绝经后女性代谢综合征患者性激素水平改变及其与胰岛素抵抗的相关性

Relationship between serum sex hormone levels and insulin resistance in postmenopausal women with metabolic syndrome

目的 探讨绝经后女性代谢综合征性激素水平的变化及其与胰岛素抵抗的相关性.方法 128例绝经后女性代谢综合征患者（代谢综合征组）和116名年龄相匹配的绝经后健康女性（对照组）均来2012年6-12月在山东省日照市人民医院健康查体中心的人群,所有研究对象均测量血压、身高、体质量,计算体重指数,测定空腹血糖、胰岛素、血脂和性激素水平.胰岛素、血清总睾酮、雌二醇检测采用电化学发光法,血清雌酮检测采用酶联免疫分析法.稳态模型评估法计算胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（HOMA-ISI）.结果 代谢综合征组患者体重指数、收缩压、舒张压、空腹血糖、三酰甘油水平均明显高于对照组[（26.6±2.2） kg/m2比（22.6±1.6） kg/m2,（129±10） mmHg（1mmHg=0.133 kPa）比（114 ±7） mmHg,（85±7）mmHg比（75±5）mmHg,（6.3±1.3） mmol/L比（5.0±0.4）mmol/L,（2.1±1.2）mmol/L比（0.9 ±0.3） mmol/L,均P＜0.01],而高密度脂蛋白胆固醇（HDL-C）水平明显低于对照组[（1.36±0.35） mmol/L比（1.64±0.24）mmol/L,P＜0.01];与对照组相比,代谢综合征组胰岛素、HOMA-IR明显增高（67.34 pmol/L比40.58 pmol/L,2.75比1.27;P＜0.05或＜0.01）,而雌二醇、雌酮、HOMA-ISI明显降低（20.80 pmol/L比31.52 pmol/L,39.52 pmol/L比47.98 pmol/L,0.016比0.035,P＜0.05或P＜0.01）;但2组间血清总睾酮水平差异无统计学意义（0.70nmol/L比0.73 nmol/L,均P＞0.05）.代谢综合征组血清总睾酮与胰岛素、HOMA-IR和HOMA-ISI无明显相关性（r=0.142、r=0.076、r=-0.073,均P＞0.05）,血清雌酮水平与血清胰岛素、HOMA-IR呈明显负相关（r=-0.546、r=-0.599,均P＜0.05）,与HOMA-ISI呈明显正相关（r=0.596,P＜0.05）;血清雌二醇水平与血清胰岛素、HOMA-IR呈明显负相关（r=-0.581、r=-0.623,P＜0.01）,与HOMA-ISI呈明显正相关（r=0.632,P＜0.01）.结论 绝经后女性代谢综合征患者雌酮、雌二醇水平明显减低,且与胰岛素抵抗密切相关.

Objective To discuss the changes of serum sex hormone levels in postmenopausal women with metabolic syndrome and to explore the relation to insulin resistance. Methods One hundred and twenty eight pa- tients with metabolic symtrome （metabolic syndrome group） and 116 control subjects （control group） were randomly selected fi＇om Physical Examination Center in People＇s Hospital of Rizhao, Shangdong Province from March to December, 2012. The height and body mass were measured to calculate body mass index （BMI） ; the blood pressure, fasting blood glocuse, fasting insulin, blood lipid and sex hormone were detected. Serum testosterone, estradiol and insulin were measured by chemiluminescence method and serum oestrone was measured by enzyme linked immunosorbenl assay. Homeostasis mode] of insulin resistance was used to calculate insulin resistance （HOMA-IR） and sensitivity index （HOMA-ISI）. Results The BMI, systolic pressure, diastolic pressure, fast- lug blood glocuse, triglycerides were significantly higher, while high density lipoprotein eholesterin was significant- lv lower in metabolic syndrome group than that in control group [ BMI： （26.6 ± 2.21 kg/m2 vs （22.6 ± 1.6 ）kg/m2 , systolic pressure： （ 129 ± 10）mmHg vs （114 ±7）mmHg, diastolic pressure： （85 ±7）mmHg vs （75 ±5）mmHg, fhsting blood glocuse ： （6.3 ± 1.3 ） mmol/L vs （ 5.0 ± 0.4 ） retool/L, triglycerides ： （ 2. 1 ± 1.2 ） mmol/L vs （ 0.9 ± 0.3 ） retool/L, high density lipoprotein cholesterin ： （ 1.36 ± 0.35 ） mmol/L vs （ 1.64 ± 0.24 ） retool/L, all P 〈0.0l]. Compared with control group, insulin and HOMA-IR were significantly increased, while cstradiol, oestrone and HOMA ISI were significantly decreased in metabolic syndrome group （ insulin： 67.34 pmol/L vs 40.58 pmol/L, HOMA-IR： 2.75 vs 1.27, estradiol： 20.80 pmol/L vs 31.52 pmol/L, oestrone： 39.52 pmol/L vs 47.98 pmol/L, HOMA ISI： 0. 016 vs 0. 035 ;P 〈 0.05 or 0.01 ）, but no significant difference of testosterone between the two groups was found （0.70 nmol/L vs 0.73 nmoL/L;P 〉 0.05 ）. In metabolic syndrome group, the serum level of testosterone was not significantly correlated with insulin, HOMA-IR and HOMA-ISI （ r = 0. 142, 0. 076 3, - 0. 073, all P 〉 0.05 ） ; the serum level of oestrone and estradiol was negatively correlated with insulin （r= -0.546, P〈0.05, r= -0.581, P〈0.01） and HOMA-IR （r= -0.599, P〈0.05, r= -0.623, P〈 0.05）, and it was positively correlated with HOMA-ISI （r = 0. 596, P 〈0. 05, r =0.632, P 〈0. 01）. Conclusion Levels of endogenous oestrogen and estradiol significantly decrease in postmenopausal women with metabolic syndrome, which are closely correlated to insulin resistance.