月經(jīng)周期對(duì)女運(yùn)動(dòng)員耐力運(yùn)動(dòng)時(shí)物質(zhì)代謝及激素變化的影響

付德榮　劉承宜　孫小華

摘要：綜述了月經(jīng)周期中雌、孕激素水平波動(dòng)對(duì)耐力運(yùn)動(dòng)時(shí)物質(zhì)代謝及相關(guān)激素的影響作用。前人的研究表明，中低強(qiáng)度運(yùn)動(dòng)時(shí)雌激素可增加脂類氧化，減少糖的利用，起著碳水化合物節(jié)省化效應(yīng)。孕激素在雌激素作用的基礎(chǔ)上提高脂類氧化，增加有氧運(yùn)動(dòng)能力。在雌、孕激素較高的黃體期進(jìn)行有氧運(yùn)動(dòng)，機(jī)體氧化脂類能力高于卵泡期，利用碳水化合物能力低于卵泡期。月經(jīng)周期對(duì)胰島素、兒茶酚胺類激素、生長(zhǎng)激素及糖皮質(zhì)激素的基礎(chǔ)值及運(yùn)動(dòng)誘導(dǎo)的反應(yīng)值沒有明顯影響作用。因此，運(yùn)動(dòng)訓(xùn)練過程中應(yīng)考慮月經(jīng)周期時(shí)相對(duì)物質(zhì)代謝的影響作用以期充分地發(fā)揮女性運(yùn)動(dòng)員的生理潛能。

關(guān)鍵詞：運(yùn)動(dòng)生理學(xué)；月經(jīng)周期；雌激素；孕激素；物質(zhì)代謝；耐力運(yùn)動(dòng)；綜述

中圖分類號(hào)：G804.7文獻(xiàn)標(biāo)識(shí)碼：A文章編號(hào)：1006-7116(2009)01-0100-06

Effects of the menstrual cycle on substance metabolism and female athletes

hormone changes of during an endurance exercise

FU De-rong1，LIU Cheng-yi1，SUN Xiao-hua2

（1.Laboratory of Laser Sports Medicine，South China Normal University，Guangzhou 510006，China；

2.Guangdong Vocational Institute of Sports，Guangzhou 510663，China）

Abstract: The authors gave an overview of the effects of the fluctuation of estrogen and progesterone levels in the menstrual cycle on substance metabolism and related hormones during an endurance exercise. Previous researches indicated that during a medium or low intensity exercise estrogen can increase lipid oxidation and reduce glucose utilization, achieving the effect of carbohydrate saving. On the basis of estrogen functions, progesterone promotes lipid oxidation and enhances the aerobic exercise capacity. During an aerobic exercise done in the corpus luteum period with a relatively high level of estrogen and progesterone, the lipid oxidation capacity of the body is higher than the same in the ovarian follicle period, while the carbohydrate utilization capacity of the body is lower than the same in the ovarian follicle period. The menstrual cycle has no significant effect on the basic values and sport induced reaction values of insulin, catecholamine hormone, growth hormone and glucocorticoid. Therefore, during sports training the effects of the menstrual cycle on substance metabolism should be considered in order to fully exert physiological potentials of female athletes.

Key words: sports physiology；menstrual cycle；estrogen；progesterone；substance metabolism；endurance exercise；overview

月經(jīng)周期是下丘腦-垂體-卵巢軸相互協(xié)調(diào)及性器官靶組織對(duì)性激素反映的結(jié)果。隨著卵泡發(fā)育成熟及排卵，體內(nèi)雌、孕激素水平呈現(xiàn)明顯的周期性波動(dòng)，子宮內(nèi)膜隨之發(fā)生周期性的剝脫和出血。雌、孕激素這種周期性的變化規(guī)律不僅調(diào)節(jié)著女性的生殖功能，還與機(jī)體的物質(zhì)代謝及運(yùn)動(dòng)能力有著密切的關(guān)系。

