围绝经期高血压发病机制及激素替代疗法研究进展
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摘要
围绝经期高血压是高血压的一种特殊类型,围绝经期女性生理、心理各方面发生变化,内分泌失调,出现一系列植物神经功能紊乱的症状,导致其血压的变化。至今对其发病机制尚无完整统一的认识。目前以围绝经期女性生理上性激素水平的变化,其中以雌激素水平下降为首要特征,心理上焦虑和抑郁,同时影响血压水平。激素替代疗法现已成为治疗围绝经期高血压的重要方法,但仍有争议。
Perimenopausal hypertension is a special type of hypertension. Physiological and psychological aspects of perimenopausal women's change, endocrine disorders, and a series of symptoms of autonomic dysfunction, leading to changes in blood pressure. Until now, there has been no complete and unified understanding of the pathogenesis. At present, changes in physiological hormone levels in women during the perimenopausal period, in which estrogen levels decline as the primary feature, psychological anxiety and depression, while affecting blood pressure levels. Hormone replacement therapy has become an important method to treat perimenopausal hypertension, but it is still controversial.
Perimenopausal hypertension is a special type of hypertension. Physiological and psychological aspects of perimenopausal women's change, endocrine disorders, and a series of symptoms of autonomic dysfunction, leading to changes in blood pressure. Until now, there has been no complete and unified understanding of the pathogenesis. At present, changes in physiological hormone levels in women during the perimenopausal period, in which estrogen levels decline as the primary feature, psychological anxiety and depression, while affecting blood pressure levels. Hormone replacement therapy has become an important method to treat perimenopausal hypertension, but it is still controversial.
引文
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[4]季晓东,刘姣,邱毅,等.围绝经期女性心血管疾病危险因素分析[J]中国卫生检验杂志,2016,26(6):819-821.
[5]王建安,应淑琴.2013ESH/ESC动脉高血压管理指南有关女性高血压解读[J].心电与循环,2014,33(1):5-9.
[6]Lima R,Wofford M,Reckelhoff J F.Hypertension in Postmenopausa Women[J].Curr Hypertens Rep,2012,14(3):254-260.
[7]Subramanian M,Mohankumar S M J,Balasubramanian P,et al.Chronic exposure to low doses of estradiol-17?increases blood pressure in young female rats:A possible role for central Endothelin-1[J].Scientific Reports,2017,7(1):139.
[8]Yeasmin N,Akhter Q S,Mahmuda S,et al.Association of Hypertension with Serum Estrogen Level in Postmenopausal Women[J].Mymensingh Med J,2017,26(3):635-641.
[9]张亮,唐靖一.绝经后高血压研究进展[J].中国康复理论与实践,2008,14(2):152-154.
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[12]Shen H H,Liao M H,Chang Y H,et al.Estrogen deficiency modifies matrix met alloproteinases activity and vascular function of mesenteric arteries in female rats[J].Journal of Medical Sciences,2017,37(2):61-68.
[13]Laurent S,Boutouyrie P.The structural factor of hypertension:large and small artery alterations.[J].Circulation Research,2015,116(6):1007-1021.
[14]杨静.高水平FSH促进肾上腺髓质儿茶酚胺合成增加引发绝经后妇女血管功能紊乱的机制研究[D].浙江:浙江大学,2015.
[15]胡剑平.雄激素对内皮相关心血管系统的影响[J].国际心血管病杂志,2009,36(1):44-46.
[16]Shifren JL.Androgens,estrogens and metabolic syndrome at midlife[J]Menopause,2009,16(2):226-228.
[17]Huang C K,Lee S O,Chang E,et al.Androgen receptor(AR)in cardiovascular diseases[J].J Endocrinol.2016,229(1):1-16.
[18]谈世进.前言-雄激素与心血管相关危险因素的关系[J].实用老年医学,2014,28(1):3-4.
