本文選題：雌二醇 + 絕經(jīng)后　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：隨著社會(huì)的發(fā)展,人們的生活水平不斷的改善,導(dǎo)致近年來(lái)心血管疾病居高不下并且呈逐年升高的趨勢(shì),已成為危害全人類(lèi)健康的常見(jiàn)病和多發(fā)病,而患者的危險(xiǎn)因素越多,越高危,這些危險(xiǎn)因素包括年齡、性別、吸煙史、高血壓、糖尿病、高LDL-C血癥等,而且多種危險(xiǎn)因素的共存將會(huì)使心血管疾病危險(xiǎn)性顯著增加,干預(yù)控制危險(xiǎn)因素可有效地防止心血管疾病的發(fā)生、發(fā)展。目前相關(guān)研究報(bào)道女性心血管疾病發(fā)病率呈上升趨勢(shì)。女性心血管疾病以其癥狀不典型,表現(xiàn)多樣化為其特點(diǎn)。其發(fā)病機(jī)制尚未明確,目前認(rèn)為多種機(jī)制參與其發(fā)生和發(fā)展。其中年齡,高血壓病史,糖尿病病史,高脂血癥病史等危險(xiǎn)因素發(fā)揮著重要作用,但這些傳統(tǒng)的危險(xiǎn)因素不能完全解釋女性心血管疾病的發(fā)生發(fā)展。新的危險(xiǎn)因素如雌激素水平主要是雌二醇(estradiol,E2)水平,纖維蛋白原(fibrinogen,Fg)水平等逐漸引起人們的關(guān)注。既往相關(guān)研究顯示女性心血管疾病發(fā)病率低于男性,且發(fā)病時(shí)間較男性晚。區(qū)別于男性的新的危險(xiǎn)因素如雌激素水平逐漸引起人們的關(guān)注。雌激素是一種脂溶性甾體激素,女性青春期前只有少量雌激素分泌,青春期之后分泌大量增加,絕經(jīng)后由于卵巢功能衰退,其合成及分泌性激素水平下降,雌激素水平降低。經(jīng)流行病學(xué)研究發(fā)現(xiàn),絕經(jīng)期后女性心血管疾病的發(fā)病率增加,短期即可達(dá)到男性相近水平,結(jié)果提示,雌激素不僅僅是一種性激素,其可能與女性心血管事件的發(fā)生率有關(guān)。心血管疾病的發(fā)病機(jī)制主要是由血管壁改變、血液成分異常、血流異常三方面所決定的。血漿Fg含量升高可引起血流變學(xué)的改變,增加血液粘度,促進(jìn)血小板和紅細(xì)胞聚集導(dǎo)致血栓形成,血管壁纖維蛋白的存在可導(dǎo)致動(dòng)脈血管疾病。美國(guó)心臟協(xié)會(huì)(AHA)于2007年女性冠心病的預(yù)防指南中明確指出,纖維蛋白原為女性冠心病的新的危險(xiǎn)因素。大量的研究表明纖維蛋白原是心血管疾病發(fā)病的危險(xiǎn)因素。Fg濃度受到E2水平的影響。有研究顯示,雌激素可以通過(guò)降低纖維蛋白原水平,影響血流動(dòng)力學(xué)來(lái)發(fā)揮其心血管的保護(hù)作用。目的:本研究旨在進(jìn)一步明確絕經(jīng)后女性e2水平與fg的相關(guān)性,以期為女性心血管疾病患者提供臨床診治參考方法:連續(xù)收集自2016年4月至2016年10月在河北省人民醫(yī)院心內(nèi)科住院的絕經(jīng)后女性患者127例,根據(jù)年齡分為對(duì)照組(Ⅰ組,年齡小于65歲)58例,試驗(yàn)組(Ⅱ組,年齡大于等于65歲)69例,測(cè)定所有入選患者e2、fg、aptt、tt、pt,并調(diào)查可能影響實(shí)驗(yàn)結(jié)果的其他因素,包括:冠心病病史、高血壓病史、糖尿病病史、絕經(jīng)年齡。對(duì)所得數(shù)據(jù)進(jìn)行收集整理,采用統(tǒng)計(jì)學(xué)方法對(duì)數(shù)據(jù)進(jìn)行分析處理。結(jié)果:1Ⅰ組與Ⅱ組基本臨床特征的比較通過(guò)收集所有入選者的臨床資料,并對(duì)入選者的基本臨床特征進(jìn)行統(tǒng)計(jì)學(xué)分析,我們得出Ⅰ組與Ⅱ組絕經(jīng)年齡、冠心病、高血壓、糖尿病患病率兩組間比較差別無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);2Ⅰ組與Ⅱ組入選者e2、tt、pt、aptt、fg水平的比較通過(guò)收集所有入選者的血液樣本,我們分別檢測(cè)了她們的e2、tt、pt、aptt、fg水平。與Ⅰ組入選者比較,Ⅱ組入選者e2水平顯著降低、fg水平顯著升高、tt縮短,差別有統(tǒng)計(jì)學(xué)意義(p0.05)。pt、aptt兩組間比較差別無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);3所有入選對(duì)象血漿e2水平與tt、pt、aptt、fg水平的相關(guān)性研究結(jié)果通過(guò)對(duì)數(shù)據(jù)進(jìn)行pearson相關(guān)分析后,我們得出e2水平與fg具有明顯的相關(guān)性,呈負(fù)相關(guān)(r為-0.466,p0.05);e2水平與pt之間呈正相關(guān)(r為0.026,p0.05);在對(duì)e2水平與aptt、tt之間進(jìn)行相關(guān)性檢測(cè)中,我們沒(méi)有發(fā)現(xiàn)其存在相關(guān)性(p0.05)。結(jié)論:1絕經(jīng)后女性隨著年齡的增加,e2水平不斷降低,fg水平升高,tt縮短。2絕經(jīng)后女性心血管疾病的發(fā)生可能與e2水平降低有密切關(guān)系。e2可能通過(guò)調(diào)節(jié)女性體內(nèi)fg的降解,影響心血管疾病的發(fā)生發(fā)展。
[Abstract]:With the development of society and the continuous improvement of people's living standards, cardiovascular disease has become high and increasing year by year. It has become a common and frequently occurring disease which endangers the health of all human beings. The more and more dangerous factors of the patients, the risk factors include age, sex, smoking history, hypertension, diabetes, and high levels. The coexistence of a variety of risk factors will increase the risk of cardiovascular disease significantly. Intervention and control of risk factors can effectively prevent the occurrence and development of cardiovascular diseases. The incidence of cardiovascular disease in women is on the rise. The incidence of cardiovascular disease in women is on the rise. Women's cardiovascular diseases are characterized by atypical symptoms and diversity in their manifestations. Its pathogenesis is not yet clear, and many mechanisms are considered to be involved in its occurrence and development. Age, history of hypertension, diabetes history, history of hyperlipidemia, and other risk factors play an important role, but these traditional risk factors do not fully explain the development of women's cardiovascular disease. New risk factors such as female shock are not fully explained. The level of estradiol (E2) and the level of fibrinogen (Fg) have gradually aroused people's attention. Previous studies have shown that the incidence of cardiovascular disease in women is lower than that of men, and the time of onset is later than men. The hormone is a fat soluble steroid hormone. Only a small amount of estrogen is secreted before puberty. After puberty, there is a large increase in secretion after puberty. After menopause, the levels of synthetic and secretory hormones decrease and the levels of estrogen decrease because of the decline of the ovarian function. The results suggest that estrogen is not only a sex hormone, but also may be related to the incidence of cardiovascular events in women. The pathogenesis of cardiovascular disease is mainly determined by three aspects of the changes of blood vessel wall, abnormal blood composition and blood flow abnormality. The increase of plasma Fg can cause the change of blood rheology and increase the blood rheology. Blood viscosity, promoting platelet and erythrocyte aggregation leading to thrombosis, the presence of fibrin in the blood vessel wall can lead to arterial disease. The American Heart Association (AHA), in the 2007 guidelines for the prevention of coronary heart disease in women, clearly indicates that fibrin is a new risk factor for coronary heart disease in women. The risk factor of vascular disease, the risk factor of.Fg, is affected by the level of E2. Studies have shown that estrogen can reduce the level of fibrinogen and influence hemodynamics to play its cardiovascular protective role. Objective: This study aims to further clarify the correlation between E2 and FG in postmenopausal women in order to be a female cardiovascular disease. 127 cases of postmenopausal women hospitalized in Department of Cardiology of Hebei People's Hospital from April 2016 to October 2016 were collected from 127 cases of postmenopausal women, 58 cases were divided into control group (group I, age less than 65 years old), and 69 cases (Group II, age older than 65 years old), and all the selected patients E2, FG, APTT, TT, Pt, were determined. Investigate other factors that may affect the results of the experiment, including: the history of coronary heart disease, the history of hypertension, the history of diabetes, the age of menopause. The basic clinical features of the selector were statistically analyzed. We found that there was no significant difference between the two groups of the menopause age in group I and group II, coronary heart disease, hypertension and diabetes (P0.05), and the level of E2, TT, Pt, APTT, FG in group I and group II were compared with the blood samples collected from all the candidates, and we detected her respectively. E2, TT, Pt, APTT, FG level. Compared with group I, the level of E2 in group II was significantly reduced, FG level increased significantly, TT shortened, and the difference was statistically significant (P0.05).Pt, and APTT two groups had no statistical significance (P0.05); and the correlation of plasma levels of all selected subjects passed logarithmic results. According to Pearson correlation analysis, we found that E2 level has a significant correlation with FG, and has a negative correlation (R is -0.466, P0.05); E2 level is positively correlated with Pt (R is 0.026, P0.05); we have no correlation between E2 level and APTT, conclusion: 1 postmenopausal women with age In addition, the level of E2 decreased, the level of FG increased, and TT shortened the incidence of cardiovascular disease in women with.2 postmenopause. It may be closely related to the decrease of E2 level..e2 may affect the development of cardiovascular disease by regulating the degradation of FG in women.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R54

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