Spencer C P, Godsland I F, Cooper A J, Ross D, Whitehead M I, Stevenson J C
Department of Endocrinology and Metabolism, Imperial College School of Medicine, St. Mary's Hospital, London, UK.
Metabolism. 2000 Jun;49(6):742-7. doi: 10.1053/meta.2000.6238.
Few studies have examined the effects of 17beta-estradiol on parameters of insulin and glucose metabolism. We studied 42 healthy, untreated postmenopausal women seeking relief from menopausal symptoms. They were randomized to receive either oral 17beta-estradiol 2 mg daily combined with sequential oral norethindrone acetate (NETA) 1 mg daily from days 12 to 22, or transdermal 17beta-estradiol 0.05 mg daily combined with sequential oral NETA 1 mg daily from days 17 to 28. Intravenous glucose tolerance tests (IVGTTs) were performed at baseline and after 46 weeks (estrogen-alone phase) and 48 weeks (combined phase) of completed therapy. Mathematical modeling analysis of plasma glucose, insulin, and C-peptide concentration profiles provided measures of insulin resistance, secretion, and elimination. Both types of therapy were associated with a decrease in fasting insulin and glucose levels. Insulin sensitivity was increased by oral estradiol during the estrogen-alone phase but was reversed by the addition of NETA. Transdermal estradiol did not affect insulin sensitivity. Hepatic insulin uptake and insulin secretion were increased with both types of treatment. The oral regimen of estradiol therapy was favorable to both insulin elimination and sensitivity. Transdermal estradiol therapy had relatively few effects on insulin metabolism.
很少有研究探讨17β-雌二醇对胰岛素和葡萄糖代谢参数的影响。我们对42名寻求缓解更年期症状的健康、未接受治疗的绝经后女性进行了研究。她们被随机分为两组，一组每天口服2毫克17β-雌二醇，并在第12天至22天每天序贯口服1毫克醋酸炔诺酮（NETA）；另一组每天经皮给予0.05毫克17β-雌二醇，并在第17天至28天每天序贯口服1毫克NETA。在基线时以及完成治疗46周（仅用雌激素阶段）和48周（联合阶段）后进行静脉葡萄糖耐量试验（IVGTT）。对血浆葡萄糖、胰岛素和C肽浓度曲线进行数学建模分析，以评估胰岛素抵抗、分泌和清除情况。两种治疗方法均与空腹胰岛素和葡萄糖水平降低有关。在仅用雌激素阶段，口服雌二醇可提高胰岛素敏感性，但添加NETA后这种作用被逆转。经皮雌二醇不影响胰岛素敏感性。两种治疗均增加了肝脏对胰岛素的摄取和胰岛素分泌。雌二醇治疗的口服方案对胰岛素清除和敏感性均有利。经皮雌二醇治疗对胰岛素代谢的影响相对较小。
