胰岛素敏感性、血脂与绝经后冠心病患者性激素水平关系的探讨

A study of sex hormone and insulin sensitivity,lipid disorder in postmenopausal women with coronary heart disease

目的探讨绝经后冠心病(CHD)患者性激素水平的变化及与胰岛素敏感性(IS)、血脂的关系。方法检测30例绝经后CHD患者和30例健康对照者的雌二醇(E2)、睾酮(T)、孕酮(P)、促卵泡激素(FSH)、促黄体生成素(LH)、(FPG)、葡萄糖耐量试验2 h血糖(2 h PG)、空腹胰岛素(FIN)、总胆固醇(TC),甘油三脂(TG),低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),计算胰岛素敏感指数(ISI)及雌二醇/睾酮(E/T)、孕酮/睾酮(P/T)、雌二醇/孕酮(E/P),并将CHD患者的E2、E/T、P/T、E/P与血脂、FIN、ISI作线性相关分析。结果与对照组比较绝经后CHD患者E2、E/T、ISI、HDL-C显著降低(P<0.01);FPG、2 h PG、FIN、TC、TG、LDL-C显著增高(P<0.05);T、P、FSH、LH、P/T差异无统计学意义(P>0.05)。相关分析表明,CHD患者的E2与FIN、TC、TG、LDL-C呈显著负相关,与ISI呈显著正相关(P均<0.05);E/T与FIN、TC、TG亦呈显著负相关,与ISI呈显著正相关(P均<0.05),与LDL-C、HDL-C无显著相关性(P>0.05);P/T、E/P与血脂、FIN、ISI无相关(P>0.05)。结论绝经后CHD患者存在内源性雌激素(E)严重缺乏,E/T、E/P比例失调,E2、E/T二者与血糖血脂异常、高胰岛素血症、IS降低和胰岛素抵抗(IR)等CHD发病危险因素的聚合有关,它们共同影响绝经后CHD的发生和发展。

Objective To study sex hormones in postmenopausal Women with coronary heart disease（CHD） and the relationship of sex hormones, insulin sensitivity index （ ISI）, and lipid. Methods The estradiol, testosterone, pregnendione, follicle stimulating hormone （FSH） ,luteinizing hormone（LH） ,fasting plasma glucose （FPG） ,Oral glucose tolerance test 2h glucose（2 h PG） ,fasting insulin（ FIN）, total cholesterol, triglyeerides,low density lipoprotein cholesterol（ LDL-C）, high density lipoprotein cholesterol （HDL-C）, insulin sensitivity index （ISI） and estradioL/testosterone, pregnendione/testosterone, estradioL/pregnendione ratio were measured in 30 postmenopausal women with CHD and 30 controls. Linear correlation was analyzed among estradiol, estradioL/testosterone （E/T）, pregnendione/testosterone （ P/T）, estradioL/pregnendione （ E/P）, and FIN, ISl,lipids. Results The results showed that the concentration of estradiol, E/T, E/P, were decreased, ISI, HDL-C （ P 〈 0.05 ） and FPG,2 h PG, FIN, total cholesterol, triglyeerides, LDL-C were elevated （ P 〈 0.05 ） in postm-enopausal CHD Women. But the concentration of testosterone, pregnendione, FSH, LH, P/T didn＇t charge significantly （ P 〉 0.05 ）. There were significant negative correlation between estradiol and FIN, total cholesterol, triglycerides, LDL-C, and between E/T ratio and FIN, total cholesterol, triglycerides. There were significant positive correlation between estradiol and ISI, and between E/T ratio and ISI （P 〈 0.05 ）. Conclusion There is a close relationship of dyslipidemia, hypefisulinism, reduce of insulin sensitivity,insulin resistance and sex hormone disorder in postmenopausal women. They play an important role in the development of CHD.