脂联素水平随40～65岁女性生殖衰老的变化及其与雄激素的相关性研究

Investigation of the change of adiponectin level with menopause status in middle aged women and its relationship with androgen

目的：探讨中年女性脂联素水平随生殖衰老的变化及与雄激素的关联性。方法招募2013年8月至10月在中山大学孙逸仙纪念医院进行健康体检、年龄40～65岁的健康妇女为观察对象，按照生殖衰老的不同阶段分为4组：绝经前组119例，绝经过渡期组60例，绝经后早期组（绝经时间〈5年）62例，绝经后晚期组（绝经时间≥5年）64例。测量身高、体质量、腰围，测定性激素结合球蛋白（SHBG）、硫酸脱氢表雄酮（DHEA-S）、总睾酮（TT）、脂联素水平，并计算游离雄激素指数（FAI）、体质指数（BMI）。结果（1）脂联素水平呈“U形”变化，在绝经过渡期最低，绝经后逐渐增高；绝经后晚期组[（13±5）mg/L]显著高于绝经过渡期组[（8±6）mg/L]和绝经后早期组[（9±6）mg/L]，分别比较，差异均有统计学意义（P〈0.05）。（2）4组妇女中，脂联素水平与腰围呈负相关（绝经前组r=－0.276，绝经过渡期组r=－0.334，绝经后早期组r=－0.211，绝经后晚期组r=－0.218，P均〈0.05）。脂联素水平在绝经过渡期组与SHBG呈正相关（r=0.536，P〈0.05），与FAI呈负相关（r=－0.363，P〈0.05）。绝经后晚期组脂联素水平与DHEA-S呈负相关（r=－0.450，P〈0.05）。在校正了年龄、BMI、腰围因素后，上述相关性仍然存在。结论脂联素水平在绝经过渡期最低，绝经后水平逐渐增高，在生殖衰老进程中呈“U形”变化。绝经过渡期脂联素水平降低与此阶段相对雄激素过多状态有密切关系。

Objective To investigate the change of adiponectin level with menopause status in women aged 40 to 65, and its relationship with androgen. Methods A cross-sectional study included woman （aged from 40 to 65） who were in hospital for routine check-up at the Sun Yat-sen Memorial Hospital from August to October in 2013. All subjects underwent laboratory examinations of adiponectin, sex hormone binding globulin （SHBG）, dehydroepiandrosterone-sulfate （DHEA-S）, total testosterone （TT）, collected anthropometric measurements and then calculated free androgen index （FAI） and body mass index （BMI）. According to their menstrual status, the subjects were divided into 4 groups： premenopausal group with 119 subjects, perimenopausal group with 60 subjects, early postmenopausal group with 62 subjects, late postmenopausal group with 64 subjects. Results （1） Adiponectin levels declined to its lowest level in menopausal transition and gradually becoming higher after menopause, which showed a U-shaped trajectory. When compared adiponectin levels in late postmenopausal group [（13 ± 5） mg/L] with those in perimenopausal [（8 ± 6） mg/L] or early postmenopausal group [（9 ± 6） mg/L], it all showed significantly difference （P〈0.05）. （2） Both the adiponectin levels were negatively correlated with waistline in the 4 groups （premenopausal group, r=-0.276;perimenopausal group, r=-0.334;early postmenopausal group, r=-0.211;late postmenopausal group, r=-0.218; all P〈0.05）. Levels of adiponectin were positively correlated with SHBG （r=0.536, P〈0.05） and negatively with FAI （r=-0.363, P〈0.05） in menopausal transition, while in late＆amp;nbsp;postmenopausal group, negatively correlated with level of DHEA-S （r=-0.450, P〈0.05）. When adjusted for age, BMI and waistline, the above correlations still exist. Conclusions Adiponectin levels declined to its lowest level in menopausal transition and gradually becoming higher after menopause, which showed a U-shaped trajectory during the sequential menopause status transition in middle aged women. Low level of adiponectin in menopausal transition is closely associated with the relative excess androgen occurred during this stage.