Saglam Kenan, Polat Zülfikar, Yilmaz M Ilker, Gulec Mustafa, Akinci Seda B
Gülhane Military Medical Academy, Department of Internal Medicine, Hacettepe University, Etlik-Ankara, Turkey.
Endocrine. 2002 Aug;18(3):211-4. doi: 10.1385/ENDO:18:3:211.
Postmenopausal hormone replacement therapy (HRT) protects women from the risk of cardiovascular system disease, osteoporosis, and dementia. There are conflicting reports about the effects of HRT on insulin resistance. The purpose of this study was to investigate the effects of HRT on insulin resistance with the hyperinsulinemic euglycemic clamp technique, the most sensitive technique measuring insulin resistance. Conjugated estrogen (0.625 mg/d) and medroxyprogesterone acetate (5 mg/d) were given to 15 postmenopausal women with insulin resistance. After 3 mo of HRT, the M value (total glucose consumption) increased 28% (p < 0.001), low-density lipoprotein (LDL) cholesterol decreased 12.9% (p < 0.044), high-density lipoprotein (HDL) cholesterol increased 17% (p < 0.009), total cholesterol decreased 9.1% (p < 0.016), and serum insulin decreased 33% (p < 0.022) compared to baseline values before HRT was started. No significant changes in glucose, C-peptide, and triglyceride levels were observed. Whereas there were no differences regarding glucose, total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels between the insulin-resistant (n = 15) and non-insulin-resistantwomen (n = 24) (p > 0.05), there were significant differences in M value, insulin, and C-peptide levels between these groups (p < 0.05). We believe that HRT with this combination may protect postmenopausal women from coronary artery disease (CAD) through its beneficial effects on insulin resistance, hyperinsulinemia, and lipid levels, which are considered to be important factors in CAD pathogenesis.
绝经后激素替代疗法（HRT）可保护女性免受心血管系统疾病、骨质疏松症和痴呆症的风险。关于HRT对胰岛素抵抗的影响，存在相互矛盾的报道。本研究的目的是采用高胰岛素正常血糖钳夹技术（测量胰岛素抵抗最敏感的技术）研究HRT对胰岛素抵抗的影响。给予15名有胰岛素抵抗的绝经后女性结合雌激素（0.625mg/d）和醋酸甲羟孕酮（5mg/d）。HRT治疗3个月后，与开始HRT前的基线值相比，M值（总葡萄糖消耗量）增加了28%（p<0.001），低密度脂蛋白（LDL）胆固醇降低了12.9%（p<0.044），高密度脂蛋白（HDL）胆固醇增加了17%（p<0.009），总胆固醇降低了9.1%（p<0.016），血清胰岛素降低了33%（p<0.022）。未观察到葡萄糖、C肽和甘油三酯水平有显著变化。胰岛素抵抗组（n=15）和非胰岛素抵抗组女性（n=24）在葡萄糖、总胆固醇、LDL胆固醇、HDL胆固醇和甘油三酯水平方面无差异（p>0.05），但这些组之间的M值、胰岛素和C肽水平存在显著差异（p<0.05）。我们认为，这种联合使用的HRT可能通过对胰岛素抵抗、高胰岛素血症和血脂水平产生有益影响，从而保护绝经后女性免受冠状动脉疾病（CAD）的侵害，而这些因素被认为是CAD发病机制中的重要因素。