[19]Ziemens B,Wallaschofski H,Volzke H,et al.Positive association between testosterone,blood pressure,and hypertension in women longitudinal findings from the Study of Health in Pomerania[J].JHypertens,2013,31(6):1106-1113.
[20]王晓慧,谈世进.雄激素对高盐饮食下大鼠血管内皮的影响及相关机制的探讨[D].苏州:苏州大学,2013.
[21]Thoonen R,Sips P Y,Bloch K D,et al.Pathophysiology of Hypertension in the Absence of Nitric Oxide/Cyclic GMP Signaling[J].Curr Hypertens Rep,2013,15(1):47-58.
[22]臧金凤,赵丕文.雌激素或雌激素样物质对心血管系统的影响及其作用途径与机制[J].世界中医药,2016,11(6):1131-1136.
[23]常青.雌激素对下丘脑-垂体-卵巢轴的影响及对心血管保护作用的研究[D].第三军医大学,2000.
[24]Hall J E,do Carmo J M,Da S A,et al.Obesity-induced hypertension:interaction of neurohumoral and renal mechanisms[J].Circulation Research,2015,116(6):991-1006.
[25]Mi K S,Lim N K,Lim J Y,et al.Difference in blood pressure between early and late menopausal transition was significant in healthy Korean women[J].BMC Women's Health,2015,15(1):1-7.
[26]Miller C N,Brown L M,Rayalam S,et al.Estrogens,inflammation and obesity:an overview[J].Frontiers in Biology,2012,7(1):40-47.
[27]Mauvais-Jarvis F,Clegg D J,Hevener A L.The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis[J].Endocr Rev,2013,34(3):309-338.
[28]马孝湘,陈晓平,程幼夫.绝经后女性高血压患者血压水平与雌激素、糖化血红蛋白的相关性[J].中华高血压杂志,2014,22(10):974-976.
[29]陈伟,肖扬.高尿酸血症与相关疾病的研究进展[J].中国实验诊断学,2016,20(12):2147-2150.
[30]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[31]中国医师协会心血管内科医师分会.绝经后女性血脂异常管理的中国专家共识[J].中华心血管病杂志,2014,42(4):279-283.
[32]王莉,王雅楠.更年期妇女心理健康状况及其相关因素[J].中国老年学杂志,2011,31(9):1635-1636.
[33]贾丁鑫,金力.更年期妇女抑郁症状发生的影响因素分析[J].更年期保健,2014,29(09):1373-1374.
[34]Shors T J,Leuner B.Estrogen-mediated effects on depression and memory formation in females[J].Journal of Affective Disorders,2003,74(1):85-96.
[35]张莉.围绝经期抑郁症状与血清性激素水平的关联性研究[J].安徽卫生职业技术学院学报,2010,9(2):29-30.
[36]张孟丽,郑桂英,吴艳军,等.围绝经期抑郁的研究进展[J].中国妇幼保健,2013,28(1):5236-5237.
[37]李会,陈红.左旋氨氯地平联合综合性心理干预治疗高血压伴围绝经综合征患者的临床观察[J].现代生物医学进展,2016,16(16):3066-3069.
[38]Hildrum B,Romild U,Holmen J.Anxiety and depression lowers blood pressure:22-year follow-up of the population based HUNT study,Norway[J].BMC Public Health,2011,11(1):1-8.
[39]McAndrew L M,Napolitano M A,Albrecht A,et al.When,why and for whom there is a relationship between physical activity and menopause symptoms[J].Maturitas.2009,64(2):119-125.
[40]臧金凤,赵丕文.雌激素或雌激素样物质对心血管系统的影响及其作用途径与机制[J].世界中医药,2016,11(6):1131-1136.
[41]De Villiers T J,Hall J E,Pinkerton J V,et al.Revised global consensus statement on menopausal hormone therapy[J].Maturitas,2016,91:153-155.