1雌、孕激素對(duì)物質(zhì)代謝的影響

耐力性運(yùn)動(dòng)中，女性利用脂肪供能比例明顯高于男子，而碳水化合物(carbohydrate，CHO)氧化(CHO oxidation，CHOox)能力弱于男性[1]，呈現(xiàn)物質(zhì)代謝的性別差異與女性體內(nèi)較高的雌激素水平有關(guān)[2-3]。成年男性補(bǔ)充雌激素后可降低運(yùn)動(dòng)時(shí)呼吸交換率(respiratory exchange ratio，RER)，在65%最大攝氧量(VO2max)強(qiáng)度運(yùn)動(dòng)時(shí)減少CHOox，提高脂類利用，提高脂肪與CHOox比達(dá)31%~75%[4]。閉經(jīng)女性補(bǔ)充雌激素后，安靜時(shí)游離脂肪酸(free fatty acids，F(xiàn)FA)明顯升高，以65% VO2max跑臺(tái)運(yùn)動(dòng)90 min后再以85% VO2max運(yùn)動(dòng)至力竭，與安慰劑組比較，雌激素補(bǔ)充組運(yùn)動(dòng)過程中糖顯現(xiàn)率(rate of appearance，Ra)及糖消率(rate of disappearance，Rd)均明顯下降[5]。人為控制正常女性體內(nèi)性激素自發(fā)性周期變化而給與外源的雌激素時(shí)，60% VO2max強(qiáng)度踏車運(yùn)動(dòng)60 min，RER明顯降低、糖Ra和Rd降低、肌糖原利用估計(jì)值(estimated muscle glycogen utilization，EMGU)下降、血漿FFA的濃度升高，CHOox呈現(xiàn)節(jié)省化，而脂類利用增加[3]。雌激素補(bǔ)充同樣可降低男性耐力運(yùn)動(dòng)時(shí)機(jī)體糖Ra和Rd[4]，從而調(diào)節(jié)運(yùn)動(dòng)時(shí)血糖平衡。

動(dòng)物實(shí)驗(yàn)顯示相似結(jié)果。雄性大鼠注射雌激素可明顯增加其運(yùn)動(dòng)肌對(duì)脂類的利用[6]，在2 h的次最大強(qiáng)度跑臺(tái)運(yùn)動(dòng)中，與對(duì)照組比較，肝糖原、肌糖原下降的速度顯著減慢[7]，糖的消耗明顯減少，脂肪酸氧化增加，血乳酸濃度降低，運(yùn)動(dòng)成績(jī)提高[8]。卵巢切除的大鼠骨骼肌結(jié)合胰島素能力下降，骨骼肌減少了對(duì)胰島素誘導(dǎo)的2-脫氧-D-葡萄糖(insulin-stimulated 2-deoxy-D-glucose，2-DOG)的攝取，減少了肌糖原的合成[9-10]，糖異生增強(qiáng)，肝、心肌、骨骼肌等各組織中糖原的含量減少，血糖升高[11]。雌激素補(bǔ)充可恢復(fù)骨骼肌結(jié)合胰島素的能力，恢復(fù)對(duì)2-DOG的正常攝取[9-10]，降低糖異生，增加肌糖原及肝糖原的沉積[11]，減少運(yùn)動(dòng)時(shí)對(duì)糖的氧化利用，出現(xiàn)碳水化合物的節(jié)省化效應(yīng)[12]。

雌激素增加脂肪氧化，減少運(yùn)動(dòng)時(shí)CHO消耗，與其調(diào)節(jié)物質(zhì)代謝過程中相關(guān)酶活性以及有關(guān)激素的敏感性有關(guān)。實(shí)驗(yàn)證明，雌激素可提高運(yùn)動(dòng)肌中脂蛋白脂肪酶(lipoprotein lipase，LPL)活性，升高股紅肌與脂肪組織中LPL活性比及心肌與脂肪組織中LPL活性比，促進(jìn)脂肪酸向運(yùn)動(dòng)肌的流向[6]；提高肉堿棕櫚酰基轉(zhuǎn)移酶活性，并可逆轉(zhuǎn)大鼠因卵巢切除所致的β-羥脂酰輔酶A脫氫酶(beta-Hydroxyacyl-CoA dehydrogenase β-HAD)活性的降低，使之恢復(fù)正常水平[13]；增加胰島素的敏感性及與靶細(xì)胞結(jié)合的能力[10]；調(diào)節(jié)糖原合成酶及檸檬酸合成酶的活性[14]；減少中等強(qiáng)度運(yùn)動(dòng)時(shí)腎上腺素的分泌量[5]；提高白色脂肪細(xì)胞中腺苷酸環(huán)化酶活性，增加腎上腺素的脂解作用[15]；減少運(yùn)動(dòng)過程中EMGU及糖Rd[3]等。雌激素通過上述多種方式減少糖利用，增加脂肪氧化供能比。

