不同生殖衰老状态女性空腹血糖与胰岛素水平现况调查及相关性分析  

Investigation of fasting plasmaglucose and insulin level of women in different reproductive aging and its correlation

作　　者：王丽[1] 周淋魄 黄艺舟 宋阳[1] 马麟娟[1] 蔡玉群 周坚红[1] WANG Li;ZHOU Lin-po;HUANG Yi-zhou;SONG Yang;MA Lin-juan;CAI Yu-qun;ZHOU Jian-hong(Obstetrics and Gynecology Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang 310006;Zhejiang University City College, Hangzhou Zhejiang 310015;Maternal and Child Health & Family Planning Service Center of Gongshu District, Hangzhou Zhejiang 310015 ,P. R. China)

机构地区：[1]浙江大学医学院附属妇产科医院,浙江杭州310006 [2]浙江大学城市学院,浙江杭州310015 [3]杭州市拱墅区妇幼保健计划生育服务中心,浙江杭州310015

出　　处：《中国计划生育和妇产科》2019年第8期71-74,89,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：国家自然科学基金(项目编号:81701368);浙江省医药卫生重大科技计划(项目编号:WKJ-ZJ-1621)

摘　　要：目的调查不同生殖衰老状态女性空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)水平并分析其相关因素。方法 2014年3~5月对杭州市拱墅区927名40~60岁女性进行横断面调查,收集其月经史及其他临床资料,根据STRAW+10标准将研究对象分为:生育期、围绝经期、绝经后期3组。检测其FPG、FINS、卵泡刺激素(follicle-stimulating hormone,FSH)、雌二醇(estradiol,E_2)水平,研究不同生殖衰老状态女性FPG受损、糖尿病的发生情况,FPG、FINS及胰岛素抵抗相关指标的差异及与年龄、FSH、E_2等因素的相关性。结果 927名参与者平均年龄(51. 02±5. 55)岁,其中生育期291名(31. 4%),围绝经期185名(20. 0%),绝经后期451名(48. 6%)。生育期、围绝经期、绝经后期女性FPG水平分别为(5. 01±0. 58)mmol/L、(4. 91±0. 59) mmol/L、(5. 11±0. 88) mmol/L,组间比较差异有统计学意义(P <0. 05)。FPG在围绝经期显著低于生育期,FINS在绝经后期显著高于生育期,胰岛素抵抗指数(homeostasis model assessmentinsulin resistance,HOMA-IR)在绝经后期显著高于生育期,胰岛素分泌指数(HOMA-B)在围绝经期及绝经后期均显著大于生育期(P均<0. 05)。根据FPG对研究对象进行分组,糖尿病患者26人,FPG受损38人,血糖正常863人,绝经后期女性中FPG受损及糖尿病的比例较生育期及围绝经期升高(P <0. 05)。其中糖尿病患者年龄及FSH水平较其他两组人群显著偏高,E_2水平偏低。相关性分析表明年龄与HOMA-IR呈正相关(P<0. 05),FSH与HOMA-B呈正相关(P <0. 05),E_2与FPG、HOMA-IR、HOMA-B均呈负相关,BMI与HOMA-IR、HOMA-B呈正相关。结论相比生育期,绝经后期女性FPG水平无明显变化,FINS以及胰岛素抵抗水平上升,血糖异常的发生率升高,FSH、E_2可能与绝经后糖尿病及胰岛素抵抗发生相关。Objective To investigate the fasting plasma glucose( FPG) and fasting insulin levels in women with different reproductive aging status in Gongshu District of Hangzhou City and analyze the related factors. Methods A cross-sectional study was carried out involving 927 participants aged from 40 to 60 years old in Gongshu District,Hangzhou from March to May 2014. The menstrual history and other clinical data were collected,and the subjects were divided into three groups according to STRAW + 10:reproductive period,perimenopausal period and postmenopausal period. FPG,fasting insulin( FINS),follicle-stimulating hormone( FSH) and estradiol( E2) were measured to study the occurrence of impaired fasting glucose and diabetes,the differences in FPG,FINS and insulin resistance related indicators and their correlation with age,FSH,E2 and other factors in women with different reproductive aging status. Results The mean( SD) age of all participants was( 51. 02 ± 5. 55) years. Among the 927 participants,31. 4 %( 291) were reproductive,20. 0 %( 185) were perimenopausal,and 48. 6 %( 451) were postmenopausal. The FPG levels of the participants of the three groups were:( 5. 01 ± 0. 58) mmol/L,( 4. 91 ± 0. 59) mmol/L,( 5. 11 ± 0. 88) mmol/L,respectively,whose difference were statistically significant among groups( P = 0. 019). FPG was significantly lower in perimenopausal period than in reproductive period,while FINS was significantly higher in postmenopausal period than in reproductive period. The HOMA-IR of postmenopausal group was significantly higher than that of reproductive group,and the HOMA-B of perimenopausal group and postmenopausal group were significantly higher than that in reproductive group( P<0. 05 for all). 927 participants were divided by FPG level,among which 27 were diabetes,38 were in impaired fasting glucose group,863 were of normal blood glucose. Women in postmenopausal groups had significantly higher percentage of impaired fasting glucose and the diabetes than women in reproductive and perimenopausal groups

关 键 词：绝经 空腹胰岛素 糖尿病 空腹血糖 雌二醇 卵泡刺激素 相关性 

分 类 号：R271.116[医药卫生—中医妇科学] R587.1[医药卫生—中医学]