绝经后妇女冠心病患者性激素水平与同型半胱氨酸水平的相关性及其对血管内皮功能的影响  

Relationship between serum level of sex hormones and homocysteine as well as their effects on endothelial function in postmenopausal women with coronary heart disease

作　　者：张密林[1] 王震[1] 高磊[1] 甄宇治[1] 崔冬生[2] 

机构地区：[1]河北医科大学第一医院心内科,河北石家庄050031 [2]河北医科大学第一医院中心实验室,河北石家庄050031

出　　处：《临床荟萃》2005年第24期1388-1392,共5页Clinical Focus

基　　金：河北省卫生厅科研基金资助项目(00002015)

摘　　要：目的探讨绝经后女性冠心病(CHD)患者内源性性激素水平与血清同型半胱氨酸(Hcy)水平之间的关系以及对血管内皮功能的影响。方法测定44例正常绝经1年以上经冠状动脉造影检查证实为CHD的女性患者[Ⅰ组,平均年龄(62.21±0.85)岁]、36例正常绝经1年以上经冠状动脉造影检查排除CHD的女性患者[Ⅱ组,平均年龄(64.01±0.76)岁]和41例无CHD的健康育龄妇女[Ⅲ组,平均年龄(39.83±0.62)岁]的血清雌二醇(E2)、睾酮(T)和孕酮(P)以及Hcy水平,应用B型超声观察静息和反应性充血时肱动脉内径并计算各自的内皮依赖性血管舒张率(FMD%)和非内皮依赖性血管舒张率(NTG%)。结果3组患者的血清E2和P水平比较差异均有统计学意义(P<0.05);Ⅰ组的E2(57.65±5.93)pmol/L和P水平(5.78±0.21)nmol/L均低于Ⅱ组(P<0.05),Ⅱ组的E2(92.63±6.71)pmol/L和P(6.64±1.01)nmol/L均低于Ⅲ组的E2(168.80±11.10)pmol/L和P(8.87±1.34)nmol/L(均P<0.01);Ⅰ组和Ⅱ组的Hcy水平均高于Ⅲ组(均P<0.05),以Ⅰ组增高更显著(P<0.01);Ⅰ组的FMD%和NTG%水平低于Ⅱ组和Ⅲ组(均P<0.05),且Ⅰ组和Ⅲ组的FMD%差异具有统计学意义(P<0.01);多元逐步回归分析显示,包括E2在内的3项指标与Hcy水平独立相关;包括E2在内的5项指标又与FMD%独立相关。结论绝经后女性CHD患者E2水平低于非CHD患者,女性高同型半胱氨酸血症是内皮功能障碍的危险因素之一,绝经后女性性激素水平下降可能引起血管内皮功能紊乱。Objective To investigate the relationship between the endogenous sex hormones and the serum level of homoeysteine（Hey） as well as their effects on endothelial function in postmenopausal women with coronary heart disease（CHD）. Methods According to the results of coronary angiography,44 postmenopausal women with CHD（group Ⅰ , average age was （62.210±0.85） years and 36 postmenopausal women（normal menopause 〉1 year） without CHD [group Ⅱ , average age was （64.01±0.76） years] were enrolled. According to the elinleal data, 41 healthy women of child-bearing age [group Ⅲ, average age was （39.83 ± 0.62） years] were enrolled, too. Serum concentrations of estradiol （E2）, testosterone （T）, pregnane （P） and Hey were investigated for all subjects. B-mode ultrasound was used to scan braehial arteries for all subjects at rest and during reactive hyperemia, and then the rates of endothelium-dependent flow-mediated vasodilatation （FMD%） and independent （NTG%） of the braehial artery were calculated. Results E2 and P values were lower in group I than those in group Ⅱ and group Ⅲ （P 〈0. 05,respeetively）, E2 and P values in group I were （57.6±5.93） pmol/L and （5.78±0.21） nmol/L,while those in group Ⅱ were （92.63±6.71） pmol/L and （6.64±1.01） nmol/L,those in group Ⅲ were （168.8±11.10） pmol/L and （8.87 ± 1.34） nmol/L（all P G0.01）. Hey values in group I and group Ⅱ were higher than that in group Ⅲ （all P G0.05） and that in group I was more significant（ P 〈0.01）. FMD% and NTG% values were lower in group 1 than those in group [[ and group Ⅲ （all P 〈0.05）, and the difference of FMD% between group Ⅰ and group Ⅲ was more significant （ P 〈 0.01）. Multiple stepwise regression analysis showed that E2 was significantly associated with Hey level independently, and E2 was associated with FMD% independently,too. Conclusion E2 value in postmenopausal women with CHD is lower than that in women without CHD. Hyperhomoeys

关 键 词：冠状动脉疾病 绝经后期 性激素类 高半胱氨酸 内皮 血管 

分 类 号：R541.4[医药卫生—心血管疾病] R711.51[医药卫生—内科学]