不同绝经阶段女性硫酸脱氢表雄酮、血清睾酮/雌二醇水平与代谢综合征的相关性

The correlationship study of dehydroepiandrosterone sulfate,serum testosterone and estradiol with metabolic syndrome in Different stages of postmenopausal women

目的探讨不同绝经阶段女性硫酸脱氢表雄酮、血清睾酮/雌二醇水平与代谢综合征的相关性。方法 2012年3月在杭州市肿瘤医院常规体检的杭州玉皇山社区40岁以上女性274例,排除相关干扰因素,入选206例,参照PENN-5分期定义,将体检人群分成5组:月经正常74例(A组)、围绝经期33例(B组)、绝经早期31例(C组)、绝经中晚期23例(D组)、绝经晚期45例(E组),A组设为对照组。专人搜集体检人员一般资料如身高、体重、月经情况等;并分批收集体检人员血清标本,放置于-80°冰箱保存,待同批次检测。后统一至浙江大学医学院附属妇产科医院检验科检测。检测指标:硫酸脱氢表雄酮(DHEAS)、雌二醇(E2)、血清睾酮(T)及甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(FBG)、空腹胰岛素(FIN)。结果绝经后硫酸脱氢表雄酮、雌二醇、血清睾酮呈下降趋势;血清睾酮/雌二醇呈上升趋势,提示雄激素水平相对增加,差异有统计学意义(P<0.05)。围绝经期始TG呈上升趋势、绝经早期开始下降;TC,LDL-C水平呈上升趋势,绝经晚期开始下降;HDL-C呈下降趋势、绝经中晚期开始上升,绝经后各阶段之间变化不明显(P>0.05)。绝经后空腹血糖、空腹胰岛素水平呈现上升趋势,但上升幅度不平行,空腹胰岛素上升更加明显,提示胰岛素抵抗。DHEAS与FIN、FBG相关系数r=-0.038、-0.147,P=0.589、0.035,DHEAS与FBG负相关(P<0.05);DHEAS与TG,TC,HDL-C,LDL-C相关系数r=-0.086、-0.234、-0.068、-0.163,P=0.217、0.001、0.331、0.019,DHEAS与TC、LDL-C负相关(P<0.01、P<0.05)。T/E2与TG,TC,LDL-C,FBG变化的相关系数r=0.276、0.354、0.331、0.330,正相关P=0.000。结论绝经后女性雄激素活性增加,发生胰岛素抵抗。硫酸脱氢表雄酮、血清睾酮可能协同雌二醇参与了女性绝经后代谢综合征的发生。

Objective To study the correlationship of the dehydroepiandrosterone sulfate, serum testosterone and estradiol with metabolic syndrome in Different stages of postmenopausal women. Methods Hangzhou Yu-huang-shan community women 274 cases, Who over 40, were routine examination in hangzhou tumor hospital in March 2012, eliminate interfer- ence factors, selected 206 cases,which were divided into 5 groups with reference to PENN-5 stages defined, 74 cases of menstruation （group A）, 33 cases of perimenopause （group B）, 31 cases of early menopause （group C）, 23 cases of middle-late menopause （group D） , 45 cases of late menopause （group E）, group A as control group. Collected general data such as height, weight, menstruation, etc. and serum specimens, and in place -80°refrigerator, with batch testing in clinical laboratory of obstetrics and gynecology hospital affiliated to zhejiang university school of medicine, test indexes such as dehydroepiandrosterone sulfate （DHEAS）, estradiol （E2 ）, serum testosterone （T） and triglyceride （TG）, total cholesterol （TC）, high-density lipoprotein （HDL-C）, low density lipoprotein （LDL-C）, fasting blood glucose （FBG）,fasting insulin （FIN）. Results Dehydroepiandrosterone sulfate, serum testosterone and estradiol present a downward, The increasing trend of serum testosterone/estradiol, prompted androgen levels relative increase in postmenopause, the difference was statistically significant （ P 〈 0.05 ）. TG was begin increasing in perimenopause, declining in early postmenopa- use. TC, LDL-C increasing in postmenopause, declining in late menopause. HDL-C was declining in postmenopause, oth- erwise inclining in middle-late menopause, which were not statistically significant difference between each stage of postm- enopause （P 〉 0.05）. Fasting blood glucose, fasting insulin levels rising in post-menopause, Which were not parallel, fasting insulin increased more obviously, prompted resistance to insulin. DHEAS was significant negative correlation with FBG （P 〈0.05）, which as well as was significant negative correlation with TC, LDL-C（P 〈 0.01 ,P 〈 0.05） ,other- wise, no-correlation with TG, HDL-C. T/E2 was significant positive correlation with TG, TC, LDL-C, FBG （P = 0. 000）. Conclusion Androgen activity increase in postmenopausal women, as well as resistance to insulin. Dehydroepi- androsterone sulfate, serum testosterone may be involved in the metabolic syndrome collaborative estradiol in postmenopa- usa[ women.