绝经后妇女T2DM人群性激素水平变化与胰岛素抵抗的临床研究

Clinical study of the relationship between sex hormones and insulin resistance in the postmenopausal women with T2DM

目的研究绝经后妇女2型糖尿病(T2DM)患者性激素与胰岛素抵抗的关系。方法 809例绝经后健康妇女为对照组,812例绝经后妇女T2DM患者为观察组,测雌二醇(E2)、孕酮(P)、睾酮(T)、催乳素(PRL)、黄体生成素(LH)、促卵泡激素(FSH)、E/T、空腹血糖(FBG)、餐后2 h血糖(2hPG)、空腹血清胰岛素(FINS)、糖化血红蛋白(HbA1c),计算稳态模型胰岛素抵抗指数(HOMA-IR),根据HOMA-IR水平分胰岛素抵抗组(>1,IR组)与无胰岛素抵抗组(<1,Non-IR组),研究绝经后妇女T2DM患者血清性激素水平与胰岛素抵抗的关系。结果与对照组比较,观察组患者E2、PRL、LH、FSH、E/T比值水平明显降低,FBG、2hPG、FINS、HbA1c、HOMA-IR、体质量指数水平明显上升;与Non-IR组比较,IR组患者BMI明显增加,E2、E/T比值水平明显降低,差异有统计学意义。结论绝经后妇女T2DM患者性激素严重紊乱,与胰岛素抵抗有关,绝经后妇女T2DM患者临床诊治要关注性激素水平,对性激素紊乱采取必要干预措施,防止、延缓并发症发生。

Objective To investigate the relationship between the serum sex hormones levels and insulin resistance in postmenopausal women with type 2 diabetes mellitus. Methods A total of 809 healthy postmenopausal women as the control group,and 812 postmenopausal women with T2DM as the observation group were involved in this study. The estradiol,progesterone,testosterone,prolactin,luteinizing hormone,follicle- stimulating hormone,E / T and fasting blood glucose,2h postprandial blood glucose,fasting serum insulin and glycated hemoglobin were measured in these people,and the homeostasis model assessment insulin resistance index were calculated. According to HOMA- IR,postmenopausal women with T2DM were divided into insulin resistance group（ 1,IR group） and non- insulin resistance group（ 1,non- IR group） to study the relationship between the serum sex hormones level and insulin resistance. Results Compared with the control group,the levels of E2,PRL,LH,FSH and E /T ratios were significantly lower,while the levels of FBG,2hPG,FINS,HbA1c,HOMA- IR and body mass index increased significantly. Compared with the non- IR group,the BMI was significantly increased in IR group,while the E2 level and E /T ratio was significantly decreased,the difference had statistical significance. Conclusion The serious sex hormones disorder in postmenopausal women with T2DM was associated with insulin resistance. It is suggested to pay more attention to the sex hormones levels in the clinical diagnosis and treatment of postmenopausal women with T2DM,and necessary intervention measures should also be taken to prevent or delay the occurrence of complications.