绝经后女性雌激素水平与纤维蛋白原的相关性研究

发布时间：2018-04-23 20:03

本文选题：雌二醇 + 绝经后　；参考：《河北医科大学》2017年硕士论文

【摘要】：随着社会的发展,人们的生活水平不断的改善,导致近年来心血管疾病居高不下并且呈逐年升高的趋势,已成为危害全人类健康的常见病和多发病,而患者的危险因素越多,越高危,这些危险因素包括年龄、性别、吸烟史、高血压、糖尿病、高LDL-C血症等,而且多种危险因素的共存将会使心血管疾病危险性显著增加,干预控制危险因素可有效地防止心血管疾病的发生、发展。目前相关研究报道女性心血管疾病发病率呈上升趋势。女性心血管疾病以其症状不典型,表现多样化为其特点。其发病机制尚未明确,目前认为多种机制参与其发生和发展。其中年龄,高血压病史,糖尿病病史,高脂血症病史等危险因素发挥着重要作用,但这些传统的危险因素不能完全解释女性心血管疾病的发生发展。新的危险因素如雌激素水平主要是雌二醇(estradiol,E2)水平,纤维蛋白原(fibrinogen,Fg)水平等逐渐引起人们的关注。既往相关研究显示女性心血管疾病发病率低于男性,且发病时间较男性晚。区别于男性的新的危险因素如雌激素水平逐渐引起人们的关注。雌激素是一种脂溶性甾体激素,女性青春期前只有少量雌激素分泌,青春期之后分泌大量增加,绝经后由于卵巢功能衰退,其合成及分泌性激素水平下降,雌激素水平降低。经流行病学研究发现,绝经期后女性心血管疾病的发病率增加,短期即可达到男性相近水平,结果提示,雌激素不仅仅是一种性激素,其可能与女性心血管事件的发生率有关。心血管疾病的发病机制主要是由血管壁改变、血液成分异常、血流异常三方面所决定的。血浆Fg含量升高可引起血流变学的改变,增加血液粘度,促进血小板和红细胞聚集导致血栓形成,血管壁纤维蛋白的存在可导致动脉血管疾病。美国心脏协会(AHA)于2007年女性冠心病的预防指南中明确指出,纤维蛋白原为女性冠心病的新的危险因素。大量的研究表明纤维蛋白原是心血管疾病发病的危险因素。Fg浓度受到E2水平的影响。有研究显示,雌激素可以通过降低纤维蛋白原水平,影响血流动力学来发挥其心血管的保护作用。目的:本研究旨在进一步明确绝经后女性e2水平与fg的相关性,以期为女性心血管疾病患者提供临床诊治参考方法:连续收集自2016年4月至2016年10月在河北省人民医院心内科住院的绝经后女性患者127例,根据年龄分为对照组(Ⅰ组,年龄小于65岁)58例,试验组(Ⅱ组,年龄大于等于65岁)69例,测定所有入选患者e2、fg、aptt、tt、pt,并调查可能影响实验结果的其他因素,包括:冠心病病史、高血压病史、糖尿病病史、绝经年龄。对所得数据进行收集整理,采用统计学方法对数据进行分析处理。结果:1Ⅰ组与Ⅱ组基本临床特征的比较通过收集所有入选者的临床资料,并对入选者的基本临床特征进行统计学分析,我们得出Ⅰ组与Ⅱ组绝经年龄、冠心病、高血压、糖尿病患病率两组间比较差别无统计学意义(p0.05);2Ⅰ组与Ⅱ组入选者e2、tt、pt、aptt、fg水平的比较通过收集所有入选者的血液样本,我们分别检测了她们的e2、tt、pt、aptt、fg水平。与Ⅰ组入选者比较,Ⅱ组入选者e2水平显著降低、fg水平显著升高、tt缩短,差别有统计学意义(p0.05)。pt、aptt两组间比较差别无统计学意义(p0.05);3所有入选对象血浆e2水平与tt、pt、aptt、fg水平的相关性研究结果通过对数据进行pearson相关分析后,我们得出e2水平与fg具有明显的相关性,呈负相关(r为-0.466,p0.05);e2水平与pt之间呈正相关(r为0.026,p0.05);在对e2水平与aptt、tt之间进行相关性检测中,我们没有发现其存在相关性(p0.05)。结论:1绝经后女性随着年龄的增加,e2水平不断降低,fg水平升高,tt缩短。2绝经后女性心血管疾病的发生可能与e2水平降低有密切关系。e2可能通过调节女性体内fg的降解,影响心血管疾病的发生发展。
[Abstract]:With the development of society and the continuous improvement of people's living standards, cardiovascular disease has become high and increasing year by year. It has become a common and frequently occurring disease which endangers the health of all human beings. The more and more dangerous factors of the patients, the risk factors include age, sex, smoking history, hypertension, diabetes, and high levels. The coexistence of a variety of risk factors will increase the risk of cardiovascular disease significantly. Intervention and control of risk factors can effectively prevent the occurrence and development of cardiovascular diseases. The incidence of cardiovascular disease in women is on the rise. The incidence of cardiovascular disease in women is on the rise. Women's cardiovascular diseases are characterized by atypical symptoms and diversity in their manifestations. Its pathogenesis is not yet clear, and many mechanisms are considered to be involved in its occurrence and development. Age, history of hypertension, diabetes history, history of hyperlipidemia, and other risk factors play an important role, but these traditional risk factors do not fully explain the development of women's cardiovascular disease. New risk factors such as female shock are not fully explained. The level of estradiol (E2) and the level of fibrinogen (Fg) have gradually aroused people's attention. Previous studies have shown that the incidence of cardiovascular disease in women is lower than that of men, and the time of onset is later than men. The hormone is a fat soluble steroid hormone. Only a small amount of estrogen is secreted before puberty. After puberty, there is a large increase in