Falkner B, Sherif K, Sumner A, Kushner H
Institute for Women's Health and the Department of Medicine, Allegheny University for the Health Sciences, Philadelphia, PA 19129, USA.
Metabolism. 1999 Jan;48(1):107-12. doi: 10.1016/s0026-0495(99)90018-5.
Hyperinsulinemia is a risk factor for cardiovascular disease, and is linked with non-insulin-dependent diabetes mellitus (NIDDM), hyperlipidemia, obesity, and hypertension. Sex hormones also play a role in the metabolic alterations associated with the risk for cardiovascular disease. A reduction in sex hormone-binding globulin (SHBG) may be predictive of future NIDDM particularly in women. The postmenopausal decline in estrogen is also associated with an increase in risk factor expression in women. Since African Americans experience a greater prevalence of NIDDM, obesity, and hypertension, conditions associated with hyperinsulinemia, the purpose of this study was to determine if alterations in sex hormone levels are associated with the plasma insulin concentration in young adult African Americans, and to determine if there are sex differences in the effect of insulin on lipids and sex hormones. In a sample of 221 nondiabetic African American men (n = 105) and women (n = 116) with a mean age of 31 years, we examined the relationship of the plasma insulin concentration with the body mass index (BMI), blood pressure, plasma lipids, and sex hormones, including free testosterone, estradiol, and SHBG. Plasma insulin increased with the BMI and other measures of adiposity (P<.001) in men and women. Significant correlations of insulin with plasma lipids were also present in both sexes. There was a significant inverse correlation of insulin with SHBG in both men (r = .28, P = .007) and women (r = .27, P = .02). There was a significant direct correlation of insulin with free testosterone in women (r = .032, P<.001). Stepwise multiple regression analyses with insulin as the dependent variable detected the BMI, triglyceride, and apolipoprotein A1 as significant contributors to the plasma insulin concentration in men. In women, the multiple regression model detected percent body fat, low-density lipoprotein (LDL) cholesterol, and free testosterone as significant contributors to plasma insulin. These data on young African Americans demonstrate a significant relationship between hyperinsulinemia and obesity, atherogenic lipid status, and lower SHBG. In the premenopausal women, the lower SHBG is linked with higher free testosterone, favoring a condition of relative androgen excess.
高胰岛素血症是心血管疾病的一个危险因素，与非胰岛素依赖型糖尿病（NIDDM）、高脂血症、肥胖和高血压有关。性激素也在与心血管疾病风险相关的代谢改变中起作用。性激素结合球蛋白（SHBG）的降低可能预示着未来患NIDDM的风险，尤其是在女性中。绝经后雌激素水平的下降也与女性危险因素表达的增加有关。由于非裔美国人中NIDDM、肥胖和高血压的患病率更高，这些疾病都与高胰岛素血症有关，因此本研究的目的是确定性激素水平的改变是否与年轻成年非裔美国人的血浆胰岛素浓度有关，并确定胰岛素对脂质和性激素的影响是否存在性别差异。在一个由221名平均年龄为31岁的非糖尿病非裔美国男性（n = 105）和女性（n = 116）组成的样本中，我们研究了血浆胰岛素浓度与体重指数（BMI）、血压、血浆脂质和性激素（包括游离睾酮、雌二醇和SHBG）之间的关系。男性和女性的血浆胰岛素水平均随BMI和其他肥胖指标的增加而升高（P<.001）。两性中胰岛素与血浆脂质之间也存在显著相关性。男性（r = .28，P = .007）和女性（r = .27，P = .02）中胰岛素与SHBG均存在显著负相关。女性中胰岛素与游离睾酮存在显著正相关（r = .032，P<.001）。以胰岛素为因变量的逐步多元回归分析发现，BMI、甘油三酯和载脂蛋白A1是男性血浆胰岛素浓度的重要影响因素。在女性中，多元回归模型发现体脂百分比、低密度脂蛋白（LDL）胆固醇和游离睾酮是血浆胰岛素的重要影响因素。这些关于年轻非裔美国人的数据表明，高胰岛素血症与肥胖、致动脉粥样硬化的脂质状态和较低的SHBG之间存在显著关系。在绝经前女性中，较低的SHBG与较高的游离睾酮有关，这有利于相对雄激素过多的状态。
