中老年妇女血清雌激素水平与冠心病心功能相关性及运动试验诊断价值的研究

目的:探讨中老年妇女血清雌激素水平与冠心病(CHD)和心功能的相关性,及其运动试验对冠心病的诊断价值。方法:选取因发作性胸痛胸闷症状疑诊CHD入院的中老年妇女85例,根据月经状况,分为围绝经期组29例,绝经后组56例。所有病例均经次极量踏车运动试验(SBET,B ruce方案)、选择性冠状动脉造影(SCAG)与左心导管检查及血清雌二醇(E2)水平测定,对比统计分析两组间E2、CHD危险因素、SCAG结果及心功能指标等改变。结果:①绝经后组的平均年龄、CHD患病率(67.9%vs 6.9%)、血胆固醇水平显著高于围绝经期组,而血清E2水平却显著低于后者(P<0.01),高血压患病率在两组间无统计学差异(P>0.05);②绝经后组的左室射血分数(LVEF)显著低于围绝经期组,左室舒张末压(LVEDP)显著高于后者(P<0.01);③绝经后组的SBET真阳性数显著高于围绝经期组,真阴性数及SBET阴性的准确性显著低于后者(P<0.01或P<0.05)。结论:①与围绝经期妇女比较,老年绝经后妇女血清雌激素水平更低,更易发生脂代谢异常、冠心病及心脏收缩与舒张功能的不利改变;②围绝经期妇女运动试验阴性者,基本可排除冠心病;③中老年妇女冠心病的诊断应最后由SCAG确定。

Study on the correlations between serum estrogen level and heart function of coronary heart disease and the evaluation of exercise test in the middle and aged women.

Objective:To study the correlations of serum estrogen level with coronary heart disease(CHD) and heart function to evaluate submaximal bicycle exercise test(SBET,Bruce programme) in the middle and aged women.Methods:85 middle and aged women admitted for paroxysmal chest pain were suspected CHD.According to their menstrual states,56 patients were in postmenopausal group,and another 29 patients were in perimenopausal group.All patients were given SBET,selected coronary arteriogram(SCAG),heart function and serum estradiol level tests..The parameters of heart function were measured by standard 6Fr pigtail catheter.Serum estradiol level,risk factors of CHD and heart function parameters were statistically analyzed.Results:① In postmenopausal group,mean ages,prevalence of CHD(67.9% vs 6.9%) and blood cholesterol level were higher and serum estradiol level was lower than those in perimenopausal group(P<0.01)..Prevalence of hypertension had no significance between the two groups(P>0.05).② Values of left ventricular ejection fraction(LVEF) and left ventricular end diastolic pressure(LVEDP) in postmenopausal group were lower/higher than in perimenopausal group(P<0.01),respectively.③ In postmenopausal group,case of true positive SBET was higher and case and veracity of true negative SBET were lower than those in perimenopausal group(P<0.01 or P<0.05).Conclusion:① Compared to perimenopausal women,the aged postmenopausal women have lower serum level of estradiol,and are more likely to have abnormal lipid metabolism,higher prevalence of CHD and disadvantageous changes of left ventricular systolic or/and diastolic function.② The perimenopausal women with negative SBET haven't CHD to a large extent.③ The final diagnosis of CHD in the middle and aged women must be determined by SCAG.