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

上下文。运动性闭经常见于训练有素的女运动员。雌激素在血管功能中起着重要作用。目标。我们调查了训练有素的年轻女运动员运动性闭经患者的血管功能。设计、布景和主题。我们招募了26名青年(16.4岁)高水平训练的女性排球运动员和年龄匹配的非运动员(对照组)志愿者。运动员包括有规律月经周期的运动员(RMC，n=14)和运动性闭经者(EAA，n=12)。对照组月经周期有规律(n=10)。主要观察指标。用高分辨率超声检测内皮依赖性血流介导的血管扩张(FMD)和非内皮非依赖性扩张剂硝酸甘油(GTN)诱导的血管扩张反应，并测定所有受试者的血清雌二醇和孕酮水平。结果。FMD和GTN诱导的血管扩张在对照组和RMC中都是相似的，因此表明运动本身不会改变年轻女性的血管功能。相反，EAA组的FMD和GTN诱导的血管扩张都比对照组少(p&lt；0.01)，更主要的是FMD。EAA患者血清雌二醇水平较低(P<0.005.0 5)，且与FMD和GTN诱导的血管扩张显著相关(r=0.5 0，P<0.0 5；r=0.36，P<0.0 5)。EAA组在停止竞技运动后，随着月经周期的恢复，血清雌二醇恢复到正常水平，FMD和GTN引起的血管扩张也随之恢复。结论雌激素对年轻女性的血管功能具有重要的调节作用。导致闭经的剧烈运动可能通过降低雌激素水平而损害内皮依赖性和非依赖性血管扩张，然而，通过停止剧烈运动可以迅速恢复。

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.