更年期妇女血清雌二醇与胰岛素抵抗和卵巢功能衰退的关系研究
摘要
目的探讨更年期妇女血清雌二醇(E_2)与胰岛素抵抗和卵巢功能衰退的关联。方法本研究选取2017年5-10月期间该院收治的80例更年期妇女为研究对象,根据血清E_2水平分组,将血清E_2水平<80 pmol/L的受试者33例纳入低E_2组,将血清E_2水平≥80 pmol/L的受试者47例纳入高E_2组。比较两组卵巢功能指标、胰岛素抵抗指数、血清单胺氧化酶(MAO)活性以及更年期症状。结果低E_2组受试者E_2水平明显低于高E_2组,卵泡刺激素(FSH)水平明显高于高E_2组、黄体生成素(LH)水平明显高于高E_2组(P<0. 05)。低E_2组受试者胰岛素抵抗指数明显高于高E_2组受试者(5. 28±0. 63 vs.4. 02±0. 55,P<0. 05)。两组受试者体重、BMI指数、绝经年龄及绝经时间差异均无统计学意义(P>0. 05)。低E_2组受试者潮热出汗、失眠、容易疲乏、暴躁易怒、胸闷心悸、性欲减退、外阴不适评分以及更年期症状总评分均明显高于高E_2组(P<0. 05)。低E_2组受试者MAO活性明显高于高E_2组(39. 68±6. 17 vs. 28. 42±3. 85,P<0. 05)。多因素Logistic回归分析结果显示,更年期妇女血清E_2表达水平与胰岛素抵抗指数、FSH与LH水平及MAO活性相关(P<0. 05),与BMI指数、绝经年龄、绝经时间及体重无显著相关性(P>0. 05)。结论更年期妇女血清E_2水平与胰岛素抵抗及卵巢功能衰退密切相关。
引文
[1]杨旭辉,莫国柱,梁嘉颖,等.抗苗勒氏激素、年龄、窦卵泡、雌二醇和促卵泡刺激素预测卵巢反应及IVF结局的临床研究[J].广东药学院学报,2016,32(5):647-653.
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[6]杨非柯,刘竟芳,陈伟,等. 17-β-雌二醇对去卵巢胰岛素抵抗大鼠骨骼肌中葡萄糖转运体4表达的影响[J].中国老年学杂志,2014,34(1):136-139.
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[10]李海,王金花,黄海玲,等.葛根素联合雌二醇对去卵巢大鼠骨组织及血钙、磷和碱性磷酸酶的影响[J].中国妇幼保健,2013,28(6):1016-1018.
[11] Uchida S,Kagitani F. Sympathetic regulation of ovarian functions under chronic estradiol treatment in rats[J]. Auton Neurosci,2016,197(1):19-24.
[12]符剑花,于英.女性血清E2及FSH水平与更年期不适临床症状的相关性分析[J].中国妇幼保健,2017,32(2):246-248.
[13] Wenner MM,Taylor HS,Stachenfeld NS. Peripheral microvascular vasodilatory response to estradiol and genistein in women with insulin resistance[J]. Microcirculation,2015,22(5):391-399.
[14]吴毓丽,徐松明,蒋利红.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[J].中国卫生检验杂志,2014,24(12):1745-1747.
[15]马娟文,陈伟伟,王惠琴,等.更年期综合征患者雌激素替代治疗对胰岛素样生长因子-1及骨密度的影响[J].中国当代医药,2017,24(29):71-74.
[16] Moreno M,Ordoez P,Alonso A,et al. Chronic 17beta-estradiol treatment improves skeletal muscle insulin signaling pathway components in insulin resistance associated with aging[J]. Age(Dordr),2010,32(1):1-13.
[17]杨艳文,栾玉芬,杨其贤,等.多囊卵巢综合征性激素水平及皮质醇检测与胰岛素抵抗的相关性分析[J].中国现代医学杂志,2014,24(35):43-46.
[18] Clapauch R,Mouro AF,Mecenas AS,et al. Endothelial function and insulin resistance in early postmenopausal women with cardiovascular risk factors:importance of ESR1 and NOS3 polymorphisms[J]. PLo S One,2014,9(7):e103444.
[19] Rohr UD,Volko CD,Schindler AE. Comparison of steady state development and reduction of menopausal symptoms after oral or transdermal delivery of 17-β-estradiol in young healthy symptomatic menopausal women[J]. Horm Mol Biol Clin Invest,2014,18(3):123-136.