孕激素調(diào)節(jié)物質(zhì)代謝的作用沒有雌激素明顯。單獨(dú)使用孕激素對(duì)卵巢切除的大鼠糖代謝動(dòng)力學(xué)參數(shù)的恢復(fù)影響不明顯[9]。與雌激素聯(lián)合應(yīng)用時(shí)，在雌激素作用基礎(chǔ)上促進(jìn)脂類氧化加強(qiáng)[16-18]，并增加有氧運(yùn)動(dòng)能力[18]。給健康女性口服避孕藥并進(jìn)行遞增負(fù)荷實(shí)驗(yàn)，隨著運(yùn)動(dòng)強(qiáng)度的增加，高孕激素組(35 μg ethinyl estradiol和1 000 μg norethisterone。high progestin，高Ph)峰值攝氧量(peak oxygen uptake VO2peak)升高的幅度大于低孕激素組(35 μg ethinyl estradiol和500 μg norethisterone。low progestin，低PL)，RER低于低P組，峰值功力輸出(peak power output，Wlpeak)有升高趨勢(shì)，運(yùn)動(dòng)至疲勞的時(shí)間延長(zhǎng)。在以75% VO2peak強(qiáng)度持續(xù)運(yùn)動(dòng)20 min時(shí)，高Ph組氧脈搏增加，RER降低，脂類的氧化增強(qiáng)，運(yùn)動(dòng)至力竭的時(shí)間相對(duì)延長(zhǎng)，峰值攝氧量有上升的趨勢(shì)，總做功量增加，但功力輸出、心率、峰值乳酸濃度不受孕激素濃度的影響[18]。孕激素對(duì)物質(zhì)代謝的作用可能與其降低己糖激酶的活性[19]、減弱磷酸戊糖途徑代謝[20]、降低脂肪細(xì)胞對(duì)胰島素的敏感性[21]、降低脂肪酸的合成[22]等多種調(diào)節(jié)途徑有關(guān)。

2月經(jīng)時(shí)相對(duì)物質(zhì)代謝的影響

月經(jīng)周期的不同時(shí)相中，雌、孕激素水平會(huì)有明顯變化。黃體期雌激素的水平比卵泡期升高3倍左右，孕激素升高達(dá)20倍左右(血清雌激素：卵泡早期0.18~0.22 nmol/L，黃體期0.55~0.7 nmol/L；血清孕激素：卵泡早期＜3 nmol/L，黃體期32~64 nmol/L)[23]。這種變化對(duì)運(yùn)動(dòng)時(shí)物質(zhì)代謝會(huì)有一定的影響，主要體現(xiàn)在對(duì)糖的Ra、Rd、糖代謝清除率(glucose metabolic clearance rate，MCR)[17，24-25]及脂類的Ra和Rd以及RER的調(diào)節(jié)上[17]。

2.1對(duì)碳水化合物代謝的影響

CHO在運(yùn)動(dòng)中的供能比例隨著運(yùn)動(dòng)強(qiáng)度的增大而增加[26-27]。當(dāng)運(yùn)動(dòng)強(qiáng)度達(dá)65% VO2max以上時(shí)，CHOox迅速上升，脂類氧化明顯降低[26]，強(qiáng)度達(dá)(89±3)%VO2max，((92±1)%HRmax)以上時(shí)，脂類氧化供能比幾乎可忽略不計(jì)[28]。在接近VO2max強(qiáng)度運(yùn)動(dòng)時(shí)，肌糖原、肝糖原是能量的主要來(lái)源[29]。

