Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycemic control, lipid metabolism, and vascular factors in type 2 diabetes - A prospective study
Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycemic control, lipid metabolism, and vascular factors in type 2 diabetes - A prospective study
复制标题
DOI：
10.2337/diacare.22.9.1401
复制
发表时间：
1999-09-01
期刊：
影响因子：
16.2
通讯作者：
Campbell, LV
中科院分区：
文献类型：
--
作者：
Samaras, K;Hayward, CS;Campbell, LV
目的：研究激素替代疗法（HRT）对超重绝经后2型糖尿病女性的脂质代谢、血糖控制、全身和腹部中心脂肪、血压（BP）和动脉脉搏波速度（APWV）的影响。研究设计和方法：这是一项为期12个月的前瞻性研究，共有14名受试者（平均+/- SD年龄57.5 +/- 5.6岁，BMI 29.5 +/- 4.8 kg/m(2)），随机分为6个月的观察组或交叉前HRT组。HRT包括2个月的共轭马雌激素（CEE） 0.625 mg /天，随后4个月的CEE和甲孕酮5 mg /天。测量包括人体测量、空腹血糖、胰岛素、HbA（1c）总胆固醇和高密度脂蛋白胆固醇、甘油三酯、载脂蛋白B、LDL颗粒大小、非酯化脂肪酸（NEFA）、性激素结合球蛋白、静息能量消耗（REE）、总腹部脂肪和中央腹部脂肪（通过双能x线吸收仪）、静息血压、APWV（通过压平血压计）、体力活动、幸福感和性功能。结果：与观察结果相比，HRT治疗6个月后腰臀比（-0.03 +/- 0.01 vs. 0.01 +/- 0.009, P = 0.007）、HbA(1c) （-0.34 +/- 0.24 vs. 0.6 +/- 0.4%, P = 0.04）、总胆固醇（-0.6 +/- 0.1 vs. 0.2 +/- 0.2 mmol/l, P = 0.001）、腹部中心脂肪（-175 +/- 51 vs. -24 +/- 56 g, P = 0.05）显著降低，身体功能改善（P = 0.05）。HRT组REE略有增加（33 +/- 23 vs -38 +/- 23 kJ/天，P = 0.04）。总脂肪量、空腹血糖、胰岛素、甘油三酯、载脂蛋白B、NEFA、静息血压、APWV和体力活动不变。结论：在这些超重的2型糖尿病女性患者中，绝经后HRT与中枢性肥胖的减少、脂质代谢和血糖控制的改善有关，而体重状况或心血管参数没有恶化。hrt诱导的这些心血管危险因素的改善是否会像在非糖尿病女性中观察到的那样降低长期心血管发病率和死亡率，有待进一步研究。
OBJECTIVE - To examine the effects of hormone replacement therapy (HRT) on lipid metabolism, glycemic control, total body and central abdominal fat, blood pressure (BP), and arterial pulse wave velocity (APWV) in overweight postmenopausal females with type 2 diabetes.RESEACH DESIGN AND METHODS - This was a 12-month prospective study of 14 subjects (mean +/- SD age 57.5 +/- 5.6 years, BMI 29.5 +/- 4.8 kg/m(2)) randomized to 6 months of observation or HRT before crossover. HRT consisted of 2 months of conjugated equine estrogen (CEE) 0.625 mg daily, followed by 4 months CEE and medroxyprogesterone 5 mg daily. Measures included anthropometry, fasting glucose, insulin, HbA(1c) total and HDL cholesterol, triglycerides, apolipoprotein B, LDL particle size, nonesterified fatty acids (NEFA), sex hormone-binding globulin, resting energy expenditure (REE), total and central abdominal fat (by dual-energy X-ray absorptiometry), resting BP, APWV (by applanation tonometry), physical activity, well-being, and sexual function.RESULTS- Six months of HRT resulted in significant reductions in waist-to-hip ratio (-0.03 +/- 0.01 vs. 0.01 +/- 0.009, P = 0.007), HbA(1c), (-0.34 +/- 0.24 vs. 0.6 +/- 0.4%, P = 0.04), total cholesterol (-0.6 +/- 0.1 vs. 0.2 +/- 0.2 mmol/l, P = 0.001), central abdominal fat (-175 +/- 51 vs. -24 +/- 56 g, P = 0.05), and improved physical functioning (P = 0.05), compared with observation. There was a minor increase in REE with HRT (33 +/- 23 vs. -38 +/- 23 kJ/day, P = 0.04). Total fat mass, fasting glucose, insulin, triglyceride, apolipoprotein B, NEFA, resting BP, APWV, and physical activity were unchanged.CONCLUSIONS - Postmenopausal HRT in these overweight women with type 2 diabetes was associated with a reduction in central adiposity and improvement in lipid metabolism and glycemic control without deterioration in weight status or cardiovascular parameters measured. Whether HRT-induced improvements in these cardiovascular risk factors result in lower long-term cardiovascular morbidity and mortality, as observed in nondiabetic women, awaits further study.