个体情况的差异.因此,激素替代治疗应当注意用药的时间、用药的个体化...     

Sequential estrogen-progestin replacement therapy in healthy postmenopausal women: effects on cholesterol efflux capacity and key proteins regulating high-density lipoprotein levels

Thirty healthy postmenopausal women were randomized into 2 groups that received a sequential combined hormone-replacement therapy (HRT) (n = 18; conjugated equine estrogen 0.625 mg/d for 28 days and 5 mg of medroxyprogesterone acetate during the last 14 days) or placebo (n = 12). Plasma samples were collected before and during treatment (days 0, 15, 43, 71). High-density lipoprotein (HDL) lipid content, lipoprotein (Lp)A-I and LpA-I:LpA-II concentration, lecithin:cholesterol acyl transferase activity (LCAT), phospholipid transfer protein (PLTP) activity, and the plasma capacity to carry out cholesterol efflux from Fu5AH cells were measured. Most significant changes were found within the first 15 days after HRT. After 71 days of HRT, we found an increase in LpA-I lipoparticles (27%) and the following HDL lipids: phospholipids (21%), triglycerides (45%), and free cholesterol (43%), as well as an increase in cholesterol efflux (12.5%). PLTP activity, on the other hand, decreased 21% after 71 days of treatment. No significant changes in LCAT activity, HDL-cholesterol ester or LpA-I:LpA-II particles were found. Positive correlation between cholesterol efflux and the variables LpA-I and HDL-phospholipids were observed. PLTP was negatively correlated with apolipoprotein (apo) A-I, LpA-I, and LpA-I:LpA-II. In summary, our study, performed during 3 hormonal cycles, shows that HRT not only modifies HDL-cholesterol level, but also its lipid composition and HDL lipoparticle distribution. HRT enhances the plasma capacity to carry out cholesterol efflux from the Fu5AH system and decreases the activity of PLTP, a key protein regulating HDL levels. Considering the protocol sampling, these results represent mainly the estrogenic effect of HRT.     

雌激素替代治疗对绝经后妇女冠心病者血脂代谢及抗氧化作用的研究

对32例绝经后妇女（PMW）冠心病患者（CHD组）进行雌激素替代治疗（ERT），以观察对其血脂代谢及机体抗氧化水平的影响。另选取绝经后健康妇女30例为对照组。CHD组口服尼尔雌醇（CEE3）每月2次，每次2mg，连用6个月，分别于用药前、用药后3个月及6个月检测总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL－C）、低密度脂蛋白胆固醇（LDL－C）、脂蛋白（a）［LP（a）］、氧化修饰低密度脂蛋白（Ox－LDL）、丙二醛（MDA）及超氧化物歧化酶（SOD）。结果表明ERT前CHD组与对照组比较LP（a）、Ox－LDL及MDA水平明显升高（P＜0．05），而SOD总活力显著降低；CHD组于ERT后TC无明显变化，TG呈升高趋势（P＞0.05），而LDL-C、TC／HDL－C和LDL－C／HDL－C显著下降（P＜0．01），LP（a）也明显降低（P＜0．05），而HDL－C显著上升（P＜0．01）；血浆Ox－LDL、血清MDA显著下降（P＜0．01），血清SOD总活力明显上升（P＜0．05），提示ERT不仅能显著改善PMW之CHD患者血脂紊乱，而且能有效地提高机体抗氧化水平。     

Successful treatment of hepatic sarcoidosis with hormone replacement in a postmenopausal woman

A possible supplementary effect of sex hormone replacement therapy (HRT) for the postmenopausal woman with sarcoidosis is described. A 53-year-old woman presented with a 12-year history of sarcoidosis in the eyes, in the submandibular lymph nodes and in the lungs. In the course of follow up without any medication, her liver function tests were abnormal, and she was diagnosed as having hepatic sarcoidosis. Daily administration of 0.625 mg conjugated oestrogen and 2.5 mg medroxyprogesterone improved her liver function. The results suggest that HRT may help to prevent the progression of sarcoidosis in postmenopausal patients.