绝经后女性的激素替代疗法、胰岛素敏感性与腹部肥胖

Hormone replacement therapy, insulin sensitivity, and abdominal obesity in postmenopausal women.

作者信息

Ryan Alice S, Nicklas Barbara J, Berman Dora M

机构信息

Department of Medicine, Division of Gerontology at the University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.

出版信息

Diabetes Care. 2002 Jan;25(1):127-33. doi: 10.2337/diacare.25.1.127.

DOI:10.2337/diacare.25.1.127

PMID:11772913

Abstract

OBJECTIVE

The purpose of this study was to determine whether insulin sensitivity differs between postmenopausal women taking estradiol, women on estrogen plus progesterone hormone replacement therapy (HRT), and women not on HRT and whether differences are explained by the differences in total and/or abdominal adiposity and fat deposition in the muscle.

RESEARCH DESIGN AND METHODS

We studied 28 obese, sedentary postmenopausal Caucasian women. Women taking oral estrogen (n = 6) were matched for age (57 +/- 3 vs. 58 +/- 2 years), weight (87.9 +/- 6.0 vs. 83.0 +/- 3.9 kg), and BMI (33.9 +/- 1.7 vs. 33.9 +/- 1.9 kg/m(2)) with women not on HRT (n = 6). Eight women taking oral estrogen plus progesterone were matched with eight different women not on HRT for age (59 +/- 2 vs. 60 +/- 2 years), weight (82.8 +/- 3.7 vs. 83.7 +/- 4.1 kg), and BMI (30.7 +/- 1.0 vs. 29.9 +/- 1.3 kg/m(2)).

RESULTS

VO(2max) (maximal aerobic capacity), percentage of fat, total body fat mass, and fat-free mass (FFM) were similar between groups. Visceral fat, subcutaneous abdominal fat, sagittal diameter, and mid-thigh low-density lean tissue (intramuscular fat) did not differ by hormone status. Basal carbohydrate and fat utilization was not different among groups. Fasting plasma glucose and insulin did not differ by hormone use. Glucose utilization (M) was measured during the last 30 min of a 3-h hyperinsulinemic-euglycemic clamp (40 mU. m(2). min(-1)). Postmenopausal women taking oral estrogen had a 31% lower M than women not on HRT (42.7 +/- 4.0 vs. 61.7 +/- 4.7 micromol. kg(FFM). min(-1), P < 0.05). M was 26% lower in women taking estrogen plus progesterone (44.0 +/- 3.5 vs. 59.7 +/- 6.2 micromol. kg(FFM). min(-1), P < 0.05) than women not on HRT. M/I, the amount of glucose metabolized per unit of plasma insulin (I), an index of insulin sensitivity, was 36% lower in women taking estrogen compared with matched women not on HRT (P < 0.05) and 28% lower in women taking estrogen plus progesterone compared with matched women not on HRT (P < 0.05).

CONCLUSIONS

Postmenopausal women taking oral estrogen or those taking a combination of estrogen and HRT are more insulin-resistant than women not on HRT, even when women are of comparable total and abdominal adiposity.

摘要

目的

本研究旨在确定服用雌二醇的绝经后女性、接受雌激素加孕激素激素替代疗法（HRT）的女性以及未接受HRT的女性之间胰岛素敏感性是否存在差异，以及这些差异是否可由总体和/或腹部肥胖及肌肉脂肪沉积的差异来解释。

研究设计与方法

我们研究了28名肥胖、久坐的绝经后白人女性。服用口服雌激素的女性（n = 6）在年龄（57±3岁对58±2岁）、体重（87.9±6.0千克对83.0±3.9千克）和体重指数（BMI）（33.9±1.7千克/米²对33.9±1.9千克/米²）方面与未接受HRT的女性（n = 6）相匹配。8名服用口服雌激素加孕激素的女性与8名不同的未接受HRT的女性在年龄（59±2岁对60±2岁）、体重（82.8±3.7千克对83.7±4.1千克）和BMI（30.7±1.0千克/米²对29.9±1.3千克/米²）方面相匹配。

结果

各组之间的最大摄氧量（VO₂max，最大有氧能力）、脂肪百分比、全身脂肪量和去脂体重（FFM）相似。内脏脂肪、腹部皮下脂肪、矢状径和大腿中部低密度瘦组织（肌内脂肪）在激素状态方面没有差异。各组之间基础碳水化合物和脂肪利用率没有差异。空腹血糖和胰岛素在激素使用方面没有差异。在3小时高胰岛素-正常血糖钳夹（40 mU·m²·min⁻¹）的最后30分钟内测量葡萄糖利用率（M）。服用口服雌激素的绝经后女性的M比未接受HRT的女性低31%（42.7±4.0对61.7±4.7微摩尔·千克（FFM）·min⁻¹，P<0.05）。服用雌激素加孕激素的女性的M比未接受HRT的女性低26%（44.0±3.5对59.7±6.2微摩尔·千克（FFM）·min⁻¹，P<0.05）。M/I，即每单位血浆胰岛素（I）代谢的葡萄糖量，是胰岛素敏感性的指标，服用雌激素的女性与匹配的未接受HRT的女性相比低36%（P<0.05），服用雌激素加孕激素的女性与匹配的未接受HRT的女性相比低28%（P<0.05）。