雌-孕激素替代治疗对绝经后妇女血脂和脂蛋白代谢的长期作用

目的　观察雌 孕激素替代治疗 (HRT)对绝经后妇女血脂和脂蛋白代谢的长期作用。方法　 193例健康绝经后妇女分为A组 (高胆固醇血症组 ) 6 3例、B组 (无高胆固醇血症组 ) 6 0例和C组 (对照组 ) 70例 ,A、B组均给予倍美力 (天然结合型雌激素 ) 0 .6 2 5mg d +安宫黄体酮 2mg d治疗 ,连续 3年监测血清性激素、血脂及脂蛋白水平。结果A组总胆固醇 (TC) ,低密度脂蛋白胆固醇 (LDL C)水平分别下降 12 .1% (P <0 .0 1)、15 .7% (P <0 .0 1) ,B组LDL C下降 4 .5 % (P <0 .0 5 ) ,A、B组高密度脂蛋白胆固醇 (HDL C)水平均明显升高 ,分别为 15 .1% (P <0 .0 1)、2 5 .8% (P <0 .0 1) ,均在第 3个月就出现明显改变 ,并在服药期间可保持疗效 ,对照组则变化不明显。B组TC有下降趋势 ,各组甘油三酯 (TG)均有增高趋势 ,但差异均无显著性意义。A、B组血清 17 β雌二醇 (17 βE2 )和孕酮于第 3个月显著升高 ,血清卵泡刺激素、黄体生成素水平则于第 6个月明显下降 ,并在服药期间可保持疗效 ,而对照组变化不明显。结论　绝经后妇女HRT能改善血清TC、TG、LDL水平 ,并在服药期间可保持疗效 ,对具有高胆固醇血症者效果更佳

Long-term effects of estrogen-progestin replacement therapy on metabolism of serum lipids and lipoprotein in postmenopausal women

s:Objective To observe the long term effects of estrogen progestin replacement therapy (HRT) on metabolism of serum lipids and lipoprotein in postmenopausal women with hypercholesterolemia.Methods 193 healthy postmenopausal women were divided into 3 groups:63 subjects with hypercholesterolemia (group A),60 subjects without hypercholesterolemia(group B)and 70 control subjects(control group).The subjects of groups A and B were given conjugated estrogen (CE) 0.625 mg/d and medroxyprogesterone acetate (MPA) 2 mg/d for 36 months, while 70 control subjects with normal lipids did not receive any hormonal medication. The serum levels of follicle stimulating hormone(FSH), luteinizing hormone(LH), progesterone and 17 β estradiol(17 β E 2) were measured by radioimmunoassay at 0,3,6,12,18,24,30, and 36 months, and the serum concentrations of total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol (HDL C) and low density lipoprotein cholesterol(LDL C)were measured by automatic biochemical analytical instrument at the same time points.Results The serum concentrations of TC and LDL C in Group A decreased significantly by 12.1 %(P<0.01)and 15.7%(P<0.01),respectively,at 36th month as compared with the baseline values.The serum level of LDL C in Group B also decreased by 4.5%(P<0.05). Meanwhile, the serum levels of HDL C in Group A and B increased significantly by 15.1%(P<0.01)and 25.8%(P<0.01),respectively.These favorable changes in lipids were first noted at 3 months and were maintained over the three year period. The lipid levels of control group changed slightly. The HRT increased the serum levels of 17 β E 2 and progesterone in Group A and B by 3 months, and decreased the serum levels of FSH and LH by 6 months. These levels were maintained throughout the study.The sex hormone levels of control group changed slightly.Conclusion HRT has a beneficial effect in postmenopausal women by increasing serum HDL C level and decreasing serum TC and LDL C levels,especially in hypercholesterolemic women, and these effects can be maintained over the 3 year period.