[20]高婷婷.血清性激素及5-羟色胺在更年期抑郁患者体内的表达及临床价值[J].中国冶金工业医学杂志,2017,34(6):630-631.
[2]高彤彤,吴燕文,许云.葛根素联合雌二醇干预对去卵巢大鼠骨质疏松疗效和认知功能影响分析[J].中国妇幼保健,2015,30(34):6112-6114.
[3] Rouskova D,Mittmann K,Schumacher U,et al. Effectiveness,tolerability and acceptance of an oral estradiol/levonorgestrel formulation for the treatment of menopausal complaints:a non-interventional observational study over six cycles of 28 days[J]. Gynecol Endocrinol,2014,30(10):712-716.
[4] Gorbenko NI,Borikov AY,Ivanova OV,et al. Effect of 17β-estradiol on bioenergetic processes in the heart mitochondria of ovariectomized rats with insulin resistance[J]. Biomed Khim,2014,60(5):576-580.
[5]陈琪,杨勇,杜静.胰岛素与血清性激素水平与子宫内膜增生相关性研究[J].中国性科学,2015,24(10):49-52.
[6]杨非柯,刘竟芳,陈伟,等. 17-β-雌二醇对去卵巢胰岛素抵抗大鼠骨骼肌中葡萄糖转运体4表达的影响[J].中国老年学杂志,2014,34(1):136-139.
[7] Camporez JP,Jornayvaz FR,Lee HY,et al. Cellular mechanism by which estradiol protects female ovariectomized mice from high-fat diet-induced hepatic and muscle insulin resistance[J]. Endocrinology,2013,154(3):1021-1028.
[8]吴海,何佳.阿法骨化醇改善多囊卵巢综合征患者胰岛素抵抗的临床研究[J].中国妇幼保健,2014,29(21):3418-3419.
[9] Veiga-Lopez A,Wurst AK,Steckler TL,et al. Developmental programming:postnatal estradiol amplifies ovarian follicular defects induced by fetal exposure to excess testosterone and dihydrotestosterone in sheep[J]. Reprod Sci,2014,21(4):444-455.
[10]李海,王金花,黄海玲,等.葛根素联合雌二醇对去卵巢大鼠骨组织及血钙、磷和碱性磷酸酶的影响[J].中国妇幼保健,2013,28(6):1016-1018.
[11] Uchida S,Kagitani F. Sympathetic regulation of ovarian functions under chronic estradiol treatment in rats[J]. Auton Neurosci,2016,197(1):19-24.
[12]符剑花,于英.女性血清E2及FSH水平与更年期不适临床症状的相关性分析[J].中国妇幼保健,2017,32(2):246-248.
[13] Wenner MM,Taylor HS,Stachenfeld NS. Peripheral microvascular vasodilatory response to estradiol and genistein in women with insulin resistance[J]. Microcirculation,2015,22(5):391-399.
[14]吴毓丽,徐松明,蒋利红.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[J].中国卫生检验杂志,2014,24(12):1745-1747.
[15]马娟文,陈伟伟,王惠琴,等.更年期综合征患者雌激素替代治疗对胰岛素样生长因子-1及骨密度的影响[J].中国当代医药,2017,24(29):71-74.
[16] Moreno M,Ordoez P,Alonso A,et al. Chronic 17beta-estradiol treatment improves skeletal muscle insulin signaling pathway components in insulin resistance associated with aging[J]. Age(Dordr),2010,32(1):1-13.
[17]杨艳文,栾玉芬,杨其贤,等.多囊卵巢综合征性激素水平及皮质醇检测与胰岛素抵抗的相关性分析[J].中国现代医学杂志,2014,24(35):43-46.
[18] Clapauch R,Mouro AF,Mecenas AS,et al. Endothelial function and insulin resistance in early postmenopausal women with cardiovascular risk factors:importance of ESR1 and NOS3 polymorphisms[J]. PLo S One,2014,9(7):e103444.
[19] Rohr UD,Volko CD,Schindler AE. Comparison of steady state development and reduction of menopausal symptoms after oral or transdermal delivery of 17-β-estradiol in young healthy symptomatic menopausal women[J]. Horm Mol Biol Clin Invest,2014,18(3):123-136.
[20]高婷婷.血清性激素及5-羟色胺在更年期抑郁患者体内的表达及临床价值[J].中国冶金工业医学杂志,2017,34(6):630-631.
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