安靜時(shí)，月經(jīng)周期時(shí)相對(duì)糖代謝動(dòng)力學(xué)、血乳酸、RER影響不明顯[17，25，30-31]。運(yùn)動(dòng)狀態(tài)下，月經(jīng)周期對(duì)物質(zhì)代謝的影響作用與運(yùn)動(dòng)強(qiáng)度、運(yùn)動(dòng)水平及運(yùn)動(dòng)持續(xù)的時(shí)間等有關(guān)。以35% VO2max及60% VO2max強(qiáng)度跑臺(tái)運(yùn)動(dòng)30 min，正常月經(jīng)周期的普通女性黃體中期氧化利用CHO的比例明顯低于卵泡中期，當(dāng)運(yùn)動(dòng)強(qiáng)度達(dá)75% VO2max時(shí)，CHOox利用在卵泡、黃體兩期中沒有差異[16]。有運(yùn)動(dòng)習(xí)慣的女性以70%乳酸閾(lactate threshold，LT)強(qiáng)度功率自行車運(yùn)動(dòng)25 min，總CHOox、血乳酸濃度、RER、糖Ra或Rd在卵泡期和黃體期中沒有差異，但在緊接其后以90% LT強(qiáng)度繼續(xù)運(yùn)動(dòng)25 min時(shí)，黃體期總CHOox比卵泡期低13%，糖Ra低于卵泡期14%，Rd低于卵泡期15%，血乳酸、RER亦明顯低于卵泡期。血糖濃度在安靜及70% LT或90% LT強(qiáng)度運(yùn)動(dòng)時(shí)，黃體期的值均高于卵泡期[17]。Devries等[24]的實(shí)驗(yàn)也顯示休閑運(yùn)動(dòng)青年女性在65% VO2peak強(qiáng)度功率車運(yùn)動(dòng)90 min時(shí)，黃體期(月經(jīng)周期的(20±1) d)Ra、Rd和MCR值均低于卵泡期(月經(jīng)周期的(9±1)d），黃體期骨骼肌利用前糖原、大糖原、總糖原比卵泡期分別降低30%、16%及24%；血糖及肌糖原在總CHOox中的貢獻(xiàn)率，卵泡期為29%和71%，黃體期為32%和68%，差異不明顯。但也有實(shí)驗(yàn)顯示中等強(qiáng)度運(yùn)動(dòng)時(shí)月經(jīng)周期時(shí)相對(duì)CHO代謝沒有明顯影響作用[25]。

如果在運(yùn)動(dòng)的前中后過程中合理補(bǔ)充糖飲料，月經(jīng)周期時(shí)相對(duì)糖代謝的影響作用就會(huì)減弱或消失。Campbell等[32]對(duì)中等程度訓(xùn)練的8名月經(jīng)周期正常的女性進(jìn)行70% VO2peak強(qiáng)度自行車運(yùn)動(dòng)2 h，緊接著再進(jìn)行4 kJ/kg的最快速度定量計(jì)時(shí)測(cè)試，結(jié)果顯示非補(bǔ)糖組卵泡期CHOox百分比((80.1±1.2)%)明顯高于黃體期((77.0±1.0)%)(P<0.05)，糖Ra、Rd，MCR及肝葡萄糖生成(hepatic glucose production，HGP)亦明顯高于黃體期，卵泡期的成績(jī)比黃體期提高13%。在補(bǔ)糖組中糖代謝動(dòng)力學(xué)的差異基本消失，總CHOox百分比、糖Ra、Rd，MCR的值在卵泡、黃體兩期中沒有明顯變化，且補(bǔ)糖組中總CHOox百分比、血糖以及糖Ra、Rd均高于非補(bǔ)糖組的任何時(shí)期，HGP低于非補(bǔ)糖組任何時(shí)期，但血LT、MCR在補(bǔ)糖組與非補(bǔ)糖組沒有明顯不同。補(bǔ)糖組的運(yùn)動(dòng)成績(jī)與非補(bǔ)糖組比較卵泡期及黃體期分別提高了19%及26%。

2.2對(duì)脂類代謝的影響

脂肪的氧化利用是中低強(qiáng)度運(yùn)動(dòng)時(shí)的主要能量來(lái)源[26，33]，耐力訓(xùn)練可提高機(jī)體利用脂肪的能力[34]。中等程度訓(xùn)練者最大氧化脂肪的運(yùn)動(dòng)強(qiáng)度范圍為(55±3)%~(72±4)% VO2max[28]，而普通人群為(48.3±0.9)% VO2max[35]。運(yùn)動(dòng)方式對(duì)脂類的氧化率亦有影響作用，同等強(qiáng)度運(yùn)動(dòng)時(shí)，跑步運(yùn)動(dòng)者脂類的氧化利用率高于自行車運(yùn)動(dòng)者[36]。

