Odmark Inga-Stina, Carlström Kjell, Jonsson Björn, Jonasson Aino Fianu
Department of Clinical Science, Obstetrics and Gynecology, University of Umeå, Umeå, Sweden.
Maturitas. 2006 Jan 10;53(1):89-96. doi: 10.1016/j.maturitas.2005.03.003. Epub 2005 Jun 16.
To study the effects of different types of continuous hormone replacement therapy on carbohydrate metabolism.
Postmenopausal women were treated with conjugated estrogens, 0.625 mg/medroxyprogesterone acetate, 2.5 or 5 mg (CEE/MPA) or tibolone 2.5 mg daily for 13 28-day cycles. Serum glucose and insulin were measured before and during a 75 g oral glucose tolerance test (OGTT) at baseline and after 3, 6 and 13 cycles and areas under the curve (AUC) were calculated. Sex hormone-binding globulin (SHBG) was measured as an additional marker of nutritional and insulin status.
Neither CEE/MPA 2.5mg nor tibolone had any effects on carbohydrate metabolism while AUC(insulin), AUC(glucose) and also body mass index (BMI) increased after 13 cycles of treatment in the CEE/MPA 5 mg group. SHBG increased significantly during CEE/MPA treatment and decreased significantly during treatment with tibolone. The effects on SHBG were less pronounced in the CEE/MPA 5mg group. Pretreatment SHBG showed significant negative correlations to BMI and to variables that may reflect a certain degree of insulin resistance, the most pronounced being fasting glucose. Changes in SHBG during treatment with tibolone were negatively correlated to pretreatment SHBG and positively to BMI, AUC(insulin) and fasting insulin resistance index, while no such correlations were found in the CEE/MPA groups. There were no correlations between changes in AUC(insulin) and AUC(glucose) on one hand and basal variables or treatment SHBG on the other in the CEE/MPA groups.
The effects of tibolone and CEE/MPA on carbohydrate metabolism were considered to have clinical significance only for CEE/MPA 5mg, indicating a less favourable role of the higher progestagen dose. The results further support the important role of metabolic and insulin status in the physiological regulation of SHBG and also indicate that the suppressive effect of tibolone on circulating SHBG is mainly depends on pretreatment SHBG levels. SHBG does not reflect changes in carbohydrate metabolism during CEE/MPA treatment.
研究不同类型的连续激素替代疗法对碳水化合物代谢的影响。
绝经后女性接受共轭雌激素、0.625毫克/醋酸甲羟孕酮2.5或5毫克（CEE/MPA）或替勃龙2.5毫克每日治疗，共13个28天周期。在基线时以及3、6和13个周期后，于75克口服葡萄糖耐量试验（OGTT）前及试验期间测量血清葡萄糖和胰岛素，并计算曲线下面积（AUC）。测量性激素结合球蛋白（SHBG）作为营养和胰岛素状态的额外标志物。
CEE/MPA 2.5毫克组和替勃龙组对碳水化合物代谢均无影响，而CEE/MPA 5毫克组在治疗13个周期后，AUC（胰岛素）、AUC（葡萄糖）以及体重指数（BMI）均升高。CEE/MPA治疗期间SHBG显著升高，替勃龙治疗期间SHBG显著降低。CEE/MPA 5毫克组对SHBG的影响不太明显。治疗前SHBG与BMI以及可能反映一定程度胰岛素抵抗的变量呈显著负相关，最显著的是空腹血糖。替勃龙治疗期间SHBG的变化与治疗前SHBG呈负相关，与BMI、AUC（胰岛素）和空腹胰岛素抵抗指数呈正相关，而CEE/MPA组未发现此类相关性。CEE/MPA组中，一方面AUC（胰岛素）和AUC（葡萄糖）的变化与另一方面的基础变量或治疗期间的SHBG之间无相关性。
替勃龙和CEE/MPA对碳水化合物代谢的影响仅在CEE/MPA 5毫克组被认为具有临床意义，表明较高孕激素剂量的作用不太有利。结果进一步支持了代谢和胰岛素状态在SHBG生理调节中的重要作用，也表明替勃龙对循环SHBG的抑制作用主要取决于治疗前SHBG水平。在CEE/MPA治疗期间，SHBG不能反映碳水化合物代谢的变化。
