女性原发性高血压患者不同年龄性激素与肾素-血管紧张素-醛固酮系统的变化及相关性分析

    Changes and correlation analysis of sex hormones and renin angiotensin aldosterone system in female patients with primary hypertension at different ages

      摘要
    • 摘要:
      目的 分析生育期、围绝经期及绝经后原发性高血压女性血清性激素及肾素-血管紧张素-醛固酮系统（RAAS）差异是否有统计学意义，探讨二者在不同年龄高血压女性中的关系。
      方法 选取2020年11月～2023年11月甘肃省人民医院就诊的原发性高血压女性207例，分为生育期女性(A组，n=51)、围绝经期女性（B组，n=79）和绝经后女性（C组，n=77）三个组。比较三组患者雌激素（E2）、睾酮（T）、泌乳素（PRL）、促卵泡激素（FSH）、促黄体生成素（LH）、硫酸脱氢表雄酮（DHEA-S）、孕激素（P）及卧立位肾素（PRA）、血管紧张素（Ang）、醛固酮（ALD）水平，并采用Spearman法分别分析三组患者性激素与RAAS的关系。
      结果 生育期女性(A组)、围绝经期女性（B组）和绝经后女性（C组）中，三组患者性激素E2、FSH、DHEA-S、P存在差异（P<0.05），而T仅A组和C组差异有统计学意义（P<0.05），A组LH显著高于B组和C组（P<0.01），三组患者RAAS仅立位Ang II存在差异（P<0.05）。Spearman相关性分析显示，B组 E2与立位PRA、ALD、Ang II及卧位ALD（r=−0.408，P<0.01；r=−0.362，P<0.01；r=−0.278，P<0.01及r=−0.505，P<0.01）负相关；FSH与立位ALD、Ang II及卧位PRA（r=0.316，P<0.01；r=0.344，P<0.01及r=0.438，P<0.01）正相关；LH与立位ALD、Ang II及卧位PRA、ALD（r=0.340，P<0.01；r=0.352，P<0.01及r=0.439，P<0.01；r=0.374，P<0.05）正相关；P与立位PRA、Ang II及卧位PRA（r=−0.230，P<0.05；r=−0.368，P<0.01及r=−0.334，P<0.05）负相关。C组E2下降，而卧立位RAAS成分却矛盾性的下降了，尤其是立位Ang II。
      结论 相较生育期及绝经后高血压女性，围绝经期女性RAAS水平与性激素改变相关，RAAS的激活参与围绝经期女性高血压的起始及进展过程。

       

      Abstract:
      AIM  To analyze whether there were statistically significant differences in serum sex hormones and renin angiotensin aldosterone system (RAAS) in women with primary hypertension during the reproductive period, the perimenopausal period and the postmenopausal period and to explore the relationship between sex hormones and RAAS in hypertensive women of different ages.
      METHODS 207 women with primary hypertension who visited the People’s Hospital of Gansu Province from November 2020 to November 2023 were selected and divided into three groups: reproductive women (Group A, n=51), perimenopausal women (Group B, n=79), and postmenopausal women (Group C, n=77). Compare the estrogen (E2), testosterone (T), prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), progesterone (P), and levels of renin (PRA) and aldosterone (ALD) in supine and upright positions among three groups of patients, And the Spearman method was used to analyze the relationship between sex hormones and RAAS in three groups of patients.
      RESULTS In reproductive-age women (Group A), perimenopausal women (Group B), and postmenopausal women (Group C), there were significant differences in the hormones E2, FSH, DHEA-S, and P among the three groups (P<0.05), with only Groups A and C showing significant differences in T (P<0.05). LH in Group A was significantly higher than in Groups B and C (P<0.01), and among the three groups, only the standing position Ang II of RAAS showed differences (P<0.05). Spearman correlation analysis showed negative correlations between E2 in Group B and standing PRA, ALD, Ang II, and supine ALD (r=−0.408, P<0.01; r=−0.362, P<0.01; r=−0.278, P<0.01; and r=−0.505, P<0.01), positive correlations between FSH and standing ALD, Ang II, and supine PRA (r=0.316, P<0.01; r=0.344, P<0.01; and r=0.438, P<0.01), positive correlations between LH and standing ALD, Ang II, and supine PRA, ALD (r=0.340, P<0.01; r=0.352, P<0.01; and r=0.439, P<0.01; r=0.374, P<0.05), and negative correlations between P and standing PRA, Ang II, and supine PRA (r=−0.230, P<0.05; r=−0.368, P<0.01; and r=−0.334, P<0.05). In Group C, E2 decreased, while the components of RAAS in the supine and standing positions paradoxically decreased, especially standing Ang II.
      CONCLUSION Compared with women with reproductive and postmenopausal hypertension, the levels of RAAS in perimenopausal women are significantly correlated with changes in sex hormones, and the activation of RAAS may be involved in the initiation and progression of hypertension in perimenopausal women.

       

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