Goodrow Gwen J, L'Hommedieu Georgia D, Gannon Barbara, Sites Cynthia K
Department of Obstetrics and Gynecology, The University of Vermont College of Medicine, Burlington, VT, USA.
Am J Obstet Gynecol. 2006 Feb;194(2):355-61. doi: 10.1016/j.ajog.2005.07.046.
The purpose of this study was to determine predictors of worsening insulin sensitivity in postmenopausal women.
Seventy-one nonobese postmenopausal women were assigned randomly to receive hormone replacement therapy (conjugated estrogens, 0.625 mg, plus medroxyprogesterone acetate, 2.5 mg) or placebo daily for 1 year (34 women received hormone replacement therapy, and 37 women received placebo). At baseline and 12 months, the women received a computed tomography scan at the L4-L5 vertebral disk space, a dual x-ray absorptiometry scan, a euglycemic hyperinsulinemic clamp to measure insulin sensitivity, and a lipid profile. Declining insulin sensitivity was defined as the largest quartile change in insulin sensitivity in the women who received the placebo (-1.42 mg/min/kg lean body mass).
By univariate analysis, we found that significant predictors of worsening insulin sensitivity were the use of hormone replacement therapy, baseline insulin sensitivity, a younger age, and <10 years since menopause. By logistic regression, we determined that hormone replacement therapy use and higher baseline insulin sensitivity were independent predictors of worsening insulin sensitivity.
The use of hormone replacement therapy and baseline insulin sensitivity are significant independent predictors of the development of worsening insulin sensitivity in postmenopausal women.
本研究旨在确定绝经后女性胰岛素敏感性恶化的预测因素。
71名非肥胖绝经后女性被随机分配，每天接受激素替代疗法（结合雌激素0.625毫克加醋酸甲羟孕酮2.5毫克）或安慰剂，为期1年（34名女性接受激素替代疗法，37名女性接受安慰剂）。在基线和12个月时，这些女性接受了L4-L5椎间盘间隙的计算机断层扫描、双能X线吸收法扫描、用于测量胰岛素敏感性的正常血糖高胰岛素钳夹试验以及血脂检测。胰岛素敏感性下降被定义为接受安慰剂的女性中胰岛素敏感性最大四分位数变化（-1.42毫克/分钟/千克瘦体重）。
通过单因素分析，我们发现胰岛素敏感性恶化的显著预测因素是激素替代疗法的使用、基线胰岛素敏感性、较年轻的年龄以及绝经后<10年。通过逻辑回归分析，我们确定激素替代疗法的使用和较高的基线胰岛素敏感性是胰岛素敏感性恶化的独立预测因素。
激素替代疗法的使用和基线胰岛素敏感性是绝经后女性胰岛素敏感性恶化发展的重要独立预测因素。
