绝经妇女胰岛素抵抗与代谢综合征的关系及其相关因素的研究

Correlation between insulin resistance and metabolic syndrome and the related factors for insulin resistance in menopausal women

目的:了解胰岛素抵抗在绝经妇女发生代谢综合征中的作用,探寻绝经妇女发生胰岛素抵抗的相关因素。方法:选取2006年7月至2007年8月来北京妇产医院体检并被确诊为自然绝经的妇女181例,年龄41～60(51.24±4.37)岁,绝经年限1～9(2.84±1.96)年。测量181例绝经妇女的身高、体重、腰围、臀围、血压,测定研究对象的促卵泡刺激素、促黄体生成素、雌二醇(E2)、甘油三酯(TG)、高密度脂蛋白胆固醇、空腹血糖(FPG)、空腹胰岛素及全身脂肪含量(BF)。结果:(1)绝经妇女代谢综合征的患病率为33.7%。(2)HOMA-IR是绝经妇女发生代谢综合征的危险因素(OR=2.889,P<0.001),HOMA-IR预测绝经妇女发生代谢综合征的临界值为1.5185。(3)HOMA-IR与代谢综合征组分(腰围、TG、收缩压、舒张压、FPG)具有正相关关系(r=0.467、0.403、0.326、0.293、0.731,P<0.001),与HDL-C具有负相关关系(r=-0.204,P<0.01)。(4)HOMA-IR与年龄及体重指数、腰臀比、WC、BF%具有正相关关系(r=0.219、0.462、0.313、0.467、0.475,P<0.01),与绝经年限及E2水平无明显相关关系。结论:胰岛素抵抗的产生可能是绝经妇女代谢综合征发病风险增加的中心环节,体脂含量及分布是影响绝经妇女胰岛素抵抗的重要因素。

Objective To learn the role of insulin resistance in the development of metabolic syndrome in menopausal women and to explore the related factors for insulin resistance. Methods 181 women aged 41 to 60 （51.24±4.37） years with natural menopause confirmed in our hospital during the period of July 2006 to August 2007 were included in our study. Their menopausal age limit was 1 to 9（2.84 ± 1.96） years. Height, body weight, waist and hip circumference, and blood pressure were measured, so were follicle stimulating hormone, luteinizing hormone, estradiol, triglyceride, high density lipoprotein-cholesterol, fasting plasma glucose, fasting insulin, and body fat. Results The incidence of metabolic syndrome was 33.7% in the women. HOMA-IR was a risk factor for metabolic syndrome （OR=2.889,P 〈 0.001）. The cutoff of HOMA-IR to predict metabolic syndrome was 1.518 5. HOMA-IR showed a positive correlation with waist circumference, triglyceride, systolic and diastolic blood pressure, and fasting plasma glucose （r = 0.467,0.403,0.326,0.293,0.731 ,P 〈 0.001）, but a negative relation with high density lipoprotein-cholesterol （r = -0.204,P 〈 0.01 ）. HOMA-IR was positively correlated with age, body mass index, waist-hip ratio, waist circumference and, body fat （r = 0.219,0.462,0.313,0.467,0.475, P 〈 0.01 ）, whereas not obviously correlated with postmenopausal durations and estriol level. Conclusions Insulin resistance may play a central role in the increased risk for the development of metabolic syndrome in menopausal women. Body fat along with its distribution is an important factor for insulin resistance.