绝经期妇女早期和长期使用绝经激素治疗对心脏代谢危险因素的影响

S. Tolstov, Salov Ia, A. Rebrov
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引用次数: 2

摘要

目的:探讨早期和长期联合应用含螺环酮的绝经期激素治疗对绝经期妇女主要心脏代谢危险因素的影响。材料和方法。该研究包括210名绝经期妇女,分为3组:1组(n=48)包括绝经后从含螺环酮的激素避孕药转向更年期激素治疗的妇女;第二组(n=84)是在绝经后早期开始接受激素治疗的妇女。绝经期激素治疗采用1mg 17β-雌二醇和2mg降螺酮-“Angeliq®”。对照组(n=78)包括未接受激素治疗的早期绝经后妇女。随访时间为5.2(4.8,5.7)年。计算脂质代谢、尿酸、免疫反应性胰岛素、c肽、口服糖耐量试验、HOMA-IR指数。结果:在延长绝经期激素治疗的背景下,血浆的动脉粥样硬化性有所降低。在对照组的女性中,在研究结束时发现了致动脉粥样硬化脂质分数的增加。第一组患者的腰围及腰围/大腿围比未见明显变化。与第一组患者相比,第二组患者的腰围和腰围/大腿围比值初始值较高,腹部肥胖的严重程度有所降低。在研究结束时,对照组的女性注意到这些指标的价值有所增加。在接受更年期激素治疗的妇女中,免疫反应性胰岛素和c肽显著下降,HOMA-IR指数下降,基础和餐后血糖水平下降。在对照组中,随着腹部肥胖的进展,所研究的指标有所增加。结论:研究表明,对于绝经后早期代谢紊乱的患者,可采用1mg 17β-雌二醇和2mg降螺酮联合使用延长绝经期激素治疗。早期和长期使用绝经期激素治疗有一些额外的优势,在绝经后早期开始激素治疗之前,血液脂质谱的变化更有利,腹部肥胖和胰岛素抵抗更少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CHANGES OF CARDIOMETABOLIC RISK FACTORS IN EARLY AND LONG-TERM USE OF MENOPAUZAL HORMONE THERAPY IN WOMEN OF THE CLIMACTERIC PERIOD
Aim:changes in the main cardiometabolic risk factors in women of the climacteric period in early and long-term use of combined drospirenone-containing menopausal hormone therapy.Material and Methods.The study included 210 menopausal women divided into 3 groups: 1 group (n=48) included women who, after reaching menopause, switched from a drospirenone-containing hormonal contraceptive to taking menopausal hormone therapy; in the second group (n=84) — women who started taking hormone therapy in the period of early postmenopause. Menopausal hormone therapy was used for 1 mg of 17β-estradiol and 2 mg of drospirenone-“Angeliq®”. The control group (n=78) included women in early postmenopausal women who did not take hormonal therapy. The duration of follow-up is 5.2 (4.8, 5.7) years. Lipid metabolism, uric acid, immunoreactive insulin and C-peptide, oral glucose tolerance test, HOMA-IR index were calculated. The waist circumference and waist circumference/thigh circumference were determined.Results.Against the backdrop of prolonged menopausal hormonal therapy, a decrease in the atherogenicity of blood plasma was noted. In women of the control group, an increase in atherogenic lipid fractions was revealed by the end of the study. Patients of the first group of significant changes in the circumference of the waist and the ratio of waist circumference/thigh circumference were not detected. In women of the second group with initially higher values of the waist circumference and the ratio of the waist circumference/thigh circumference than in the patients of the 1st group, a decrease in the severity of abdominal obesity was established. Women of the control group noted an increase in the value of these indicators by the end of the study. In women receiving menopausal hormone therapy, there was a significant decrease in immunoreactive insulin and C-peptide, a decrease in the HOMA-IR index, combined with a decrease in basal and postprandial blood glucose levels. In women of the control group, as the abdominal obesity progresses, the increase in the studied indicators is noted.Conclusion.The study suggests the possibility of using a combination of 1 mg of 17β-estradiol and 2 mg of drospirenone for prolonged menopausal hormone therapy in patients with early postmenopausal metabolic disorders. Early and longterm use of menopausal hormone therapy has some additional advantages before prescribing hormone therapy in the early postmenopausal period with more favorable changes in the lipid spectrum of the blood, less pronounced abdominal obesity and insulin resistance.
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