[42]Vitalea C,Mammia C,Gambaccianib M,et al.Effect of hormone replacement therapy with the anti-mineralocorticoid progestin Drospirenone compared to tibolone on endothelial function and central haemodynamics in post-menopausal women[J].Int J Cardiol,2017,227:217-221.
[43]Rohdewald P J.Relief from Menopausal Symptoms by Non-hormonal Treatment with Pycnogenol?(French Maritime Pine Bark Extract)[J].J Genit Syst Diso,2017,5(4):7.
[2]Licy L.Yanes,Jane F.Reckelhoff,Ph.D,et al.Postmenopausa Hypertension[J].Am J Hypertens,2011,24(7):1-18.
[3]Zhou Y,Zhou X,Guo X,et al.Prevalence and risk factors of hypertension among pre-and post-menopausal women:A cross-sectional study in a rura area of northeast China[J].Maturitas,2015,80(3):282-287.
[4]季晓东,刘姣,邱毅,等.围绝经期女性心血管疾病危险因素分析[J]中国卫生检验杂志,2016,26(6):819-821.
[5]王建安,应淑琴.2013ESH/ESC动脉高血压管理指南有关女性高血压解读[J].心电与循环,2014,33(1):5-9.
[6]Lima R,Wofford M,Reckelhoff J F.Hypertension in Postmenopausa Women[J].Curr Hypertens Rep,2012,14(3):254-260.
[7]Subramanian M,Mohankumar S M J,Balasubramanian P,et al.Chronic exposure to low doses of estradiol-17?increases blood pressure in young female rats:A possible role for central Endothelin-1[J].Scientific Reports,2017,7(1):139.
[8]Yeasmin N,Akhter Q S,Mahmuda S,et al.Association of Hypertension with Serum Estrogen Level in Postmenopausal Women[J].Mymensingh Med J,2017,26(3):635-641.
[9]张亮,唐靖一.绝经后高血压研究进展[J].中国康复理论与实践,2008,14(2):152-154.
[10]Routledge F S,Hinderliter A L,Mcfetridge-Durdle J,et al.Endothelia function in postmenopausal women with nighttime systolic hypertension[J]Menopause-the Journal of the North American Menopause Society2015,22(8):857-863.
[11]Staessen J A,Celis H,Fagard R.The epidemiology of the association between hypertension and menopause[J].J Hum Hypertens,1998,12(9):587-592.
[12]Shen H H,Liao M H,Chang Y H,et al.Estrogen deficiency modifies matrix met alloproteinases activity and vascular function of mesenteric arteries in female rats[J].Journal of Medical Sciences,2017,37(2):61-68.
[13]Laurent S,Boutouyrie P.The structural factor of hypertension:large and small artery alterations.[J].Circulation Research,2015,116(6):1007-1021.
[14]杨静.高水平FSH促进肾上腺髓质儿茶酚胺合成增加引发绝经后妇女血管功能紊乱的机制研究[D].浙江:浙江大学,2015.
[15]胡剑平.雄激素对内皮相关心血管系统的影响[J].国际心血管病杂志,2009,36(1):44-46.
[16]Shifren JL.Androgens,estrogens and metabolic syndrome at midlife[J]Menopause,2009,16(2):226-228.
[17]Huang C K,Lee S O,Chang E,et al.Androgen receptor(AR)in cardiovascular diseases[J].J Endocrinol.2016,229(1):1-16.
[18]谈世进.前言-雄激素与心血管相关危险因素的关系[J].实用老年医学,2014,28(1):3-4.
[19]Ziemens B,Wallaschofski H,Volzke H,et al.Positive association between testosterone,blood pressure,and hypertension in women longitudinal findings from the Study of Health in Pomerania[J].JHypertens,2013,31(6):1106-1113.
[20]王晓慧,谈世进.雄激素对高盐饮食下大鼠血管内皮的影响及相关机制的探讨[D].苏州:苏州大学,2013.
