Escalante Pulido J M, Alpizar Salazar M
Departamento Clínico de Endocrinología, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
Arch Med Res. 1999 Jan-Feb;30(1):19-22. doi: 10.1016/s0188-0128(98)00008-6.
Several clinical conditions suggest an effect of sex steroids on glucose homeostasis in women. Studies examining this phenomenon have yielded controversial results.
To investigate the effect of the menstrual cycle on insulin sensitivity, glucose effectiveness and acute insulin response to glucose using the tolbutamide-modified intravenous glucose tolerance test (IVGTT) during the follicular (day 8 +/- 1) and luteal (day 23 +/- 1) phases of the menstrual cycle, the authors recruited 12 healthy regularly menstruating women. All had fasting glucose concentration of < 100 mg/dl [corrected] (89.7 +/- 6.2) with no family history of diabetes mellitus; their body mass indices were < 25 kg/m2 (22.41 +/- 1.44 kg/m2).
The mean insulin sensitivity (Si) values decreased during the cycle. Insulin sensitivity (Si x 10(-4)/min.mU/ml) was higher in the follicular phase (5.03 +/- 0.72) and decreased in the luteal phase (2.22 +/- 0.45) (p < 0.001). Glucose effectiveness (Sg min-1) did not change as a function of the phase of the menstrual cycle. Sg estimates were 0.0229 +/- 0.00323 in the follicular phase, and 0.0225 +/- 0.00319 (p = NS) in the luteal phase, respectively. Acute insulin response (AIRg mU/ml) was 276.4 +/- 27.8 in the follicular phase. An adaptive increase (304.4 +/- 51.1) in response to the insulin resistance during the luteal phase was observed, but this increase was not statistically significant (p = NS).
Knowledge of the variations in insulin sensitivity that occur during the normal menstrual cycle provides a basis of comparison for studies of other clinical conditions. Also, this phenomenon should be considered if the determination of insulin resistance is the purpose of certain epidemiological studies.
多种临床情况提示性类固醇对女性葡萄糖稳态有影响。研究这一现象的结果存在争议。
为了使用甲苯磺丁脲改良的静脉葡萄糖耐量试验（IVGTT），在月经周期的卵泡期（第8±1天）和黄体期（第23±1天）研究月经周期对胰岛素敏感性、葡萄糖效能及对葡萄糖的急性胰岛素反应的影响，作者招募了12名月经规律的健康女性。所有人空腹血糖浓度<100mg/dl[校正后]（89.7±6.2），且无糖尿病家族史；她们的体重指数<25kg/m²（22.41±1.44kg/m²）。
胰岛素敏感性（Si）均值在月经周期中降低。卵泡期胰岛素敏感性（Si×10⁻⁴/min·mU/ml）较高（5.03±0.72），黄体期降低（2.22±0.45）（p<0.001）。葡萄糖效能（Sg min⁻¹）并不随月经周期阶段而变化。卵泡期Sg估计值为0.0229±0.00323，黄体期为0.0225±0.00319（p=无显著性差异）。卵泡期急性胰岛素反应（AIRg mU/ml）为276.4±27.8。观察到黄体期对胰岛素抵抗有适应性增加（304.4±51.1），但这种增加无统计学意义（p=无显著性差异）。
了解正常月经周期中发生的胰岛素敏感性变化为其他临床情况的研究提供了比较基础。此外，如果某些流行病学研究的目的是测定胰岛素抵抗，那么这一现象也应予以考虑。
