激素补充治疗对绝经后妇女血液流变学的影响

目的探讨不同剂量结合雌激素(倍美力)配伍安宫黄体酮(MPA)的连续联合方案对绝经后妇女血液流变学的影响,以便更合理地为绝经后妇女的激素补充治疗提供指导和咨询.方法将60例绝经1～4年的健康妇女随机分为3组,A、B组分别口服结合雌激素0.625mg/d或0.3mg/d配伍MPA2mg/d,加复方碳酸钙(钙尔奇-D)600mg/d;C组口服复方碳酸钙600mg/d,为期半年,对比3组用药前、后以及用药后各组间血液流变学各项指标的变化.结果治疗前3组血液流变学各项指标比较,差异无显著性(P＞0.05).用药后,A组的全血高切粘度从(5.23±0.37)毫帕@秒(mPa@s)降至(5.03±0.43)mPa@s(P＜0.05),血浆粘度从(1.66±0.19)mPa@s降至(1.58±0.15)mPa@s(P＜0.05),红细胞变形能力从(4.76±0.32)mPa@s降至(4.54±0.34)mPa@s(P＜0.05),有明显改善.B组全血高切粘度从(5.10±0.30)mPa@s降至(4.87±0.30)mPa@s(P＜0.05),红细胞变形能力从(4.65±0.34)mPa@s降至(4.43±0.29)mPa@s(P＜0.05),也有明显改善.C组各项指标无明显变化.治疗后,A组血浆粘度及纤维蛋白原水平低于C组(P＜0.05);B组全血高切粘度、全血低切粘度及血浆粘度低于C组(P＜0.05).血栓弹力图于治疗前及治疗后各组间比较及治疗前后自身对比,差异无显著性(P＞0.05).结论两种剂量结合雌激素配伍MPA连续联合方案,均可降低血浆粘度、提高红细胞变形能力、改善微循环.

Effect of hormone replacement therapy on hemorheology in postmemopausal women

OBJECTIVE: Our study is to observe the effects of conjugated equine estrogen (CEE) combined with medroxyprogesterone acetate (MPA) on hemorheology in postmenopausal women in order to evaluate mechanism responsible for the increase in the incidence of cardiovascular disease after menopause and also to provide proper instruction and advice of hormone replacement therapy (HRT) for postmenopausal women. METHODS: 60 healthy postmenopausal women were assigned to 3 groups randomly, 20 cases in each group. Group A: CEE 0.625 mg/d + MPA 2 mg/d + calcium carbonate co. (Ca-D) 600 mg/d. Group B: CEE 0.3 mg/d + MPA 2 mg/d + Ca-D 600 mg/d. Group C: Ca-D 600 mg/d only served as control. Measurements of hemorheological parameters were performed before and 6 months after treatment. RESULTS: After 6 months of HRT, group A: blood viscosity under the shear rate of 94.5 s-1 dropped from (5.23 +/- 0.37) mPa.s to (5.03 +/- 0.43) mPa.s (P < 0.05), plasma viscosity dropped from (1.66 +/- 0.19) mPa.s to (1.58 +/- 0.15) mPa.s (P < 0.05), erythrocyte deformability dropped from (4.76 +/- 0.32) mPa.s to (4.54 +/- 0.34) mPa.s (P < 0.05). Group B: blood viscosity under the shear rate of 94.5 s-1 dropped from (5.10 +/- 0.30) mPa.s to (4.87 +/- 0.30) mPa.s (P < 0.05), erythrocyte deformability dropped from (4.65 +/- 0.34) mPa.s to (4.43 +/- 0.29) mPa.s (P < 0.05). No change was found in the control group. After treatment, the levels of plasma viscosity and fibrinogen in group A were much lower than that in group C (P < 0.05). The whole blood viscosity and plasma viscosity in group B were much lower than that in group C (P < 0.05). Thrombelastogram study demonstrated no change regardless HRT or not (P > 0.05). CONCLUSION: Both different dosages of CEE have favor effects on blood viscosity and erythrocyte deformabillity, which could play the role in preventing cardiovascular disease in postmenopausal women.