Lower DHEA-S levels predict disease and worse outcomes in post-menopausal women with idiopathic, connective tissue disease- and congenital heart disease-associated pulmonary arterial hypertension.
Lower DHEA-S levels predict disease and worse outcomes in post-menopausal women with idiopathic, connective tissue disease- and congenital heart disease-associated pulmonary arterial hypertension.
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较低的DHEA-S水平可以预测特发性，结缔组织疾病和先天性心脏病相关的肺动脉高压的绝经后妇女的疾病和恶化。
DOI：
10.1183/13993003.00467-2018
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Ventetuolo CE
中科院分区：
文献类型：
--
作者：
Baird GL;Archer-Chicko C;Barr RG;Bluemke DA;Foderaro AE;Fritz JS;Hill NS;Kawut SM;Klinger JR;Lima JAC;Mullin CJ;Ouyang P;Palevsky HI;Palmisicano AJ;Pinder D;Preston IR;Roberts KE;Smith KA;Walsh T;Whittenhall M;Ventetuolo CE
高雌二醇（E2）和低硫酸脱氢表雄酮（DHEA-S）水平是男性肺动脉高压（PAH）的危险因素，但性激素是否与女性PAH有关尚不清楚。年龄大于或等于55岁的绝经后PAH妇女与没有心血管疾病的妇女按年龄和体重指数进行匹配。采用免疫分析法测定血浆性激素水平。低水平的DHEA-S （p<0.001）和高水平的E2 （p=0.02）与PAH相关。在PAH病例（n=112）中，较低的DHEA-S水平与较差的血流动力学（均p<0.01）和更多的右心室扩张和功能障碍（均p=0.001）相关。较低的DHEA-S水平与较短的6分钟步行距离（6MWD） （p=0.01）和较差的功能等级（p=0.004）相关。DHEA-S每降低Ln(1 μg·dL−1)，死亡风险增加一倍（风险比2.0,95% CI 1.5-2.7; p<0.001）。E2水平越高，6MWD越短（p=0.03），功能分级越差（p=0.01）。高E2和低DHEA-S水平与绝经后妇女患PAH的风险和严重程度有关。应研究激素调节作为PAH的治疗策略。
High oestradiol (E2) and low dehydroepiandrosterone-sulfate (DHEA-S) levels are risk factors for pulmonary arterial hypertension (PAH) in men, but whether sex hormones are related to PAH in women is unknown. Post-menopausal women aged ⩾55 years with PAH were matched by age and body mass index to women without cardiovascular disease. Plasma sex hormone levels were measured by immunoassay. Lower levels of DHEA-S (p<0.001) and higher levels of E2 (p=0.02) were associated with PAH. In PAH cases (n=112), lower DHEA-S levels were associated with worse haemodynamics (all p<0.01) and more right ventricular dilatation and dysfunction (both p=0.001). Lower DHEA-S levels were associated with shorter 6-min walking distance (6MWD) (p=0.01) and worse functional class (p=0.004). Each Ln(1 μg·dL−1) decrease in DHEA-S was associated with a doubling in the risk of death (hazard ratio 2.0, 95% CI 1.5–2.7; p<0.001). Higher levels of E2 were associated with shorter 6MWD (p=0.03) and worse functional class (p=0.01). High E2 and low DHEA-S levels are associated with the risk and severity of PAH in post-menopausal women. Hormonal modulation should be studied as a treatment strategy in PAH.
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