Relation of Exercise Induces Amenorrhea and Endothelial Function-The Follow up Study

上下文运动相关性闭经常见于高强度训练的女运动员。雌激素在血管功能中起重要作用。Objective.我们调查了高强度训练的年轻女性运动员运动相关性闭经的血管功能。设计，设置和主题。我们招募了26名志愿者年轻（16.4岁）训练有素的女性排球运动员和年龄匹配的女性非运动员（对照组）。运动员包括月经周期正常的运动员（RMC，n=14）和运动相关性闭经的运动员（EAA，n=12）。对照组有规律的月经周期（n=10）。主要结局指标。通过高分辨率超声测量内皮依赖性血流介导的血管舒张（FMD）和硝酸甘油（GTN，内皮非依赖性扩张剂）诱导的血管舒张来评价肱动脉的血管舒张反应，并测量所有受试者的血清雌二醇和孕酮水平。结果FMD和GTN诱导的血管舒张在对照组和RMC之间相似，因此表明运动本身不会改变年轻女性的血管功能。相反，EAA中FMD和GTN诱导的血管舒张作用均低于对照组（p<0.01），主要是FMD。EAA患者血清雌二醇水平明显低于正常对照组（P<0.05），且与FMD和GTN引起的血管舒张反应呈显著正相关（分别为r= 0.50，p <0.005和r= 0.36，p <0.05）。在EAA退出竞技运动后，血清雌二醇恢复正常水平，与月经规律的恢复，然后FMD和GTN诱导的血管舒张功能恢复。结论雌激素在调节血管功能中具有重要作用，即使在年轻女性中也是如此。剧烈运动诱发闭经可通过降低雌激素水平损害内皮依赖性和非依赖性血管舒张功能，然而，通过停止剧烈运动可迅速恢复。

Context. Exercise-associated amenorrhea is frequently observed in highly trained female athletes. Estrogen plays an important role in vascular function. Objective. We investigated vascular function in highly trained young female athletes with exercise-associated amenorrhea. Design, Setting and subject. We enrolled 26 volunteer young (16.4 years old) female highly trained volleyball players and age-matched female non-athletes (controls). The players consisted of athletes with a regular menstrual cycle(RMC, n=14) and those with exercise-associated amenorrhea(EAA, n=12). Controls had a regular menstrual cycle (n=10). Main Outcome Measures. Vasodilatory responses of the brachial artery were evaluated by measuring endothelium-dependent flow-mediated vasodilation(FMD) and glyceryltrinitrate(GTN, endothelium-independent dilator)-induced vasodilation using high-resolution ultrasonography.Serum levels of estradiol and progesterone were measured in all subjects. Results. Both FMD and GTN-induced vasodilation were similar between controls and RMC, thus indicating that exercise itself dose not alter vascular function in young females. In contrast, both FMD and GTN-induced vasodilation were less (p<0.01) in EAA than in controls, more predominantly for FMD. Serum estradiol levels were lower (p<0.05) in EAA, and the levels were significantly correlated with FMD and GTN-induced vasodilation, (r=0.50,p<0.005 and r=0.36,p<0.05,respectively). In EAA after quitting competitive sport activity, serum estradiol returned to normal levels, in association with the recovery of regular menstruation, and then FMD and GTN-induced vasodilation were restored. Conclusions Estrogen has important roles in regulation of vascular function even in young females. Strenuous sports activity that induces amenorrhea may impair endothelium-dependent and -independent vasodilations by decreasing estrogen levels, however, they can be restored quickly by quitting strenuous sport activity.