绝经后激素替代治疗对脂代谢及胰岛素抵抗的影响

目的　观察激素替代治疗(HRT)对绝经后高血压妇女的血压、脂代谢及胰岛素抵抗的影响。方法　选择绝经后轻、中度高血压妇女共 50 例。随机分成降压治疗组 25 例、降压治疗 HRT组(联合治疗组)25 例。两组均予口服福辛普利 10 mg/d 或福辛普利 10 mg/d 寿比山 2 5mg/d降压治疗;联合治疗组加服替勃龙(Tibolone)2 5 mg/d作为激素替代治疗,两组平均连续用药9月,观察治疗前后血压、血脂、胰岛素敏感指数(ISI)的变化。另设绝经后正常血压组22例作为对照组。　结果　1.治疗前绝经后高血压患者 ISI较对照组明显降低(P<0 .01)。降压治疗组在治疗后收缩压(SBP)和舒张压(DBP)较治疗前分别下降了12. 3%和15 7%;联合治疗组SBP和DBP较治疗前分别下降14 8%和17 2%,两组差异不显著(P>0. 05)。2.降压治疗组治疗前后血脂无明显变化;联合治疗组治疗后的总胆固醇(TC)下降 13 2%(P<0. 05),脂蛋白 a(Lpa)下降 33 3%(P<0 .01)。甘油三酯(TG)有上升的趋势,但无显著性差异(P> 0 05)。3.降压治疗组 ISI 上升 18 1% (P<0 .05),联合治疗组ISI下降了20 3%(P<0 .01),两组差异显著(P<0 .01)。结论　1.替勃龙联合降压药物治疗绝经后高血压对降压疗效无影响。2.能明显降低血总胆固醇及脂蛋白(a),对心脑血管疾病可能有益。3.绝经后高血

The Effects of Tibolone Replacement Therapy on Blood Pressure and Metabolism in Postmenopausal Women With Hypertension

Objective To study the effect of tibolone on blood pressure, carbohydrate and lipid metabolism in postmenopausal women with hypertension. Methods Fifty subjects were recruited and randomly divided into two groups:antihypertension group(fosinopril 10 mg/d or plus indapamide 2.5 mg/d, n=25) and combination group(fosinopril 10 mg/d combined with tibolone 2.5 mg/d,n=25). Both groups were treated for 9 months. Blood pressure, lipid level and insulin sensitive index (ISI) were examined before and after treatment. Results Before treatment ISI was lower in postmenopausal hypertensive women than control group(P<0.01). SBP and DBP were decreased by 12.3% and 15.7% in antihypertensive group, while by 14.8% and 17.2% in combination group(P>0.05). Tc and Lp(a) in combination group were decreased by 13.2% and 33.3% ,but with increasing tendency in TG(P>0.05). ISI was decreased by 20.3% in combination group, but increased by 18.1% in antihypertensive group (P<0.01). Conclusion Although HRT of tibolone significantly ameliorated the blood pressure and lipid level, howevers, it seemed to accentuate insulin resistance in postmenopausal women with hypertension.