Lee Cathy C, Kasa-Vubu Josephine Z, Supiano Mark A
Department of Pediatrics, Division of Geriatrics, University of Michigan Health System, Ann Arbor, MI, USA.
Metabolism. 2004 Apr;53(4):507-12. doi: 10.1016/j.metabol.2003.10.018.
An increase in androgenicity may contribute to the development of insulin resistance in postmenopausal women. Increased androgenicity in women has been found to be associated with the development of type 2 diabetes. In addition, obesity and central obesity are associated with greater androgenicity. Insulin sensitivity, androgenicity, and body composition were characterized in 34 nondiabetic postmenopausal women age 72 +/- 1 years (mean +/- SEM) to test the hypothesis that androgenicity is a predictor of insulin sensitivity independent of measures of obesity. Androgenicity was measured using levels of sex hormone-binding globulin (SHBG), total and free testosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione, and free androgen index (FAI). Insulin sensitivity (S(I)) was determined from a frequently sampled intravenous glucose tolerance test. Body composition measures included body mass index (BMI) and dual energy x-ray absorptiometry measurements of total and central fat mass. S(I) was found to be associated with total fat mass (r = -.51, P =.002), central fat mass (r = -.62, P =.0001), BMI (r = -.55, P =.0008), SHBG levels (r =.65, P =.0001), and FAI (r = -.41, P =.01). SHBG levels were inversely correlated with central fat mass (r = -.59, P =.0002). Using multiple regression, SHBG and central fat mass were the only significant independent predictors of S(I), accounting for 50% of its variance (r =.71, P =.0001); total fat mass, BMI, total and free testosterone, DHEA-S, androstenedione, and FAI did not enter the model. We conclude that there is a significant association between insulin sensitivity and androgenicity in postmenopausal women that is independent of obesity. Interventions to decrease androgenicity may therefore be useful in improving insulin sensitivity in postmenopausal women.
雄激素水平升高可能促使绝经后女性发生胰岛素抵抗。研究发现，女性雄激素水平升高与2型糖尿病的发生有关。此外，肥胖及中心性肥胖与更高的雄激素水平相关。本研究对34名年龄为72±1岁（均值±标准误）的非糖尿病绝经后女性的胰岛素敏感性、雄激素水平及身体成分进行了评估，以验证雄激素水平是独立于肥胖指标之外的胰岛素敏感性预测因素这一假设。采用性激素结合球蛋白（SHBG）、总睾酮及游离睾酮、硫酸脱氢表雄酮（DHEA-S）、雄烯二酮水平及游离雄激素指数（FAI）来评估雄激素水平。通过频繁采样静脉葡萄糖耐量试验测定胰岛素敏感性（S(I)）。身体成分测量指标包括体重指数（BMI）以及采用双能X线吸收法测量的总体脂和中心脂肪量。结果发现，S(I)与总体脂量（r = -0.51，P = 0.002）、中心脂肪量（r = -0.62，P = 0.0001）、BMI（r = -0.55，P = 0.0008）、SHBG水平（r = 0.65，P = 0.0001）及FAI（r = -0.41，P = 0.01）相关。SHBG水平与中心脂肪量呈负相关（r = -0.59，P = 0.0002）。多元回归分析显示，SHBG及中心脂肪量是S(I)仅有的显著独立预测因素，可解释其50%的变异（r = 0.71，P = 0.0001）；总体脂量、BMI、总睾酮及游离睾酮、DHEA-S、雄烯二酮和FAI未纳入该模型。我们得出结论，绝经后女性的胰岛素敏感性与雄激素水平之间存在显著关联，且独立于肥胖因素。因此，降低雄激素水平的干预措施可能有助于改善绝经后女性的胰岛素敏感性。
