건강한 폐경 여성에서 호르몬 치료 후 Adipokine 및 Inflammatory Marker의 평가

Abstract

Recent research has demonstrated that adipose tissue is an active endocrine organ, which secretes various hormones, such as adiponectin, resistin, and leptin, referred to as adipo(cyto)kines. Adiponectin has anti- inflammatory, anti diabetic, and anti-atherogenic properties and resistin is known to increase insulin resistance. Adipokines are related to inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP), Interleukin (IL)-6, Tumor necrosis factor (TNF)-α. Adipose tissue is redistributed after menopause, and the risk of metabolic syndrome and cardiovascular events increases in postmenopausal women. Adipokines are considered to play an important role in this, but much is not known about the effects of menopause and hormone therapy on adipokines.The objectives of this study are to assess the changes of adipokines after menopause and effects of hormone therapy on adipokines and to evaluate the relations between cardiovascular risk factors and adipokines.Study subjects consisted of 36 premenopausal and 33 healthy, early menopausal women. 27 of the menopausal women received 6 months of hormone therapy. Initially body mass index (BMI), waist to hip ratio (WHR), and blood pressure (BP) were measured and lipid profile, fasting glucose, insulin, hs-CRP, IL-6, TNF-α, adiponectin, and resistin were assayed. Homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated.Total cholesterol, HDL cholesterol and fasting glucose levels in menopausal women were significantly higher than premenopausal women (169.39±30.04 vs. 197.55±35.37 mg/dL, 53.94±10.54 vs. 59.99±11.55 mg/dL, 4.75±0.36 vs. 5.04±0.46 mmol/L, P < 0.05), but not HOMA-IR index. Adiponectin was significantly raised in menopausal women (4.56 ± 2.42 vs. 7.76 ± 4.99 µg/mL, P < 0.05), but no difference was observed in levels of resistin, hs-CRP, TNF-a, and IL-6. Through multivariate regression analysis, hs-CRP and BMI were positively correlated, and adiponectin was positively correlated with age, and negatively correlated with BMI. TNF-α was significantly correlated with fasting glucose, and IL-6 with HOMA-IR index. After 6 months of hormone therapy, hs-CRP increased significantly (0.51±0.30 vs.1.22±1.52 mg/L, P < 0.05), but levels of adiponectin, resistin, TNF-a, and IL-6 were not altered.In conclusion, since adiponectin levels in healthy menopausal women increase significantly, it doesn’t seem to play a primary role in developing cardiovascular events and metabolic syndrome in menopausal women. Short term hormone therapy in menopausal women didn’t affect the levels of adipokines. Even though hs-CRP, an inflammatory marker, was increased after short-term hormone therapy, homocysteine and insulin levels went down and lipid profile was improved.