Short-term estrogen administration improves abnormal endothelial function in women with systemic sclerosis and Raynaud's phenomenon
Short-term estrogen administration improves abnormal endothelial function in women with systemic sclerosis and Raynaud's phenomenon
复制标题
DOI：
10.1016/s0002-8703(98)70137-1
复制
发表时间：
1998-11-01
影响因子：
4.8
通讯作者：
Moulopoulos, S
中科院分区：
文献类型：
--
作者：
Lekakis, J;Mavrikakis, M;Moulopoulos, S
背景系统性硬化症和雷诺现象患者血管内皮细胞的形态改变是常见的。本研究的目的是评价这些患者的内皮依赖性和非内皮依赖性的血管扩张，并观察短期雌激素治疗对这些患者血管反应的影响。方法和结果12例女性系统性硬化症和雷诺现象患者(年龄49+/-14岁)和12例年龄和性别匹配的健康对照组。采用高分辨率超声成像技术，测量静息状态、反应性充血(内皮依赖性反应)和舌下含服硝酸甘油(非内皮依赖性扩张)时的肱动脉内径。同时测量颈总动脉内膜中层厚度。患者和对照组的基线直径相似；患者组内膜-中层厚度显著高于对照组(0.83+/-0.3vs0.46+/-0.2 mm，P=0.002)。血流介导的血管扩张减少(3.6%+/-7%比11.9%+/-4.6%，P=.003)，雷诺现象患者的非内皮依赖性血管扩张也减少(14%+/-7%比23%+/-6%，P=.003)。10例患者在静脉注射结合雌激素(25 Mg)15分钟后观察血管反应，雌激素治疗后内皮依赖性血管扩张显著增加(1.7%+/-4%至6.3%+/-4%，P=0.01)，而非内皮依赖性血管扩张无明显变化(13.4%+/-8%至15.5%+/-7%，P=.01)。结论系统性硬化症继发雷诺现象患者内皮依赖性和非内皮依赖性血管扩张受损，内膜-中层厚度增加。短期服用雌激素可以改善这类患者的内皮功能障碍。
Background Morphologic changes of the vascular endothelium are common in patients with systemic sclerosis and Raynaud's phenomenon. The aim of this study was to evaluate the endothelium-dependent vasodilatation and endothelium-independent vasodilatation and to examine the effects of short-term estrogen administration on vascular responses in these patients.Methods and Results The study included 12 female patients with systemic sclerosis and Raynaud's phenomenon (aged 49 +/- 14 years) and 12 age- and sex-matched healthy control subjects. With the use of high-resolution ultrasound imaging, brachial artery diameter was measured at rest, during reactive hyperemia (endothelium-dependent response), and after administration of sublingual nitroglycerin (endothelium-independent dilatation). Intima-media thickness of the common carotid artery was also measured. Baseline diameter was similar in patients and control subjects; intima-media thickness was significantly higher in patients (0.83 +/- 0.3 vs 0.46 +/- 0.2 mm, P = .002) than in control subjects. Flow-mediated dilatation was reduced in patients (3.6% +/- 7% vs 11.9% +/- 4.6%, P = .003); endothelium-independent dilatation also was reduced in patients with Raynaud's phenomenon (14% +/- 7% vs 23% +/- 6%, P = .003). Vascular responses in 10 patients were examined 15 minutes after administration of conjugated estrogens (25 mg intravenously); there was a significant increase of endothelium-dependent dilatation after estrogen administration (1.7% +/- 4% to 6.3% +/- 4%, P = .01), whereas endothelium-independent dilatation did not change (13.4% +/- 8% to 15.5% +/- 7%, not significant).Conclusions Endothelium-dependent vasodilatation and endothelium-independent vasodilatation are impaired in patients with Raynaud's phenomenon secondary to systemic sclerosis, whereas intima-media thickness is increased. Shortterm estrogen administration can improve endothelial dysfunction in this group of patients.