雌激素对绝经后冠心病妇女糖、脂代谢和内皮功能的调节作用

目的 研究雌激素替代治疗(ERT)对绝经后妇女冠心病(CHD)患者血糖、胰岛素、血脂、血浆一氧化氮(NO)、内皮素(ET-1)及前列环素(PGI2)的影响,探讨雌激素对心血管的保护效应。方法 58例绝经后妇女CHD患者随机分为治疗组和安慰剂组,治疗组每天给予病人服用克龄蒙(含戊酸雌二醇2mg,第1-12天服;戊酸雌二醇2mg和醋酸环丙孕酮1mg,第13-22天服)1片,安慰剂组每天给予安慰剂1片,观察治疗6个月后血糖、胰岛素、胰岛索敏感性指标、血脂、血浆NO、ET-1及PGI2的变化。结果 治疗组血糖、总胆固醇、低密度脂蛋白显著降低(P<0.05),胰岛素水平、ET-1显著降低(P<0.01),胰岛素敏感性指标、NO、NO/ET-1及PGI2水平显著升高(P<0.01),安慰剂组则变化不明显。结论 ERT能改善绝经后妇女冠心病患者糖代谢、脂代谢及血管内皮功能,可能有助于绝经后妇女CHD的二级预防。

The effect of estrogen on glucose and lipid metabolism and vascular endothelium function in postmenopausal women with coronary artery disease

Objietive To investigate the changes of intravenous glucose, insulin ,blood lipids, nitric oxide, endothe-lin-1 and prostacyclin in postmenopausal women with coronary artery disease after received estrogen replacement therapy(ERT) and study its benifit effects for cardiovasular system. Methods 58 coronary artery disease patients of postmenopausal women were randomly divided into treatment and placebo groups, received 1 tablet of Climen (2mg valeric acid estradiol on days 1-12 and 2mg estradiol plus 1mg horethisterone acetate on days 13-22)and placebo respectivly. Introvenous glucose, insulin, insulin sensitivity index, nitric oxide, endothelin-1 and prostacyclin were dectected at basline and after 6 months of ERT. Results Introvenous glucose and insulin were significantly decreased from the basline 5. 35±0. 35 to 4. 62±0. 13mmol/LCP<0. 05) and 22. 78±4. 32 to 12. 65±1. 36 mmol/L(P<0. 01). Total cholesterol and low density lipoprotein-cholesterol are significantly decreased from the basline 4. 94±1. 08 to 4. 26±0. 82mmol/L(P<0. 05)and3. 56±1. 15 to 2. 91±0. 77mmol/L (P<0. 05)and en-dothelium-1 from 20. 14±4. 75 to 18. 65±5. 64(P<0. 01). Insulin sensitivity index were significantly increased from the basline 0. 022±0. 005 to 0. 045±0. 002mmol/ml (P<0. 01), nitric oxide and prostacyclin were significantly increased from 26. 59±6. 96 to29. 29±8. 9 and 1. 87±0. 67 to 2. 88±0. 83 (P<0. 01) respectively and nitric oxide to endothelium-1 ratio from 1. 41±0. 39 tol. 75±0. 65 (P<0. 01). Conclusion ERT results in the improvements of glucose and lipid metabolism and vascular endothelium function which maybe provides second prevention benefit for cardiovascular diseases.