Selda DEMİRCAN, Hasan YÜKSEL, Ali Rıza ODABAŞI, Samet KAFKAS, Ergün ONUR, Pınar ERKAN

DİDROGESTERON İLE İNTRANAZAL VE TRANSDERMAL ÖSTRADİOL KOMBİNASYONUNUN LİPİD, LİPOPROTEİN(A) VE APOLİPOPROTEİNLERE ETKİLERİNİN KARŞILAŞTIRILMASI

Amaç:Bu araştırmanın amacı, postmenopozal kadınlarda, intranazal ve transdermal 17didrogesteronun kombine kesintisiz hormon replasman tedavisinin, serum lipid, lipoprotein(a) ve apolipoproteindüzeyleri üzerindeki etkilerini karşılaştırmaktır.Gereç ve Yöntem:Bu prospektif araştırmaya yaşları 43-54 arasında değişen, sağlıklı 50 postmenopozal kadındahil edildi. Olgular, 12 hafta süre ile 300μg/g17β- östradiol (n=25) almak üzere iki gruba randomize edildi. Bütün olgulara 10 mg/gün oral didrogesteronkesintisiz verildi. Araştırmanın başında ve sonunda, total kolesterol, trigliserid, HDL, LDL, VLDL,lipoprotein(a), Apo A-I ve Apo B düzeyleri, grup içi ve gruplar arasında farkın yüzdeleri karşılaştırıldı.İstatistiksel analiz için Mann-Whitney U ve Wilcoxon testi kullanıldı. P<0,05 anlamlı kabul edildi.Bulgular:Araştırmayı, intranazal grubunda 16, transdermal gurubunda 18 olmak üzere 34 olgu tamamladı.İntranazal östradiol grubunda, tedavi başlangıcına kıyasla, tedavi sonunda sadece apolipoprotein B düzeyindeanlamlı bir azalma izlenirken (2,0±0,4'den 0,9±0,1'ye, p=0,028), total kolesterol, trigliserid, HDL, LDL, VLDL,lipoprotein(a) ve Apo A-I düzeylerinde anlamlı değişiklik izlenmedi. Transdermal östradiol gurubunda hiçbirdeğişkende anlamlı değişiklik gözlenmedi. Her iki grup arasında, tüm değişkenler açısından anlamlı farklılıkyoktu.Sonuç:İntranazal ve transdermal östradiolün, didrogesteron kombinasyonuyla yapılan kesintisiz hormonreplasman tedavisinin, total kolesterol, trigliserid, HDL, LDL, VLDL, lipoprotein(a) ve Apo A-I düzeylerineetkileri benzerdir

Anahtar Kelimeler:

İntranazal ve transdermal östradiol, didrogesteron, lipid, lipoprotein(a), apolipoprotein

Comparison of the Effects of Intranasal and Transdermal Estradiol Plus Dydrogestorone on Lipids, Lipoprotein(a) and Apolipoproteins in Postmenopausal Women

Objective: To compare the effects of continuous hormon replacement therapy in the form of intranasal and transdermal 17β-estradiol combined with dydrogesterone on serum lipids, lipoprotein(a) and apolipoproteins among postmenopausal women. Materials and methods: In this prospective study, 50 healthy postmenopausal women aged 43-54 years were randomly assigned to receive either 300 μg/day intranasal 17β- estradiol (n=25) or 50 μg/day transdermal 17β- estradiol (n=25) for 12 weeks. All women also received 10 mg/day oral dydrogesterone continuously. At the end of the study, changes in serum total cholesterol, triglyceride, HDL, LDL, VLDL, lipoprotein(a), Apo A-I and Apo B levels within and percent changes between the groups were compared. Mann-Whitney U and Wilcoxon tests were used as indicated. P-values below 0.05 were considered significant. Results: Thirty-four women completed this study (intranasal group, n=16; transdermal group, n=18). In intranasal estradiol group, only apolipoprotein B levels were decreased significantly after 12 weeks of treatment (2.0±0.4 to 0.9±0.1, p=0.028) whereas no changes in the levels of total cholesterol, triglyceride, HDL, LDL, VLDL, lipoprotein(a) and Apo A-I were observed. Also, in transdermal estradiol group, no significant changes were seen in all variables. No significant differences with regard to variables were noted between the groups at the end of the study. Conclusions: The effects of intranasal and transdermal estradiol plus dydrogestorone asa continouos hormone replacement therapy on the serum total cholesterol, triglyceride, HDL, LDL, VLDL, lipoprotein(a) and Apo A-I levels are similar in postmenopausal women.

Keywords:

Intranasal and transdermal estradiol, dydrogesterone, lipid, lipoprotein(a), apolipoprotein,

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