Abstract:
AIM:To investigate the impact of menopausal hormone therapy (MHT) on the expression of risk factors for cardiovascular events (CVEs) in patients with Shereshevsky-Turner syndrome (STS); to elaborate an algorithm for patient management using MHT. SUBJECTS AND METHODS:From 2010 to 2012, a total of 41 patients aged 14 to 35 years with STS were examined in the framework of a prospective observational study. 100 STS case histories in 2000 to 2009 were retrospectively analyzed. The indicators of the so-called cardiometabolic risk, such as body mass index (BMI), lipidogram readings, venous plasma glucose levels, and blood pressure, were estimated in relation to the type of MHT. In the prospective part of the investigation, an angioscan was used to estimate vessel characteristics (stiffness, wall tone, endothelial function (EF)), by using the examination data. RESULTS:90% of the patients with STS were found to have risk factors for CVEs: atherogenic dyslipidemia (85%; 51% in the general female population of the same age), diastolic hypertension (36%; no more than 5% that is not typical for age-matched healthy general female population). In addition to increased arterial wall stiffness (AWS), obvious EF disorder is typical for STS patients. MHT was accompanied by a dose-dependent (estradiol, at least 2 mg) reduction in diastolic blood pressure by an average of 13% over 24 months, an increase in high density lipoprotein levels by more than 10% over 24 months and also contributedto a decrease in AWS and an improvement in EF. CONCLUSION:By favorably affecting the EF of vessels and reducing the severity of atherogenic dyslipidemia, MHT potentially enables a reduction in CV risk in patients with STS. :Цель исследования. Изучить влияние менопаузальной гормональной терапии (МГТ) на выраженность факторов риска развития сердечно-сосудистых осложнений (ССО) у больных с синдромом Шерешевского-Тернера (СШТ); выработать алгоритм ведения пациенток с использованием МГТ. Материалы и методы. С 2010 по 2012 г. в рамках проспективного наблюдательного исследования обследовали 41 пациентку с СШТ в возрасте от 14 до 35 лет. Проведен ретроспективный анализ 100 историй болезни пациенток с СШТ за период с 2000 по 2009 г. Оценивали показатели так называемого кардиометаболического риска в зависимости от типа МГТ: индекс массы тела (ИМТ), параметры липидограммы, уровень глюкозы в венозной плазме крови, артериальное давление. В проспективной части исследования по данным обследования с помощью аппарата Ангиоскан оценивали характеристики сосудов (ригидность, тонус стенки, функция эндотелия - ФЭ). Результаты. У 90% больных с СШТ выявлялись факторы риска развития ССО: атерогенная дислипидемия (85%; в общей популяции женщин того же возраста 51%), диастолическая артериальная гипертония (36%; нехарактерно для сопоставимых по возрасту здоровых женщин общей популяции, не более 5%). Помимо увеличения жесткости артериальной стенки (ЖАС) для больных с СШТ типично выраженное нарушение ФЭ. МГТ сопровождалась зависимым от дозы (по содержанию эстрадиола не менее 2 мг) снижением уровня диастолического артериального давления в среднем на 13% за 24 мес, повышением уровня липопротеидов высокой плотности более чем на 10% за 24 мес, а также способствовала уменьшению ЖАС и улучшению ФЭ. Заключение. МГТ, благоприятно влияя на ФЭ сосудов и снижая выраженность атерогенной дислипидемии, потенциально способствует уменьшению риска развития ССО у больных с СШТ.
journal_name
Ter Arkhjournal_title
Terapevticheskii arkhivauthors
Yevstigneeva OA,Andreeva EN,Grigoryan OR,Volevodz NN,Melnichenko GA,Dedov IIdoi
10.17116/terarkh2017891048-53subject
Has Abstractpub_date
2017-01-01 00:00:00pages
48-53issue
10eissn
0040-3660issn
2309-5342journal_volume
89pub_type
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doi:
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doi:
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doi:
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doi:
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