非糖尿病绝经后女性的激素治疗与胰岛素抵抗：一项系统评价和荟萃分析。
Hormone therapy and insulin resistance in non-diabetic postmenopausal women: a systematic review and meta-analysis.
作者信息
Li Tanya, Jiang Nathan S, Kaskey Julia, Schnatz Peter F, Nudy Matthew
机构信息
Department of Medicine and Ob/Gyn, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
出版信息
Climacteric. 2025 Jun 18:1-9. doi: 10.1080/13697137.2025.2509844.
OBJECTIVE
Menopause increases the risk of insulin resistance and cardiometabolic diseases. This study summarizes the effects of hormone therapy (HT) on insulin resistance in non-diabetic postmenopausal women.
METHOD
The study analyzed randomized controlled trials (1998-2024) that assessed the impact of HT on insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR) in non-diabetic postmenopausal women. Raw mean differences (RMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analysis compared estrogen alone (E alone) and estrogen plus progestogen (E + P) to placebo.
RESULTS
Seventeen randomized controlled trials with 5772 women (3644 on HT: E alone [ = 1259] or E + P [ = 2385]; 2128 on placebo) were included. The weighted mean (standard deviation) age was 56.91 (5.95) years, with treatment lasting 8 weeks to 3 years. HT significantly reduced HOMA-IR (RMD = -0.24 [-0.32 to -0.16], < 0.001, = 60.3%). Subgroup analysis showed reductions in both E alone (RMD = -0.42 [-0.55 to -0.29], < 0.001, = 35%) and E + P (RMD= -0.14 [-0.23 to -0.04], = 0.005, = 13.7%) compared to placebo.
CONCLUSION
HT significantly lowers insulin resistance in healthy, non-diabetic postmenopausal women, with E alone yielding greater reductions than combination therapy.
目的
绝经会增加胰岛素抵抗和心脏代谢疾病的风险。本研究总结了激素疗法（HT）对非糖尿病绝经后女性胰岛素抵抗的影响。
方法
该研究分析了1998年至2024年的随机对照试验，这些试验使用胰岛素抵抗稳态模型评估（HOMA-IR）来评估HT对非糖尿病绝经后女性胰岛素抵抗的影响。采用随机效应模型计算95%置信区间（CI）的原始平均差异（RMD）。亚组分析比较了单纯雌激素（单用E）和雌激素加孕激素（E+P）与安慰剂的效果。
结果
纳入了17项随机对照试验，共5772名女性（3644名接受HT治疗：单用E[=1259]或E+P[=2385]；2128名接受安慰剂治疗）。加权平均（标准差）年龄为56.91（5.95）岁，治疗持续8周至3年。HT显著降低了HOMA-IR（RMD=-0.24[-0.32至-0.16]，P<0.001，I²=60.3%）。亚组分析显示，与安慰剂相比，单用E（RMD=-0.42[-0.55至-0.29]，P<0.001，I²=35%）和E+P（RMD=-0.14[-0.23至-0.04]，P=0.005，I²=13.7%）均有降低。
结论
HT可显著降低健康非糖尿病绝经后女性的胰岛素抵抗，单用E比联合治疗的降低幅度更大。
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