Correlation Of Homocysteine And Glucolipid Metabolism And The Effect Of MHT On Them In Perimenopausal And Postmenopausal Women

Objective 1.To observe the homocysteine（HCY）level in women of different menopause status and ages,and to explore the relationship between HCY level and menopausal status,age,blood pressure,glucolipid metabolism in perimenopausal and postmenopausal women.2.To investigate the effect of menopausal hormone therapy（MHT）on HCY and glucolipid metabolism in menopausal women.Methods 1.A total of 409 perimenopausal and postmenopausal women aged between 40 and 60 were selected from September 2019 to December 2021 at Hangzhou Women’s Hospital.General information such as age,menopausal status,body mass index,waist hip rate and blood pressure were collected.In the meantime,sex hormone,HCY and glucolipid metabolism were determined.The level of serum HCY in different menopausal stages and different ages were compared.Correlation analysis was conducted to explore the relationship between HCY level and menopause status,age,glucolipid metabolism and other indicators.2.A total of 50 perimenopausal women visited this hospital from September 2019 to December 2020 were recruited as the treatment group,and 47 healthy perimenopausal women who underwent physical examination in this hospital during the same period were recruited as the control group.The treatment group was going to receive MHT,while the control group without any therapy.The changes of serum HCY,sex hormone and glucolipid metabolism were analyzed and compared between the two groups at baseline and after 12 months of follow-up.Results 1.The serum HCY level of perimenopausal women was significantly higher than that of premenopausal women（P<0.05）,and the serum HCY level of postmenopausal women was higher than that of perimenopausal women（P<0.05）.The HCY level increased with age before 51～55 years old（P<0.05）,and it remained stable after 51～55 years old（P>0.05）with higher level than that in 40～45 years old.2.There were no difference between the HHCY group and the normal HCY group among the items of blood pressure,follicle stimulating hormone（FSH）,HOMA-IR,HOMA-β,total cholesterol（TC）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）and apolipoprotein Al（ApoA1）（P>0.05）.However,the luteinizing hormone（LH）,follicle stimulating hormone（FSH）and apolipoprotein B（ApoB）levels were higher in the HHCY group（P<0.05）,the levels of estradiol（E2）,prolactin（PRL）,fasting blood glucose（FPG）and triglyceride（TG）were lower in the HHCY group（P<0.05）.3.Uni variate analysis showed that HCY level was positively correlated with age,menopausal status,LH,FSH and ApoB,but negatively correlated with E2,PRL,FPG and TG（P<0.05）.By multi-factor regression analysis,we found that HCY level was only positively correlated with menopause（compared to premenopausal women,perimenopausal women have an OR of 9.669,95%CI 1.98-47.28,P=0.005;postmenopausal women have an OR of 18.973,95%CI 3.48-103.56,P=0.001）and ApoB（OR=506.511,95%CI 31.17-8229.79,P=0.001）,but negatively correlated with FPG（OR=0.533,95%CI 0.29-0.97,P=0.039）,TG（OR=0.391,95%CI 0.22-0.69,P=0.001）and LDL-C（OR=0.204,95%CI 0.08-0.54,P=0.001）.4.After 12-month follow-up,4.1 compared with the control group,LH and FSH levels decreased（P<0.05）,E2 level increased（P<0.05）significantly,while PRL level remain stable in the MHT group（P>0.05）.4.2 In the MHT group,the HCY level decreased significantly after treatment（P<0.05）.4.3 As for the glucose metabolism,there were no difference between the two groups among the items of FINS,FPG,HOMA-IR and HOMA-β.4.4 In the MHT group,TC,HDL-C and ApoB level decreased significantly after treatment（P<0.05）;In the control group,the level of TC increased and the ApoB level decreased significantly compared with baseline（P<0.05）.After 12-month follow-up,the HCY,TC and ApoB levels in the MHT group were significantly lower than those in the control group（P<0.05）,while the apolipoprotein A1 level was higher than the control group（P<0.05）.5.Decreased levels of HCY,TC,ApoB and TG,and increased level of ApoA1 in women with HHCY were found after 12 months of MHT（P<0.05）.Conclusion 1.The level of HCY in perimenopausal and postmenopausal women was higher than that in premenopausal women.And,the HCY level was increased with age.2.Adjusting for potential confounding factors,HCY level was correlated with menopausal status,FPG,TG,LDL-C and ApoB,among which menopause and ApoB are the main risk factors of HHCY.3.MHT had reversible effect on increased level of HCY in postmenopausal women.4.Short-term MHT did not affect the LDL-C level in perimenopausal women,but those with high ApoB and high TC levels can benefit from it.And MHT can also regulate the TG level in perimenopausal women with HHCY.5.MHT did not show an advantage of maintaining glucose homeostasis or plasma insulin.