HORMONE REPLACEMENT THERAPY AND METABOLIC CARDIOVASCULAR RISK

全身脂肪及其分布与非胰岛素依赖型糖尿病(NIDDM)的发生发展有关。目前尚不清楚绝经后妇女的胰岛素敏感性与腹内脂肪、皮下脂肪、总脂肪或其他局部脂肪之间的关系是否更密切。我们用计算机断层扫描(CT)测量了L4-L5间盘间隙的腹内脂肪、皮下脂肪和矢状径；用双光子X射线吸收测量仪测量了全身脂肪、百分比脂肪(PF)、上肢脂肪(AF)、腿部脂肪(LF)和躯干脂肪(Tf)；使用正常血糖钳测量了27名年龄为50.814/1岁的非糖尿病绝经后早期妇女的胰岛素敏感性(M)。平均值和标准差分别为：IAF=88.1132.7 cm~2，SQF=270.3186.4 cm~2，SD=214.4 cm，TBF=22.717.0 kg，PF=34.615.9%，AF=2.410.9 kg，LF=8.512.7 kg，Tf=10.31 3.5 kg，M=449.71119.5 mg/min。M与SQF(r=-0.39，p=0.04)和SD(r=-0.42，p=0.02)的相关性比与IAF(r=-0.32，p=0.11)、TBF(r=-0.26，p=0.19)、PF(r=-0.20，p=0.31)、AF(r=-0.15，p=0.44)、LF(r=-0.22，p=0.28)或TF(r=0.32，p=0.10)更强。我们得出结论，绝经后妇女腹部SQF和SD与胰岛素敏感性高度相关。减少SQF的努力对降低绝经后妇女患NIDDM的风险最有帮助。正在进行的研究将确定激素替代疗法是否会影响这些女性的身体脂肪隔间和胰岛素敏感性。

Total body fat and its distribution are related to the development of non-insulin dependent diabetes mellitus (NIDDM). It is unknown whether insulin sensitivity is correlated more closely to intra-abdominal, subcutaneous, total, or other regional fat in postmenopausal women. We measured intra-abdominal fat (IAF), subcutaneous fat (SQF), and sagittal diameter (SD) at the L4-L5 vertebral disc space with computed tomography (CT); total body fat (TBF), % fat (PF), arm fat (AF), leg fat (LF), and trunk fat (TF) using dual photon x-ray absorptiometry (DEXA); and insulin sensitivity (M) using euglycemic clamps in 27 non-diabetic early postmenopausal women, ages 50.814/1 years, who were not taking hormone replacement. The means and standard deviations were: IAF= 88.1132.7 cm2, SQF=270.3186.4 cm2, SD=214.4 cm, TBF= 22.717.0 kg, PF=34.615.9%, AF=2.410.9 kg, LF=8.512.7 kg, TF=10.31 3.5 kg, and M= 449.71119.5 mg/min. M correlated more strongly with SQF (r= -0.39, p= 0.04) and SD (r= -0.42, p=0.02), than to IAF (r=-0.32, p=0.11), TBF (r= -0.26, p=0.19), PF (r=-0.20, 0.31), AF (r= -0.15, p=.44), LF (r= -0.22, p=0.28), or TF (r= 0.32, p= 0.10). We conclude that abdominal SQF and SD are most highly correlated to insulin sensitivity in postmenopausal women. Efforts to reduce SQF should be most helpful in reducing the risk of NIDDM in postmenopausal women. Ongoing studies will determine if hormone replacement therapy affects body fat compartments and insulin sensitivity in these women.