安靜狀態(tài)下月經(jīng)周期時(shí)相對(duì)脂類的代謝沒有影響[17，37]。在35% VO2max及60% VO2max強(qiáng)度跑臺(tái)運(yùn)動(dòng)時(shí)，正常月經(jīng)周期的普通女性黃體中期氧化脂肪的能力明顯高于卵泡中期，當(dāng)運(yùn)動(dòng)強(qiáng)度達(dá)75% VO2max時(shí)，這種差異消失[16]。Zderic等[17]對(duì)運(yùn)動(dòng)習(xí)慣的民眾進(jìn)行70% LT強(qiáng)度功率自行車運(yùn)動(dòng)25 min，總脂類的氧化在卵泡期和黃體期沒有差異，但在緊接其后的90% LT強(qiáng)度運(yùn)動(dòng)時(shí)，黃體期總脂類的氧化利用高于卵泡期23%。Campbell等[32]實(shí)驗(yàn)也顯示在70% VO2peak強(qiáng)度運(yùn)動(dòng)時(shí)，中等程度訓(xùn)練的女性黃體期脂類氧化百分比明顯高于卵泡期。運(yùn)動(dòng)過程中合理補(bǔ)充糖飲料，可降低月經(jīng)各期中脂類的氧化百分比，并消除卵泡黃體兩期中氧化脂類的差異[32]。但Horton等[38]實(shí)驗(yàn)卻顯示50%VO2max強(qiáng)度90 min功力車運(yùn)動(dòng)時(shí)，月經(jīng)時(shí)相對(duì)脂類的代謝沒有明顯影響作用。

月經(jīng)周期時(shí)相對(duì)CHO及脂類代謝的影響作用與運(yùn)動(dòng)者的運(yùn)動(dòng)水平、運(yùn)動(dòng)模式、運(yùn)動(dòng)強(qiáng)度以及運(yùn)動(dòng)時(shí)間的選擇有關(guān)。高水平運(yùn)動(dòng)者氧化脂類的能力高于低水平運(yùn)動(dòng)者。運(yùn)動(dòng)模式不同募集的運(yùn)動(dòng)肌群不同，氧化能源有所差異。運(yùn)動(dòng)強(qiáng)度與運(yùn)動(dòng)時(shí)間的安排直接決定了CHO及脂類的功能比例。運(yùn)動(dòng)者個(gè)體間性激素周期性波動(dòng)幅度的差異對(duì)物質(zhì)代謝也可能存在著一定影響作用。

3月經(jīng)周期對(duì)相關(guān)激素水平的影響

體內(nèi)物質(zhì)代謝受多種激素的調(diào)節(jié)，如胰島素、兒茶酚胺類激素、腎上腺皮質(zhì)激素以及生長(zhǎng)激素等，這些激素的水平變化可直接影響機(jī)體的物質(zhì)代謝及運(yùn)動(dòng)能力的發(fā)揮。

