17-β雌二醇对马来酸甲基麦角新碱所致绝经期女性冠状动脉血管收缩反应的影响

背景：雌激素对心血管系统有许多有利的影响，其中非血管内皮依赖性影响仅仅在体外被证实，而在体内则尚无明确证据。本研究目的是在16例绝经期冠心病女性中评价17-β雌二醇急性给药对甲基麦角新碱所致冠状动脉反应的影响。方法：16例绝经期冠心病女性患者接受冠状动脉内给予17-β雌二醇（20μg／L，1ml／min，共20min；8例）或安慰剂（5％葡萄糖，1ml／min；8例）之前和之后20min，分别在静息状态下和冠状动脉内递增剂量给予甲基麦角新碱（2μg、10μg、30μg）后行冠状动脉血管造影。     

Effect of estradiol 17beta upon coronary artery vasoconstrictor response to methylergometrine maleate in female menopausal patients

BACKGROUND: Estrogens produce several beneficial effects upon the cardiovascular system. Amongst these, an endothelium-independent effect has been convincingly demonstrated only in vitro, while there is no evidence for such an effect in vivo. The aim of the present study was to evaluate the effect of acute administration of estradiol 17beta upon coronary artery reactivity to methylergometrine in 16 menopausal patients with coronary artery disease. METHODS: Sixteen menopausal patients underwent coronary angiography at rest and after incremental doses of methylergometrine (intracoronary 2, 10, 30 microg) before and 20 min after either intracoronary estradiol 17beta (20 ng/mL at 1 mL/min for 20 min; 8 patients) or placebo (Dextrose 5%, 1 mL/min; 8 patients). RESULTS AND CONCLUSIONS: No significant differences were observed in baseline coronary artery diameter or area between the 2 groups. No significant differences in the degree of coronary artery constriction were observed after either estradiol 17beta or placebo at submaximal doses of methylergometrine. However, the degree of coronary artery constriction after maximal doses of methylergometrine was significantly attenuated by estradiol 17beta compared to placebo (change in diameter: -0.9+/-4.5% vs. -19+/-6%, p<0.001; change in area: -3.2+/-9% vs. -32.2+/-10%, p<0.001). Estradiol 17beta reduces coronary artery constriction following methylergometrine administration in menopausal patients with coronary artery disease. This effect may be related to the calcium-antagonist properties of the ovarian hormone.