HORMONE REPLACEMENT THERAPY AND METABOLIC CARDIOVASCULAR RISK

体内总脂肪及其分布与非胰岛素依赖型糖尿病（NIDDM）的发生有关。目前尚不清楚绝经后妇女的胰岛素敏感性是否与腹腔内、皮下、总脂肪或其他区域脂肪更密切相关。我们用计算机断层扫描（CT）测量了L4-L5椎间盘间隙的腹内脂肪（IAF）、皮下脂肪（SQF）和矢状直径（SD）；采用双光子x射线吸收仪（DEXA）测定全身脂肪（TBF）、脂肪% （PF）、手臂脂肪（AF）、腿部脂肪（LF）和躯干脂肪（TF）；27例未使用激素替代的非糖尿病早期绝经后妇女，年龄50.814/1岁，使用正糖钳对胰岛素敏感性(M)的影响。平均值和标准差为：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， M= 449.71119.5 mg/min。M与SQF更强烈的相关性(r = -0.39, p = 0.04)和SD (r = -0.42, p = 0.02),比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 =无误),低频(r = -0.22, p = 0.28),或特遣部队(r = 0.32, p = 0.10)。我们得出结论，腹部SQF和SD与绝经后妇女的胰岛素敏感性高度相关。努力减少SQF对降低绝经后妇女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体脂区和胰岛素敏感性。

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.