實(shí)驗(yàn)顯示，安靜狀態(tài)下胰島素濃度在正常月經(jīng)周期的卵泡期和黃體期中沒有明顯差異[17，25]，但對(duì)其敏感性存在不同觀點(diǎn)。Diamond[39]和Toth等[40]的實(shí)驗(yàn)顯示胰島素敏感性不受月經(jīng)周期時(shí)相的影響，而Valdes[37]和Escalante[41]等的實(shí)驗(yàn)表明胰島素敏感性在黃體期時(shí)明顯下降(前者P＜0.007，后者P＜0.001)。運(yùn)動(dòng)可提高胰島素的敏感性[42]，降低體內(nèi)胰島素的水平[43-44]。月經(jīng)周期的不同時(shí)期運(yùn)動(dòng)，對(duì)胰島素濃度的影響各實(shí)驗(yàn)結(jié)果間存在一定差異。Zderic等[17]報(bào)道在月經(jīng)不同時(shí)期以70% LT或90% LT的不同強(qiáng)度運(yùn)動(dòng)，胰島素在運(yùn)動(dòng)中的反應(yīng)水平不受月經(jīng)周期時(shí)相的影響；Horton TJ等[25]實(shí)驗(yàn)顯示，50% VO2max強(qiáng)度90 min運(yùn)動(dòng)時(shí)，胰島素濃度在黃體中期明顯高于卵泡早期和卵泡中期(P＜0.001)，伴有明顯的血糖升高的同步變化，尤其在運(yùn)動(dòng)的最初45 min內(nèi)；而Braun等[43]的實(shí)驗(yàn)則顯示52% VO2peak強(qiáng)度功率車運(yùn)動(dòng)15 min時(shí)，黃體期胰島素的值明顯低于卵泡期，隨運(yùn)動(dòng)時(shí)間的延長(zhǎng)這種差異消失。運(yùn)動(dòng)過程中合理補(bǔ)充糖飲料可降低長(zhǎng)時(shí)間運(yùn)動(dòng)引起的血糖及胰島素水平的下降，延長(zhǎng)至疲勞的時(shí)間[32，45]。

運(yùn)動(dòng)明顯升高兒茶酚胺類激素的水平[25，30，46-47]，在接近100% VO2max強(qiáng)度運(yùn)動(dòng)時(shí)，腎上腺素濃度可升高14倍，去甲腎上腺素可升高18倍[47]。運(yùn)動(dòng)水平對(duì)其存在影響作用，運(yùn)動(dòng)員安靜及運(yùn)動(dòng)時(shí)腎上腺素的濃度均高于非運(yùn)動(dòng)員[46]。月經(jīng)周期時(shí)相對(duì)兒茶酚胺類激素不產(chǎn)生明顯影響[30，48]。Dean[30]的實(shí)驗(yàn)顯示在卵泡早期、卵泡中期及黃體中期中，腎上腺素的安靜值分別為(24±2)、(23±3)、(26±5) pg/mL，去甲腎上腺素的安靜值分別為(242±60)、(229±33)、(225±16) pg/mL；在乳酸閾強(qiáng)度運(yùn)動(dòng)結(jié)束時(shí)，腎上腺素的質(zhì)量濃度分別為(418±110)、(336±70)、(353±51) pg/mL，去腎上腺素的質(zhì)量濃度分別為(3 800±1 109)、(4 135±1 076)、

(4 034±961) pg/mL，均沒有明顯差異。Braun[43]及Botcazou等[48]的實(shí)驗(yàn)也同樣說明了腎上腺素及去甲腎上腺素的水平變化與月經(jīng)周期時(shí)相沒有聯(lián)系，而與運(yùn)動(dòng)強(qiáng)度及運(yùn)動(dòng)時(shí)間關(guān)系密切[25，48]。

安靜時(shí)腎上腺皮質(zhì)激素及促皮質(zhì)激素(adrenocorticotropic hormone，ACTH)濃度不受月經(jīng)周期的影響，以70% VO2max運(yùn)動(dòng)明顯升高該2激素的水平，但在月經(jīng)周期的不同時(shí)相中其對(duì)運(yùn)動(dòng)刺激的反應(yīng)相似[49]。Horton等[25]的實(shí)驗(yàn)顯示可的松的安靜值在月經(jīng)周期的不同階段水平相似，在50% VO2max強(qiáng)度90 min運(yùn)動(dòng)時(shí)，可的松水平明顯升高，并存在時(shí)間效應(yīng)關(guān)系，但這種反應(yīng)不受月經(jīng)周期時(shí)間差別的影響。Braun[43]、Bailey[45]及Kanaley[50]的實(shí)驗(yàn)同樣反映出可的松水平在安靜時(shí)及運(yùn)動(dòng)時(shí)均不受月經(jīng)周期時(shí)相的影響。運(yùn)動(dòng)過程中合理補(bǔ)糖對(duì)可的松濃度有影響。在70% VO2max強(qiáng)度運(yùn)動(dòng)至疲勞的實(shí)驗(yàn)中，運(yùn)動(dòng)至60 min時(shí)，補(bǔ)糖組可的松濃度大于非補(bǔ)糖組((357±26)、(274±28) nmol/L)，但運(yùn)動(dòng)至疲勞時(shí)，補(bǔ)糖組可的松水平低于非補(bǔ)糖組((486±57)、(625±59) nmol/L)[45]。

