口服避孕药中使用的炔雌醇剂量会降低正常女性的胰岛素敏感性。

Insulin sensitivity is decreased in normal women by doses of ethinyl estradiol used in oral contraceptives.

作者信息

Kojima T, Lindheim S R, Duffy D M, Vijod M A, Stanczyk F Z, Lobo R A

机构信息

Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.

出版信息

Am J Obstet Gynecol. 1993 Dec;169(6):1540-4. doi: 10.1016/0002-9378(93)90432-i.

DOI:10.1016/0002-9378(93)90432-i

PMID:8267059

Abstract

OBJECTIVE

We determined the independent effects of various doses of ethinyl estradiol used in oral contraceptives or norethindrone acetate, as well as their combination, on insulin sensitivity in normal women.

STUDY DESIGN

Thirty-three normal ovulatory female volunteers were recruited for this study. Insulin tolerance tests were performed after carbohydrate loading to determine the kinetic disappearance of glucose and insulin. After initial testing the women were randomized into four groups: ethinyl estradiol 20 micrograms, 35 micrograms, and 50 micrograms and norethindrone 1 mg. Insulin tolerance tests were repeated after 1 month of treatment and again after a second month, when all ethinyl estradiol groups received the addition of norethindrone 1 mg to their doses of ethinyl estradiol. Plasma glucose and insulin were measured, and insulin sensitivity (K(itt) glucose) and the disappearance of insulin (K(itt) insulin) were calculated.

RESULTS

All groups were comparable at baseline, and no significant changes in fasting glucose and insulin were evident with treatment. After ingestion of 50 micrograms ethinyl estradiol the K(itt) glucose value decreased significantly (p < 0.03) and ingestion of 20 micrograms and 35 micrograms showed individual changes, but as groups the changes were not statistically significant. All ethinyl estradiol groups combined had a significant decrease in K(itt) glucose (p < 0.01). Norethindrone 1 mg alone did not change K(itt) glucose values, and after the addition of norethindrone to ethinyl estradiol, K(itt) glucose values normalized. K(itt) insulin values were also lower with treatment but were lower with ethinyl estradiol plus norethindrone compared with ethinyl estradiol alone (p < 0.04), suggesting an attenuation of insulin clearance with the progestin.

CONCLUSION

Ethinyl estradiol alone decreases insulin sensitivity, and this may occur at lower doses, but norethindrone 1 mg does not appear to do so. However, progestins may alter insulin clearance.

摘要

目的

我们确定了口服避孕药中使用的不同剂量炔雌醇或醋酸炔诺酮及其组合对正常女性胰岛素敏感性的独立影响。

研究设计

招募了33名正常排卵的女性志愿者参与本研究。在碳水化合物负荷后进行胰岛素耐量试验，以确定葡萄糖和胰岛素的动力学消失情况。初始测试后，将女性随机分为四组：炔雌醇20微克、35微克和50微克组以及炔诺酮1毫克组。治疗1个月后重复胰岛素耐量试验，在第二个月后再次进行，此时所有炔雌醇组在其炔雌醇剂量中添加炔诺酮1毫克。测量血浆葡萄糖和胰岛素，并计算胰岛素敏感性（K（itt）葡萄糖）和胰岛素消失率（K（itt）胰岛素）。

结果

所有组在基线时具有可比性，治疗后空腹血糖和胰岛素无明显变化。摄入50微克炔雌醇后，K（itt）葡萄糖值显著降低（p < 0.03），摄入20微克和35微克时显示个体变化，但作为组来看，这些变化无统计学意义。所有炔雌醇组合并后K（itt）葡萄糖显著降低（p < 0.01）。单独使用1毫克炔诺酮不会改变K（itt）葡萄糖值，在炔雌醇中添加炔诺酮后，K（itt）葡萄糖值恢复正常。治疗后K（itt）胰岛素值也较低，但与单独使用炔雌醇相比，炔雌醇加炔诺酮时更低（p < 0.04），表明孕激素会降低胰岛素清除率。