绝经后女性的血清雄激素水平与胰岛素抵抗：与激素治疗、替勃龙和雷洛昔芬的关联

Serum androgen levels and insulin resistance in postmenopausal women: association with hormone therapy, tibolone and raloxifene.

作者信息

Christodoulakos G, Lambrinoudaki I, Panoulis C, Sioulas V, Rizos D, Caramalis G, Botsis D, Creatsas G

机构信息

2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, V. Sofias 76, GR-11528, Athens, Greece.

出版信息

Maturitas. 2005 Apr 11;50(4):321-30. doi: 10.1016/j.maturitas.2004.08.002.

DOI:10.1016/j.maturitas.2004.08.002

PMID:15780533

Abstract

OBJECTIVE

To assess endogenous androgen and insulin resistance status in postmenopausal women receiving continuous combined hormone therapy (HT), tibolone, raloxifene or no therapy.

METHODS

A total of 427 postmenopausal women aged 42-71 years were studied in a cross-sectional design. Among them 84 were taking HT (46 women conjugated equine estrogens 0.625 mg; medroxyprogesterone acetate, 5 mg, CEE/MPA; and 38 women 17beta-estradiol 2 mg; norethisterone acetate 1 mg, E2/NETA); 83 were taking tibolone 2.5 mg; 50 were taking raloxifene HCl 60 mg; and 210 women were not receiving any therapy. Main outcome measures were FSH, LH, estradiol, total testosterone, SHBG, free androgen index (FAI), Delta4-Androstendione (Delta4-A), Dehydroepiandrosterone sulphate (DHEAS) and HOMA insulin resistance index (HOMA-IR).

RESULTS

In women not on hormone therapy smoking and older age was associated with lower DHEAS levels. FAI values increased linearly with increasing BMI. Age and BMI were positive determinants of HOMA-IR, while no association was identified between endogenous sex steroids and insulin resistance. CEE/MPA therapy was associated with higher SHBG, lower FAI and lower HOMA-IR values compared to women not on therapy (age and BMI-adjusted SHBG: CEE/MPA 148.8 nmol/l, controls 58.7 nmol/l, p < 0.01; age-adjusted FAI: CEE/MPA 0.8, controls 3.2, p < 0.05; age-adjusted HOMA-IR: CEE/MPA 1.3, controls 2.6, p < 0.05). On the contrary, E2/NETA treatment had no effect on these parameters. Women on tibolone had lower SHBG, higher FAI and similar HOMA-IR values compared to controls (age and BMI-adjusted SHBG: 24.1 nmol/l, p < 0.01; FAI: 6.0, p < 0.05; HOMA-IR: 2.3, p = NS). Raloxifene users did not exhibit any difference with respect to sex steroids and HOMA-IR levels.

CONCLUSIONS

CEE/MPA users had lower free testosterone and improved insulin sensitivity. Tibolone on the other hand associated with higher free testosterone, while raloxifene did not relate to any of these parameters.

摘要

目的

评估接受连续联合激素治疗（HT）、替勃龙、雷洛昔芬或未接受治疗的绝经后女性的内源性雄激素和胰岛素抵抗状况。

方法

采用横断面设计对427名年龄在42 - 71岁的绝经后女性进行研究。其中84名女性接受HT治疗（46名女性服用结合马雌激素0.625mg；醋酸甲羟孕酮5mg，CEE/MPA；38名女性服用17β-雌二醇2mg；醋酸炔诺酮1mg，E2/NETA）；83名女性服用替勃龙2.5mg；50名女性服用盐酸雷洛昔芬60mg；210名女性未接受任何治疗。主要观察指标为促卵泡激素（FSH）、促黄体生成素（LH）、雌二醇、总睾酮、性激素结合球蛋白（SHBG）、游离雄激素指数（FAI）、Δ4-雄烯二酮（Δ4-A）、硫酸脱氢表雄酮（DHEAS）和稳态模型胰岛素抵抗指数（HOMA-IR）。

结果

未接受激素治疗的女性中，吸烟和年龄较大与较低的DHEAS水平相关。FAI值随体重指数（BMI）升高呈线性增加。年龄和BMI是HOMA-IR的正性决定因素，而未发现内源性性类固醇与胰岛素抵抗之间存在关联。与未接受治疗的女性相比，CEE/MPA治疗与较高的SHBG、较低的FAI和较低的HOMA-IR值相关（年龄和BMI校正后的SHBG：CEE/MPA为148.8nmol/l，对照组为58.7nmol/l，p<0.01；年龄校正后的FAI：CEE/MPA为0.8，对照组为3.2，p<0.05；年龄校正后的HOMA-IR：CEE/MPA为1.3，对照组为2.6，p<0.05）。相反，E2/NETA治疗对这些参数无影响。与对照组相比，服用替勃龙的女性SHBG较低，FAI较高，HOMA-IR值相似（年龄和BMI校正后的SHBG：24.1nmol/l，p<0.01；FAI：6.0，p<0.05；HOMA-IR：2.3，p=无显著性差异）。服用雷洛昔芬的女性在性类固醇和HOMA-IR水平方面未表现出任何差异。