運(yùn)動(dòng)明顯升高血生長(zhǎng)激素(growth hormone GH)水平，其峰值幅度與運(yùn)動(dòng)負(fù)荷量明顯相關(guān)[51-53]。年齡、性別及運(yùn)動(dòng)水平對(duì)GH的濃度有影響作用。優(yōu)秀女子運(yùn)動(dòng)員GH基礎(chǔ)值高于優(yōu)秀男子運(yùn)動(dòng)員[52]，年輕女性GH對(duì)運(yùn)動(dòng)刺激的反應(yīng)釋放量高于同齡男子及年長(zhǎng)者[51]，長(zhǎng)期耐力訓(xùn)練可提高GH的敏感性，降低GH的基礎(chǔ)值及對(duì)運(yùn)動(dòng)刺激的反應(yīng)值[53]。實(shí)驗(yàn)顯示，月經(jīng)周期對(duì)GH安靜值及運(yùn)動(dòng)刺激的反應(yīng)值均無(wú)明顯影響作用[17，54]。以60% VO2max強(qiáng)度運(yùn)動(dòng)90 min時(shí)，卵泡早期、卵泡中期及黃體中期的GH反應(yīng)值分別是(37.5±11.5)、(61.9±11.5)及(48.1±12.8) μg/L，沒有明顯差異[54]。Zderic等[17]報(bào)道GH安靜值在卵泡期((1.4±0.03) ng/mL)及黃體期((1.6±0.19) ng/mL)中相似，以70%和90% LT運(yùn)動(dòng)后，黃體期GH值(70% LT(11.6±4.2) ng/mL，90% LT(11.1±2.4) ng/mL)稍高于卵泡期(70% LT(8.8±4.3) ng/mL，90% LT(8.5±2.6) ng/mL)，但差異無(wú)顯著性。

參考文獻(xiàn)：

[1] Devries M C，Hamadeh M J，Phillips S M，et al. Menstrual cycle phase and sex influence muscle glycogen utilization and glucose turnover during moderate-intensity endurance exercise[J]. Am J Physiol Regul Integr Comp Physiol，2006，291(4)：1120-1128.

[2] D'Eon T，Braun B. The roles of estrogen and progesterone in regulating carbohydrate and fat utilization at rest and during exercise[J]. J Womens Health Gend Based Med，2002，11(3)：225-237.

[3] D'Eon T M，Sharoff C，Chipkin S R，et al. Regulation of exercise carbohydrate metabolism by estrogen and progesterone in women[J]. Am J Physiol Endocrinol Metab，2002，283(5)：E1046-1055.

[4] Devries M C，Hamadeh M J，Graham T E，et al. 17 beta-estradiol supplementation decreases glucose rate of appearance and disappearance with no effect on glycogen utilization during moderate intensity exercise in men[J]. J Clin Endocrinol Metab，2005，90(11)：6218-6225.

[5] Ruby B C，Robergs R A，Waters D L，et al. Effects of estradiol on substrate turnover during exercise in amenorrheic females[J]. Med Sci Sports Exerc，1997，29(9)：1160-1169.

[6] Ellis G S，Lanza-Jacoby S，Gow A，et al. Effects of estradiol on lipoprotein lipase activity and lipid availability in exercised male rats[J]. J Appl Physiol，1994，77(1)：209-215.

[7] Rooney T P，Kendrick Z V，Carlson J，et al. Effect of estradiol on the temporal pattern of exercise-induced tissue glycogen depletion in male rats[J]. J Appl Physiol，1993，75(4)：1502-1506.

[8] Kendrick Z V，Ellis G S. Effect of estradiol on tissue glycogen metabolism and lipid availability in exercised male rats[J]. J Appl Physiol，1991，71(5)：1694-1699.

[9] Campbell S E，F(xiàn)ebbraio M A. Effect of the ovarian hormones on GLUT4 expression and contraction-stimulated glucose uptake[J]. Am J Physiol Endocrinol Metab，2002，282(5)：E1139-1146.