secretion after puberty. After menopause, the levels of synthetic and secretory hormones decrease and the levels of estrogen decrease because of the decline of the ovarian function. The results suggest that estrogen is not only a sex hormone, but also may be related to the incidence of cardiovascular events in women. The pathogenesis of cardiovascular disease is mainly determined by three aspects of the changes of blood vessel wall, abnormal blood composition and blood flow abnormality. The increase of plasma Fg can cause the change of blood rheology and increase the blood rheology. Blood viscosity, promoting platelet and erythrocyte aggregation leading to thrombosis, the presence of fibrin in the blood vessel wall can lead to arterial disease. The American Heart Association (AHA), in the 2007 guidelines for the prevention of coronary heart disease in women, clearly indicates that fibrin is a new risk factor for coronary heart disease in women. The risk factor of vascular disease, the risk factor of.Fg, is affected by the level of E2. Studies have shown that estrogen can reduce the level of fibrinogen and influence hemodynamics to play its cardiovascular protective role. Objective: This study aims to further clarify the correlation between E2 and FG in postmenopausal women in order to be a female cardiovascular disease. 127 cases of postmenopausal women hospitalized in Department of Cardiology of Hebei People's Hospital from April 2016 to October 2016 were collected from 127 cases of postmenopausal women, 58 cases were divided into control group (group I, age less than 65 years old), and 69 cases (Group II, age older than 65 years old), and all the selected patients E2, FG, APTT, TT, Pt, were determined. Investigate other factors that may affect the results of the experiment, including: the history of coronary heart disease, the history of hypertension, the history of diabetes, the age of menopause. The basic clinical features of the selector were statistically analyzed. We found that there was no significant difference between the two groups of the menopause age in group I and group II, coronary heart disease, hypertension and diabetes (P0.05), and the level of E2, TT, Pt, APTT, FG in group I and group II were compared with the blood samples collected from all the candidates, and we detected her respectively. E2, TT, Pt, APTT, FG level. Compared with group I, the level of E2 in group II was significantly reduced, FG level increased significantly, TT shortened, and the difference was statistically significant (P0.05).Pt, and APTT two groups had no statistical significance (P0.05); and the correlation of plasma levels of all selected subjects passed logarithmic results. According to Pearson correlation analysis, we found that E2 level has a significant correlation with FG, and has a negative correlation (R is -0.466, P0.05); E2 level is positively correlated with Pt (R is 0.026, P0.05); we have no correlation between E2 level and APTT, conclusion: 1 postmenopausal women with age In addition, the level of E2 decreased, the level of FG increased, and TT shortened the incidence of cardiovascular disease in women with.2 postmenopause. It may be closely related to the decrease of E2 level..e2 may affect the development of cardiovascular disease by regulating the degradation of FG in women.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54

【参考文献】