JCEM：ILS不能改变性类固醇激素

在没有多囊卵巢综合症（PCOS）病史的绝经前女性中间，强化生活方式改变（ILS）或二甲双胍是否能改变性类固醇激素仍不清除。为了验证为期一年的干预对性类固醇激素（雌二醇、睾酮、脱氢表雄酮和雄烯二酮[A4]）和性激素结合球蛋白（SHBG）的影响，以及是否有种族/族裔的差异，来自美国密歇根大学的Catherine Kim教授及其团队进行了一项研究，该研究发现在绝经前糖耐量异常的女性中间，干预没有改变性类固醇激素。强化生活方式改变增加性激素结合球蛋白，尽管其与血糖的关系没有意义。不同种族/族裔间性激素结合球蛋白和性类固醇激素相似，可能的例外是西班牙裔与非西班牙裔白人（NHWs）相比，基线雄烯二酮水平较低。该研究结果在线发表在5月24日的《临床内分泌代谢杂志》（The Journal of clinical endocrinology & metabolism）上。

该研究中的受试者来自糖尿病预防计划（DPP）中一个亚组，包括绝经前、没有使用雌激素、没有多囊卵巢综合症或月经不规则病史，以及种族/族裔为非西班牙裔白人（NHW）、西班牙裔、或者非裔美国人的受试者。随机分配到：1）目标位初始体重下降7%的强化生活方式改变和每周150分钟的中度强化锻炼；2）二甲双胍850mg，一天两次；或者3）安慰剂。

该研究结果表明，与安慰剂组相比，两种干预都不改变性类固醇激素。与安慰剂组性激素结合球蛋白中位数下降1.1nmol/l相比，强化生活方式改变组，而非二甲双胍组，性激素结合球蛋白中位数增加3.1nmol/l（～11%）（p＜0.05）。在校正协变量的变化，包括腰围后，这些比较仍有意义。然而，与血糖的关系没有意义。西班牙裔与非西班牙裔受试者相比，基线雄烯二酮中位数较低（5.7nmol/l vs 6.5nmol/l，p＜0.05），但西班牙裔比非西班牙裔受试者相比，雄烯二酮增加更多（3.0nmol/l vs 1.2nmol/l，p＜0.05），并且，这些差异在干预后没有显著不同。其他种族/族裔的差异没有意义。

该研究发现，在绝经前糖耐量异常的女性中间，干预没有改变性类固醇激素。强化生活方式改变增加性激素结合球蛋白，尽管其与血糖的关系没有意义。不同种族/族裔间性激素结合球蛋白和性类固醇激素相似，可能的例外是西班牙裔与非西班牙裔白人（NHWs）相比，基线雄烯二酮水平较低。

Sex hormone binding globulin and sex steroids among premenopausal women in the Diabetes Prevention Program.
Abstract
ContextIt is unknown whether intensive lifestyle modification (ILS) or metformin change sex steroids among premenopausal women without a history of polycystic ovarian syndrome (PCOS).ObjectivesTo examine one-year intervention impact upon sex steroids (estradiol, testosterone, dehydroepiandrosterone, and androstenedione [A4]) and sex hormone binding globulin (SHBG) and differences by race/ethnicityParticipantsA subgroup of Diabetes Prevention Program (DPP) participants who were premenopausal, not using estrogen, without a history of PCOS or irregular menses, and who reported non-Hispanic white (NHW), Hispanic, or African-American race/ethnicity (n=301).InterventionsRandomization arms were: 1) ILS with the goals of weight reduction of 7% of initial weight and 150 minutes per week of moderate intensity exercise, 2) metformin 850 mg twice a day, or 3) placebo.ResultsNeither intervention changed sex steroids compared to placebo. ILS, but not metformin, increased median SHBG by 3.1 nmol/l (∼11%) compared to decreases of 1.1 nmol/l in the placebo arm (p<0.05). This comparison remained significant after adjustment for changes in covariates including waist circumference. However, associations with glucose were not significant. Median baseline A4 was lower in Hispanics compared to NHWs (5.7 nmol/l vs. 6.5 nmol/l, p<0.05) and increases in A4 were greater in Hispanics compared to NHWs (3.0 nmol/ vs. 1.2 nmol/l, p<0.05), and these differences did not differ significantly by intervention arm. No other racial/ethnic differences were significant.ConclusionsAmong premenopausal glucose intolerant women, no intervention changed sex steroids. ILS increased SHBG, although associations with glucose were not significant. SHBG and sex steroids were similar by race/ethnicity, with the possible exception of lower baseline A4 levels in Hispanics compared to NHWs.