Cao Yuan-kui, Zhang Shao-fen, Zou Shi-en, Xia Xian, Xu Lin-na
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China. Email:
Zhonghua Fu Chan Ke Za Zhi. 2013 Oct;48(10):740-4.
To investigate the relationship between insulin resistance and endogenous androgens at early and late phase of postmenopause.
A total of 105 women with early postmenopause ( ≤ 5 years since menopause) and 107 women with late postmenopause ( ≥ 10 years since menopause) were enrolled in this study.In the mean time, those women were classified into normal weight[body mass index (BMI), BMI <24 kg/m(2)] group and overweight (BMI ≥ 24 kg/m(2)) group.Sex hormone-binding globulin (SHBG), testosterone (T) , dehydroepiandrosterone-sulfate (DHEA-S) , fasting blood glucose(FBG), fasting insulin (FINS) levels were measured and then calculated free androgen index (FAI) and homeostatic model assessment of insulin resistance (HOMA-IR) . The relationship between sex hormones and insulin resistance was analyzed by partial correlation and multiple linear regression analyses.
Compared to early postmenopausal women, late postmenopausal women had higher FINS [(7.9 ± 6.6) mU/L versus (6.6 ± 4.0) mU/L] and HOMA-IR(2.1 ± 1.9 versus 1.7 ± 1.1), but they had lower DHEA-S[(0.9 ± 0.5) mg/L versus (1.1 ± 0.5) mg/L, all P < 0.05) ]. Both in early postmenopausal and late postmenopausal groups, overweight women had higher HOMA-IR (early group, 2.2 ± 1.0 versus 1.2 ± 0.9;late group, 2.8 ± 2.6 versus 1.6 ± 1.1) and FINS early group[(6.9 ± 2.9) mU/L versus (4.6 ± 2.0) mU/L];late group[(10.2 ± 9.3) mU/L versus (6.4 ± 3.6) mU/L] than those at women with normal weight group (all P < 0.05) .In early postmenopausal group, overweight women had lower SHBG[ (52 ± 37) nmol/L versus (71 ± 37) nmol/L] and higher FAI (2.5 ± 2.1) versus (1.3 ± 1.1) than those at normal weight women group (all P < 0.05) .In late postmenopausal group, overweight women had higher DHEA-S (1.0 ± 0.5) mg/L versus (0.8 ± 0.4) mg/L (P < 0.05) . The analyses suggested that in early postmenopausal group, SHBG was correlated negatively with FINS and HOMA-IR (β = -0.386, P < 0.05;β = -0.553, P < 0.05) , DHEA-S was correlated positively with FBG (β = 0.348, P < 0.05) in early postmenopausal group.FAI was correlated positively with FBG in late postmenopausal group (β = 0.505, P < 0.05) .
The increased androgenic activities are associated with insulin resistance after of menopause. These correlations are different at different stages of postmenopause, which SHBG levels correlate with high risk of insulin resistance and DHEA-S levels correlates with high blood glucose levels at early postmenopause and FAI correlates with high blood glucose levels at late postmenopause.
探讨绝经早期和晚期胰岛素抵抗与内源性雄激素之间的关系。
本研究共纳入105例绝经早期（绝经≤5年）女性和107例绝经晚期（绝经≥10年）女性。同时，将这些女性分为正常体重组[体重指数（BMI），BMI<24 kg/m²]和超重组（BMI≥24 kg/m²）。测量性激素结合球蛋白（SHBG）、睾酮（T）、硫酸脱氢表雄酮（DHEA-S）、空腹血糖（FBG）、空腹胰岛素（FINS）水平，然后计算游离雄激素指数（FAI）和胰岛素抵抗稳态模型评估（HOMA-IR）。通过偏相关分析和多元线性回归分析来分析性激素与胰岛素抵抗之间的关系。
与绝经早期女性相比，绝经晚期女性的FINS水平更高[（7.9±6.6）mU/L对（6.6±4.0）mU/L]，HOMA-IR更高（2.1±1.9对1.7±1.1），但DHEA-S水平更低[（0.9±0.5）mg/L对（1.1±0.5）mg/L，所有P<0.05]。在绝经早期组和绝经晚期组中，超重女性的HOMA-IR均更高（早期组，2.2±1.0对1.2±0.9；晚期组，2.8±2.6对1.6±1.1），FINS水平也更高（早期组[（6.9±2.9）mU/L对（4.6±2.0）mU/L]；晚期组[（10.2±9.3）mU/L对（6.4±3.6）mU/L]），均高于正常体重组女性（所有P<0.05）。在绝经早期组中，超重女性的SHBG水平更低[（52±37）nmol/L对（71±37）nmol/L]，FAI更高（2.5±2.1对1.3±1.1），均与正常体重女性组存在差异（所有P<0.05）。在绝经晚期组中，超重女性的DHEA-S水平更高（1.0±0.5）mg/L对（0.8±0.4）mg/L（P<0.05）。分析表明，在绝经早期组中，SHBG与FINS和HOMA-IR呈负相关（β=-0.386，P<0.05；β=-0.553，P<0.05），DHEA-S与FBG呈正相关（β=0.348，P<0.05）。在绝经晚期组中，FAI与FBG呈正相关（β=0.505，P<0.05）。
绝经后雄激素活性增加与胰岛素抵抗相关。这些相关性在绝经后的不同阶段有所不同，在绝经早期，SHBG水平与胰岛素抵抗高风险相关，DHEA-S水平与高血糖水平相关；在绝经晚期，FAI与高血糖水平相关。
