绝经后不同阶段内源性雄激素与胰岛素抵抗的相关性研究
절경후불동계단내원성웅격소여이도소저항적상관성연구
Study on relationship between endogenous androgens and insulin resistance at the different stages of postmenopause
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2013年 10期 740-744 ,共5页

    曹远奎%张绍芬%邹世恩%夏贤%许琳娜

    조원규%장소분%추세은%하현%허림나

    绝经期%雄激素类%胰岛素抵抗 絕經期%雄激素類%胰島素牴抗
    절경기%웅격소류%이도소저항
    Menopause%Androgens%Insulin resistance
    目的 探讨绝经后早期、晚期内源性雄激素水平及活性变化与胰岛素抵抗之间的相关性.方法 募集2009年9月至2011年9月在复旦大学附属妇产科医院就诊的绝经后早期妇女(绝经时间≤5年)105例(绝经后早期组)、绝经后晚期妇女(绝经时间≥10年)107例(绝经后晚期组),并进一步根据体质指数(BMI)分为正常体质量者(BMI＜ 24 kg/m2)和超重者(BMI≥24 kg/m2).采用全自动生化分析仪测定空腹血糖(FBG)水平；采用全自动化学发光仪测定睾酮、硫酸脱氢表雄酮(DHEA-S)、性激素结合球蛋白(SHBG)及空腹胰岛素(FINS)水平,并计算游离雄激素指数(FAI,代表雄激素活性)和稳态模型胰岛素抵抗指数(HOMA-IR)；采用偏相关分析法、多元线性回归法分析SHBG、FAI、睾酮、DHEA-S与胰岛素抵抗的相关性.结果 绝经后晚期组妇女FINS[(7.9±6.6) mU/L]、HOMA-IR(2.1±1.9)高于绝经后早期组[FINS水平为(6.6 ±4.0) mU/L、HOMA-IR为1.7±1.1],而绝经后晚期组DHEA-S为(0.9±0.5)mg/L,低于绝经后早期组的(1.1 ±0.5) mg/L,两组上述各指标间分别比较,差异均有统计学意义(P＜0.05).两组妇女中,超重者HOMA-IR(绝经后早期组为2.2±1.0；绝经后晚期组为2.8±2.6)、FINS[绝经后早期组(6.9±2.9)mU/L；绝经后晚期组(10.2 ±9.3)mU/L]高于正常体质量者HOMA-IR(绝经后早期组为1.2±0.9；绝经后晚期组为1.6±1.1)、FINS[绝经后早期组(4.6±2.0)mU/L；绝经后晚期组(6.4±3.6)mU/L],差异有统计学意义(P＜0.05).绝经后早期组妇女中,超重者SHBG[(52±37) nmol/L]低于正常体质量者[(71±37) nmol/L],而超重者FAI(2.5 ±2.1)高于正常体质量者(1.3±1.1)；在绝经后晚期组妇女中,超重者DHEA-S为(1.0±0.5)mg/L,高于正常体质量者的(0.8±0.4)mg/L,分别比较差异均有统计学意义(P＜0.05).绝经后早期组妇女SHBG与FINS、HOMA-IR呈负相关(β值分别为-0.386、-0.553,P均＜0.05),DHEA-S与FBG呈正相关(β=0.348,P＜0.05)；绝经后晚期妇女FAI与FBG呈正相关(β=0.505,P＜0.05).结论 绝经后雄激素活性相对升高与胰岛素抵抗风险增加有关,这种相关性在绝经后不同阶段表现有所不同,主要表现为在绝经后早期SHBG与胰岛素抵抗风险增加呈负相关,DHEA-S与血糖升高风险呈正相关；在绝经后晚期,FAI与血糖升高风险呈正相关.
    목적 탐토절경후조기、만기내원성웅격소수평급활성변화여이도소저항지간적상관성.방법 모집2009년9월지2011년9월재복단대학부속부산과의원취진적절경후조기부녀(절경시간≤5년)105례(절경후조기조)、절경후만기부녀(절경시간≥10년)107례(절경후만기조),병진일보근거체질지수(BMI)분위정상체질량자(BMI＜ 24 kg/m2)화초중자(BMI≥24 kg/m2).채용전자동생화분석의측정공복혈당(FBG)수평；채용전자동화학발광의측정고동、류산탈경표웅동(DHEA-S)、성격소결합구단백(SHBG)급공복이도소(FINS)수평,병계산유리웅격소지수(FAI,대표웅격소활성)화은태모형이도소저항지수(HOMA-IR)；채용편상관분석법、다원선성회귀법분석SHBG、FAI、고동、DHEA-S여이도소저항적상관성.결과 절경후만기조부녀FINS[(7.9±6.6) mU/L]、HOMA-IR(2.1±1.9)고우절경후조기조[FINS수평위(6.6 ±4.0) mU/L、HOMA-IR위1.7±1.1],이절경후만기조DHEA-S위(0.9±0.5)mg/L,저우절경후조기조적(1.1 ±0.5) mg/L,량조상술각지표간분별비교,차이균유통계학의의(P＜0.05).량조부녀중,초중자HOMA-IR(절경후조기조위2.2±1.0；절경후만기조위2.8±2.6)、FINS[절경후조기조(6.9±2.9)mU/L；절경후만기조(10.2 ±9.3)mU/L]고우정상체질량자HOMA-IR(절경후조기조위1.2±0.9；절경후만기조위1.6±1.1)、FINS[절경후조기조(4.6±2.0)mU/L；절경후만기조(6.4±3.6)mU/L],차이유통계학의의(P＜0.05).절경후조기조부녀중,초중자SHBG[(52±37) nmol/L]저우정상체질량자[(71±37) nmol/L],이초중자FAI(2.5 ±2.1)고우정상체질량자(1.3±1.1)；재절경후만기조부녀중,초중자DHEA-S위(1.0±0.5)mg/L,고우정상체질량자적(0.8±0.4)mg/L,분별비교차이균유통계학의의(P＜0.05).절경후조기조부녀SHBG여FINS、HOMA-IR정부상관(β치분별위-0.386、-0.553,P균＜0.05),DHEA-S여FBG정정상관(β=0.348,P＜0.05)；절경후만기부녀FAI여FBG정정상관(β=0.505,P＜0.05).결론 절경후웅격소활성상대승고여이도소저항풍험증가유관,저충상관성재절경후불동계단표현유소불동,주요표현위재절경후조기SHBG여이도소저항풍험증가정부상관,DHEA-S여혈당승고풍험정정상관；재절경후만기,FAI여혈당승고풍험정정상관.
