Salgin Burak, Amin Rakesh, Yuen Kevin, Williams Rachel M, Murgatroyd Peter, Dunger David B
University Department of Paediatrics, University of Cambridge, Cambridge, UK.
Horm Res. 2006;65(2):69-75. doi: 10.1159/000090907. Epub 2006 Jan 10.
BACKGROUND/AIMS: Turner's syndrome (TS) is associated with increased insulin resistance and adiposity, which might be associated with type 2 diabetes in later life. We aimed to determine whether the defect in insulin sensitivity is a primary intrinsic defect in TS or dependent on variation in body composition.
Sixteen women with TS not on growth hormone replacement but receiving oestrogen replacement therapy [age (mean +/- SD): 30.2 +/- 8.5 years; height-corrected fat-free mass: 26.1 +/- 3.1 kg/height] and a control group of 16 normal healthy women (age: 30.1 +/- 8.2 years; height-corrected fat-free mass: 25.9 +/- 2.4 kg/height) were studied. Fasting blood samples were obtained for measurement of glucose, insulin, IGF-I, IGFBP-1, IGFBP-3 and lipid levels. The hyperinsulinaemic euglycaemic clamp was performed to assess peripheral insulin sensitivity (M value), and the Homeostasis Model Assessment (HOMA-S) was used to estimate fasting insulin sensitivity. Body composition was assessed using a dual-energy X-ray absorptiometry scan.
Fasting insulin sensitivity (HOMA-S 103.2 +/- 78.6 vs. 193.9 +/- 93.5, p = 0.006) was lower in TS subjects compared to controls as was whole-body insulin sensitivity (M value 2.9 +/- 1.9 vs. 5.5 +/- 2.6 mg/kg/min, p = 0.003). In a multiple regression analysis the Turner karyotype was significantly related to insulin sensitivity (p = 0.008) independent of any differences in fat-free mass and percent whole-body fat mass.
The increased insulin resistance in women with TS is independent of measures of body composition and may represent an intrinsic defect related to their chromosomal abnormality.
背景/目的：特纳综合征（TS）与胰岛素抵抗增加和肥胖有关，这可能与晚年的2型糖尿病有关。我们旨在确定胰岛素敏感性缺陷是TS的原发性内在缺陷还是取决于身体成分的变化。
研究了16名未接受生长激素替代但接受雌激素替代疗法的TS女性[年龄（平均±标准差）：30.2±8.5岁；身高校正后的去脂体重：26.1±3.1kg/身高]和16名正常健康女性对照组（年龄：30.1±8.2岁；身高校正后的去脂体重：25.9±2.4kg/身高）。采集空腹血样以测量血糖、胰岛素、IGF-I、IGFBP-1、IGFBP-3和血脂水平。进行高胰岛素正常血糖钳夹试验以评估外周胰岛素敏感性（M值），并使用稳态模型评估（HOMA-S）来估计空腹胰岛素敏感性。使用双能X线吸收法扫描评估身体成分。
与对照组相比，TS受试者的空腹胰岛素敏感性（HOMA-S 103.2±78.6对193.9±93.5，p = 0.006）较低，全身胰岛素敏感性（M值2.9±1.9对5.5±2.6mg/kg/min，p = 0.003）也较低。在多元回归分析中，特纳核型与胰岛素敏感性显著相关（p = 0.008），与去脂体重和全身脂肪百分比的任何差异无关。
TS女性胰岛素抵抗增加与身体成分测量无关，可能代表与其染色体异常相关的内在缺陷。
