低剂量口服避孕药对非裔美国女性代谢危险因素的影响。
Effect of low-dose oral contraceptives on metabolic risk factors in African-American women.
作者信息
Frempong Barbara A, Ricks Madia, Sen Sabyasachi, Sumner Anne E
机构信息
Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
出版信息
J Clin Endocrinol Metab. 2008 Jun;93(6):2097-103. doi: 10.1210/jc.2007-2599. Epub 2008 Mar 11.
CONTEXT
The effect of oral contraceptive pill (OCP) use on cardiovascular risk in African-American women is unknown.
OBJECTIVE
Our objective was to examine in African-American women the effect of OCP use on insulin resistance, glucose intolerance, and triglycerides (TGs).
DESIGN
This was a cross-sectional study.
SETTING
The study was conducted at the National Institutes of Health Clinical Research Center.
PARTICIPANTS
A total of 104 healthy nondiabetic African-American women [21 OCP users, 83 controls, age mean +/- sd, 34.7 +/- 7.6 yr, body mass index (BMI) 31 +/- 8.4 kg/m(2)] was included in the study.
INTERVENTIONS
Subjects had oral glucose tolerance tests, insulin-modified frequently sampled iv glucose tolerance tests, and fasting lipid profiles. Insulin resistance was determined by the insulin sensitivity index (S(I)).
MAIN OUTCOME MEASURES
Insulin resistance, glucose tolerance status, and TG levels were determined.
RESULTS
Fasting glucose did not differ between OCP users and controls (P = 0.27). In contrast, compared with controls, 2-h glucose (135 +/- 23 vs.120 +/- 25 mg/dl; P = 0.01) and fasting TGs (73 +/- 31 vs.57 +/- 27 mg/dl; P = 0.02) were higher in OCP users. OCP users tended to be more insulin resistant than controls (S(I): 2.51 +/- 2.01 vs. 3.46 +/- 2.09; P = 0.09). Multiple regression analysis revealed that BMI, age, and OCP use were significant determinants of 2-h glucose (adjusted R(2) = 0.37; P < 0.001) and TG levels (adjusted R(2) = 0.21; P < 0.001). As BMI was a determinant of both 2-h glucose and TGs, participants were divided into nonobese and obese groups, and the analyses repeated. Among the nonobese women, the OCP users were more insulin resistant (S(I): 2.91 +/- 1.58 vs. 4.35 +/- 1.88; P = 0.03) and had a higher prevalence of glucose intolerance than controls (odds ratio 5.7; 95% confidence interval 1.4-24; P = 0.01).
CONCLUSION
In African-American women, OCP use is associated with an increase in markers of cardiovascular risk manifested by increased insulin resistance, glucose intolerance, and elevated TGs.
背景
口服避孕药（OCP）对非裔美国女性心血管风险的影响尚不清楚。
目的
我们的目的是研究OCP对非裔美国女性胰岛素抵抗、葡萄糖耐量和甘油三酯（TGs）的影响。
设计
这是一项横断面研究。
地点
该研究在国立卫生研究院临床研究中心进行。
参与者
共有104名健康的非糖尿病非裔美国女性[21名OCP使用者，83名对照者，年龄均值±标准差，34.7±7.6岁，体重指数（BMI）31±8.4kg/m²]纳入研究。
干预措施
受试者进行口服葡萄糖耐量试验、胰岛素改良的频繁取样静脉葡萄糖耐量试验和空腹血脂谱检查。通过胰岛素敏感性指数（S(I)）确定胰岛素抵抗。
主要观察指标
测定胰岛素抵抗、葡萄糖耐量状态和TG水平。
结果
OCP使用者和对照者的空腹血糖无差异（P = 0.27）。相比之下，与对照者相比，OCP使用者的2小时血糖（135±23 vs.120±25mg/dl；P = 0.01）和空腹TGs（73±31 vs.57±27mg/dl；P = 0.02）更高。OCP使用者比对照者更倾向于胰岛素抵抗（S(I)：2.51±2.01 vs. 3.46±2.09；P = 0.09）。多元回归分析显示，BMI、年龄和OCP使用是2小时血糖（调整后R² = 0.37；P < 0.001）和TG水平（调整后R² = 0.21；P < 0.001）的重要决定因素。由于BMI是2小时血糖和TGs的决定因素，将参与者分为非肥胖和肥胖组，并重复分析。在非肥胖女性中，OCP使用者更具胰岛素抵抗（S(I)：2.91±1.58 vs. 4.
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