    Objective To investigate the relationship between insulin resistance and endogenous androgens at early and late phase of postmenopause.Methods A total of 105 women with early postmenopause (≤5 years since menopause) and 107 women with late postmenopause (≥ 10 years since menopause) were enrolled in this study.In the mean time,those women were classified into normal weight [body mass index (BMI),BMI ＜24 kg/m2] group and overweight (BMI≥24 kg/m2) group.Sex hormonebinding globulin (SHBG),testosterone (T),dehydroepiandrosterone-sulfate (DHEA-S),fasting blood glucose(FBG),fasting insulin (FINS)levels were measured and then calculated free androgen index(FAI) and homeostatic model assessment of insulin resistance (HOMA-IR).The relationship between sex hormones and insulin resistance was analyzed by partial correlation and multiple linear regression analyses.Results Compared to early postmenopausal women,late postmenopausal women had higher FINS [(7.9 ± 6.6) mU/L versus (6.6 ±4.0) mU/L] and HOMA-IR(2.1 ± 1.9 versus 1.7 ± 1.1),but they had lower DHEA-S [(0.9 ± 0.5) mg/L versus (1.1 ± 0.5) mg/L,all P ＜ 0.05)].Both in early postmenopausal and late postmenopausal groups,overweight women had higher HOMA-IR (early group,2.2 ± 1.0 versus 1.2 ±0.9 ; late group,2.8 ± 2.6 versus 1.6±1.1)and FINS early group[(6.9±2.9) mU/L versus (4.6±2.0) mU/L] ;late group [(10.2 ± 9.3) mU/L versus (6.4 ± 3.6) mU/L] than those at women with normal weight group(all P ＜ 0.05).In early postmenopausal group,overweight women had lower SHBG [(52 ±37) nmol/L versus (71 ±37) nmol/L] and higher FAI(2.5 ±2.1) versus (1.3 ± 1.1) than those at normal weight women group(all P ＜ 0.05).In late postmenopausal group,overweight women had higher DHEA-S (1.0 ± 0.5) mg/L versus (0.8 ± 0.4) mg/L (P ＜ 0.05).The analyses suggested that in early postmenopausal group,SHBG was correlated negatively with FINS and HOMA-IR (β =-0.386,P ＜ 0.05 ;β =-0.553,P ＜0.05),DHEA-S was correlated positively with FBG (β =0.348,P ＜ 0.05) in early postmenopausal group.FAI was correlated positively with FBG in late postmenopausal group (β =0.505,P ＜ 0.05).Conclusions The increased androgenic activities are associated with insulin resistance after of menopause.These correlations are different at different stages of postmenopause,which SHBG levels correlate with high risk of insulin resistance and DHEA-S levels correlates with high blood glucose levels at early postmenopause and FAI correlates with high blood glucose levels at late postmenopause.
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