medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»medalphabet-656Research ArticleСтатьиВлияние ультранизкодозированной и стандартной гормональной терапии на фибринолиз и образование тромбина у женщин в постменопаузеEffects of ultra-low-dose versus standard hormone therapy on fibrinolysis and thrombin generation in postmenopausal womenКузнецоваИ. В.KuznetsovaI. V.noemail@neicon.ruДрапкинаЮ. С.DrapkinaYu. S.noemail@neicon.ruФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет)РоссияFirst Moscow State Medical University n.a. I.M. SechenovRussian FederationФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава РоссииРоссияNational Medical Research Centre for Obstetrics, Gynecology and Perinatology n.a. academician V.I. KulakovRussian Federation201828042018213Современная гинекология3538Copyright © Кузнецова И.В., Драпкина Ю.С., 20182018Кузнецова И.В., Драпкина Ю.С.Kuznetsova I.V., Drapkina Y.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/656

Пероральная гормональная терапия (ГТ) ассоциирована с повышением риска венозной тромбоэмболии (ВТЭ), при этом наибольший риск приходится на первый год лечения. Риск ВТЭ зависит от формы выпуска, дозировки и продолжительности ГТ. В рандомизированном контролируемом исследовании, включившем 150 женщин в постменопаузе, было проведено сравнение влияния различных режимов пероральной ГТ на образование тромбина и продуктивность фибринолиза. ГТ применялась в стандартном (1 мг 17ß-эстрадиола / 5 мг дидрогестерона) или ультранизкодозирован-ном режиме (0,5 мг 17ß-эстрадиола / 2,5 мг дидрогестерона). До начала терапии и через 24 недели ее применения оценивались следующие показатели: фибринолитическая активность плазмы (ФАП), активаторы и ингибиторы фибринолиза, образование тромбина (фрагменты протромбина 1+2 [F 1+2], эндогенный тромбиновый потенциал [ETP]), нормализованный показатель чувствительности к активированному протеину C (нчАПС) и активность фактора (F)Viii. Результаты исследования показали, что, в противоположность стандартной ГТ, ультранизкодозированная ГТ может усиливать фибринолиз за счет снижения уровней PAi-1. Впервые показаны значимые различия между комбинированной пероральной ультранизко-дозированной ГТ и стандартной ГТ с точки зрения влияния на фибринолиз и образование тромбина у женщин в постменопаузе.

Oral hormone therapy (HT) is associated with an increased risk of venous thromboembolism (VTE), with the highest risk during the first year of treatment. Differences in the formulation, dose and duration of HT may affect the risk of VTE. A clinical trial was conducted to compare the effects of different oral HT regimens on thrombin generation and efficiency of fibrinolysis in postmenopausal women. 150 postmenopausal women were assigned in a randomized controlled study in which the effect of standard dose (1 mg of 17ß-estradiol / 5 mg of dydrogesterone), ultra-low-dose HT (0.5 mg of 17ß-estradi-ol / 2.5 mg of dydrogesterone) on fibrinolysis and coagulation was compared to controls. Factors measured included plasma clot lysis time (CLT), fibrinolysis activators and inhibitors, thrombin generation (prothrombin fragments 1+2 [F 1+2], endogenous thrombin potential [ETP]), normalized activated protein C sensitivity ratio (nAPCsr), and factor (F)Viii activity and were determined before and after 24 weeks of HT. The results demonstrated that in contrast to the standard HT, ultra-low-dose HT may enhance fibrinolysis through reduced PAi-1 levels. The current study is the first to show significant differences between combined oral ultra-low-dose HT and standard HT in the effects on fibrinolysis and thrombin generation in postmenopausal women.

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The authors declare that there are no conflicts of interest present.