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

上下文。在训练有素的女运动员中经常观察到运动相关的闭经。雌激素在血管功能中起着重要作用。目标。我们研究了训练有素的年轻女运动员与运动相关闭经的血管功能。设计，设置和主题。我们招募了26名年轻（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）和运动相关闭经的运动员（EAA, n=12）。对照组月经周期规律（n=10）。主要结果测量。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）和三硝酸甘油（GTN，内皮非依赖型扩张剂）诱导的血管舒张，评估肱动脉的血管舒张反应。测定了所有受试者的血清雌二醇和黄体酮水平。结果。FMD和gtn诱导的血管舒张在对照组和RMC之间相似，这表明运动本身不会改变年轻女性的血管功能。与对照组相比，EAA组FMD和gtn诱导的血管舒张均较对照组减少（p<0.01）， FMD更明显。EAA组血清雌二醇水平较低（p<0.05），且与FMD和gtn诱导的血管舒张呈显著相关（r=0.50,p<0.005和r=0.36,p<0.05）。在退出竞技体育活动后的EAA组，血清雌二醇恢复到正常水平，月经恢复正常，然后FMD和gn诱导的血管舒张恢复。结论雌激素在年轻女性血管功能调节中具有重要作用。剧烈运动引起的闭经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舒张，然而，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.