[21]Thoonen R,Sips P Y,Bloch K D,et al.Pathophysiology of Hypertension in the Absence of Nitric Oxide/Cyclic GMP Signaling[J].Curr Hypertens Rep,2013,15(1):47-58.
[22]臧金凤,赵丕文.雌激素或雌激素样物质对心血管系统的影响及其作用途径与机制[J].世界中医药,2016,11(6):1131-1136.
[23]常青.雌激素对下丘脑-垂体-卵巢轴的影响及对心血管保护作用的研究[D].第三军医大学,2000.
[24]Hall J E,do Carmo J M,Da S A,et al.Obesity-induced hypertension:interaction of neurohumoral and renal mechanisms[J].Circulation Research,2015,116(6):991-1006.
[25]Mi K S,Lim N K,Lim J Y,et al.Difference in blood pressure between early and late menopausal transition was significant in healthy Korean women[J].BMC Women's Health,2015,15(1):1-7.
[26]Miller C N,Brown L M,Rayalam S,et al.Estrogens,inflammation and obesity:an overview[J].Frontiers in Biology,2012,7(1):40-47.
[27]Mauvais-Jarvis F,Clegg D J,Hevener A L.The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis[J].Endocr Rev,2013,34(3):309-338.
[28]马孝湘,陈晓平,程幼夫.绝经后女性高血压患者血压水平与雌激素、糖化血红蛋白的相关性[J].中华高血压杂志,2014,22(10):974-976.
[29]陈伟,肖扬.高尿酸血症与相关疾病的研究进展[J].中国实验诊断学,2016,20(12):2147-2150.
[30]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[31]中国医师协会心血管内科医师分会.绝经后女性血脂异常管理的中国专家共识[J].中华心血管病杂志,2014,42(4):279-283.
[32]王莉,王雅楠.更年期妇女心理健康状况及其相关因素[J].中国老年学杂志,2011,31(9):1635-1636.
[33]贾丁鑫,金力.更年期妇女抑郁症状发生的影响因素分析[J].更年期保健,2014,29(09):1373-1374.
[34]Shors T J,Leuner B.Estrogen-mediated effects on depression and memory formation in females[J].Journal of Affective Disorders,2003,74(1):85-96.
[35]张莉.围绝经期抑郁症状与血清性激素水平的关联性研究[J].安徽卫生职业技术学院学报,2010,9(2):29-30.
[36]张孟丽,郑桂英,吴艳军,等.围绝经期抑郁的研究进展[J].中国妇幼保健,2013,28(1):5236-5237.
[37]李会,陈红.左旋氨氯地平联合综合性心理干预治疗高血压伴围绝经综合征患者的临床观察[J].现代生物医学进展,2016,16(16):3066-3069.
[38]Hildrum B,Romild U,Holmen J.Anxiety and depression lowers blood pressure:22-year follow-up of the population based HUNT study,Norway[J].BMC Public Health,2011,11(1):1-8.
[39]McAndrew L M,Napolitano M A,Albrecht A,et al.When,why and for whom there is a relationship between physical activity and menopause symptoms[J].Maturitas.2009,64(2):119-125.
[40]臧金凤,赵丕文.雌激素或雌激素样物质对心血管系统的影响及其作用途径与机制[J].世界中医药,2016,11(6):1131-1136.
[41]De Villiers T J,Hall J E,Pinkerton J V,et al.Revised global consensus statement on menopausal hormone therapy[J].Maturitas,2016,91:153-155.
[42]Vitalea C,Mammia C,Gambaccianib M,et al.Effect of hormone replacement therapy with the anti-mineralocorticoid progestin Drospirenone compared to tibolone on endothelial function and central haemodynamics in post-menopausal women[J].Int J Cardiol,2017,227:217-221.
[43]Rohdewald P J.Relief from Menopausal Symptoms by Non-hormonal Treatment with Pycnogenol?(French Maritime Pine Bark Extract)[J].J Genit Syst Diso,2017,5(4):7.