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目的:探讨中老年妇女血清雌激素水平与冠心病(CHD)和心功能的相关性,及其运动试验对冠心病的诊断价值。方法:选取因发作性胸痛胸闷症状疑诊CHD入院的中老年妇女85例,根据月经状况,分为围绝经期组29例,绝经后组56例。所有病例均经次极量踏车运动试验(SBET,B ruce方案)、选择性冠状动脉造影(SCAG)与左心导管检查及血清雌二醇(E2)水平测定,对比统计分析两组间E2、CHD危险因素、SCAG结果及心功能指标等改变。结果:①绝经后组的平均年龄、CHD患病率(67.9%vs 6.9%)、血胆固醇水平显著高于围绝经期组,而血清E2水平却显著低于后者(P<0.01),高血压患病率在两组间无统计学差异(P>0.05);②绝经后组的左室射血分数(LVEF)显著低于围绝经期组,左室舒张末压(LVEDP)显著高于后者(P<0.01);③绝经后组的SBET真阳性数显著高于围绝经期组,真阴性数及SBET阴性的准确性显著低于后者(P<0.01或P<0.05)。结论:①与围绝经期妇女比较,老年绝经后妇女血清雌激素水平更低,更易发生脂代谢异常、冠心病及心脏收缩与舒张功能的不利改变;②围绝经期妇女运动试验阴性者,基本可排除冠心病;③中老年妇女冠心病的诊断应最后由SCAG确定。
Objective: To investigate the correlation between serum estrogen level and coronary heart disease (CHD) and heart function in middle-aged and elderly women and the diagnostic value of exercise test on coronary heart disease. Methods: A total of 85 middle-aged and elderly women were selected for CHD admitted to hospital due to suspected chest pain due to chest pain. According to the menstrual status, they were divided into 29 cases of perimenopausal group and 56 cases of menopausal group. All patients were sub-maximal treadmill exercise test (SBET, B ruce program), selective coronary angiography (SCAG) and left cardiac catheterization and serum estradiol (E2) levels were compared between the two groups by statistical analysis of E2 , CHD risk factors, SCAG results and cardiac function changes. Results: ①The average age of postmenopausal group, the prevalence of CHD (67.9% vs 6.9%), the level of serum cholesterol were significantly higher than those in perimenopausal group, but the level of serum E2 was significantly lower than the latter (P <0.01) The prevalence of blood pressure had no significant difference between the two groups (P> 0.05). ② The left ventricular ejection fraction (LVEF) of postmenopausal group was significantly lower than that of perimenopausal group, and the left ventricular end-diastolic pressure (LVEDP) (P <0.01). ③The true positive number of SBET in postmenopausal group was significantly higher than that in perimenopausal group. The true negative number and SBET negative rate were significantly lower than those in the latter (P <0.01 or P <0.05). Conclusion: ① Compared with perimenopausal women, the elderly postmenopausal women have lower serum estrogen levels, more prone to abnormal lipid metabolism, coronary heart disease and adverse cardiac systolic and diastolic changes; ② perimenopausal women with negative exercise test, the basic Can rule out coronary heart disease; ③ diagnosis of coronary heart disease in middle-aged and elderly women should be finally determined by SCAG.