胰岛素敏感性、血脂与绝经后冠心病患者性激素水平关系的探讨

目的探讨绝经后冠心病（CHD）患者性激素水平的变化及与胰岛素敏感性（IS）、血脂的关系。方法检测30例绝经后CHD患者和30例健康对照者的雌二醇（E2）、睾酮（T）、孕酮（P）、促卵泡激素（FSH）、促黄体生成素（LH）、（FPG）、葡萄糖耐量试验2h血糖（2hPG）、空腹胰岛素（FIN）、总胆固醇（TC），甘油三脂（TG），低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C），计算胰岛素敏感指数（ISI）及雌二醇／睾酮（E／T）、孕酮／睾酮（P／T）、雌二醇／孕酮（E／P），并将CHD患者的E2、E／T、P／T、E／P与血脂、FIN、ISI作线性相关分析。结果与对照组比较绝经后CI-ID患者E2、E／T、ISI、HDL-C显著降低（P〈0．01）；FPG、2hPG、FIN、TC、TG、LDL-C显著增高（P〈0.05）；T、P、FSH、LH、P／T差异无统计学意义（P〉0．05）。相关分析表明，CHD患者的E2与FIN、TC、TG、LDL-C呈显著负相关，与ISI呈显著正相关（P均〈0．05）；E／T与FIN、TC、TG亦呈显著负相关，与ISI呈显著正相关（P均〈0．05），与LDL-C、HDL-C无显著相关性（P〉0．05）；P／T、E／P与血脂、FIN、ISI无相关（P〉0．05）。结论绝经后CHD患者存在内源性雌激素（E）严重缺乏，E／T、E／P比例失调，E2、E／T二者与血糖血脂异常、高胰岛素血症、IS降低和胰岛素抵抗（IR）等CHD发病危险因素的聚合有关，它们共同影响绝经后CHD的发生和发展。

A study of sex hormone and insulin sensitivity, lipid disorder in postmenopausal women with coronary heart disease

Objective To study sex hormones in postmenopausal Women with coronary heart disease(CHD) and the relationship of sex hormones,insulin sensitivity index(ISI),and lipid.Methods The estradiol,testosterone,pregnendione,follicle stimulating hormone(FSH),luteinizing hormone(LH),fasting plasma glucose(FPG),Oral glucose tolerance test 2h glucose(2 h PG),fasting insulin(FIN),total cholesterol,triglycerides,low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),insulin sensitivity index(ISI) and estradiol/testosterone,pregnendione/testosterone,estradiol/pregnendione ratio were measured in 30 postmenopausal women with CHD and 30 controls.Linear correlation was analyzed among estradiol,estradiol/ testosterone(E/T),pregnendione/testosterone(P/T),estradiol/pregnendione(E/P),and FIN,ISI,lipids.Results The results showed that the concentration of estradiol,E/T,E/P,were decreased,ISI,HDL-C(P<0.05) and FPG,2 h PG,FIN,total cholesterol,triglycerides,LDL-C were elevated(P<0.05) in postmenopausal CHD Women.But the concentration of testosterone,pregnendione,FSH,LH,P/T didn't charge significantly(P>0.05).There were significant negative correlation between estradiol and FIN,total cholesterol,triglycerides,LDL-C,and between E/T ratio and FIN,total cholesterol,triglycerides.There were significant positive correlation between estradiol and ISI,and between E/T ratio and ISI(P<0.05).Conclusion There is a close relationship of dyslipidemia,hyperisulinism,reduce of insulin sensitivity,insulin resistance and sex hormone disorder in postmenopausal women.They play an important role in the development of CHD.