[10] Kumagai S，Holm?ng A，Bj?rntorp P. The effects of oestrogen and progesterone on insulin sensitivity in female rats[J]. Acta Physiol Scand，1993，149(1)：91-97.

[11] Ahmed-Sorour H，Bailey C J. Role of ovarian hormones in the long-term control of glucose homeostasis, glycogen formation and gluconeogenesis[J]. Ann Nutr Metab，1981，25(4)：208-212.

[12] Kendrick Z V，Steffen C A，Rumsey W L，et al. Effect of estradiol on tissue glycogen metabolism in exercised oophorectomized rats[J]. J Appl Physiol，1987，63(2)：492-496.

[13] Campbell S E，F(xiàn)ebbraio M A. Effect of ovarian hormones on mitochondrial enzyme activity in the fat oxidation pathway of skeletal muscle[J]. Am J Physiol Endocrinol Metab，2001，281(4)：E803-808

[14] Beckett T，Tchernof A，Toth M J. Effect of ovariectomy and estradiol replacement on skeletal muscle enzyme activity in female rats[J]. Metabolism，2002，51(11)：1397-1401.

[15] Pasquier Y N，Pecquery R，Giudicelli Y. Increased adenylate cyclase catalytic activity explains how estrogens “in vivo” promote lipolytic activity in rat white fat cells[J]. Biochem Biophys Res Commun，1988，154(3)：1151-1159.

[16] Hackney A C，McCracken-Compton M A，Ainsworth B. Substrate responses to submaximal exercise in the midfollicular and midluteal phases of the menstrual cycle[J]. Int J Sport Nutr，1994，4(3)：299-308.

[17] Zderic T W，Coggan A R，Ruby B C. Glucose kinetics and substrate oxidation during exercise in the follicular and luteal phases [J]. J Appl Physiol，2001，90(2)：447-453.

[18] Redman L M，Scroop G C，Westlander G，et al. Effect of a synthetic progestin on the exercise status of sedentary young women[J]. J Clin Endocrinol Metab，2005，90(7)：3830-3837.

[19] Sutter-Dub M T，Vergnaud M T. Progesterone and glucose metabolism in the female rat adipocyte：effect on hexokinase activity[J]. J Endocrinol，1982，95(3)：369-375.

[20] Sutter-Dub M T，Dazey B，Hamdan E，et al. Progesterone and insulin-resistance：studies of progesterone action on glucose transport, lipogenesis and lipolysis in isolated fat cells of the female rat[J]. J Endocrinol，1981，88(3)：455-462.

[21] Sutter-Dub M T，Kaaya A，Sfaxi A，et al. Progesterone and synthetic steroids produce insulin resistance at the post-receptor level in adipocytes of female rats[J]. Steroids，1988，52(5-6)：583-608.

[22] Cordoba P，Kaaya A，Richard O，et al. Inhibition of glucose metabolism by progesterone in adipocytes: role of protein synthesis[J]. Can J Physiol Pharmacol，1991，69(12)：1861-1867.

[23] 曹澤毅. 中華婦產(chǎn)科學(xué)[M]. 北京：人民衛(wèi)生出版社，1999：35-58.

[24] Devries M C，Hamadeh M J，Phillips S M，et al. Menstrual cycle phase and sex influence muscle glycogen utilization and glucose turnover during moderate-intensity endurance exercise[J]. Am J Physiol Regul Integr Comp Physiol，2006，291(4)：R1120-1128.

[25] Horton T J，Miller E K，Glueck D，et al. No effect of menstrual cycle phase on glucose kinetics and fuel oxidation during moderate-intensity exercise[J]. Am J Physiol Endocrinol Metab，2002，282(4)：E752-762.

[26] Romijn J A，Coyle E F，Sidossis L S，et al. Substrate metabolism during different exercise intensities in endurance-trained women[J]. J Appl Physiol，2000，88(5)：1707-1714.

[27] De Feo P，Di Loreto C，Lucidi P，et al. Metabolic response to exercise[J]. J Endocrinol Invest，2003，26(9)：851-854.

[28] Achten J，Gleeson M，Jeukendrup A E. Determination of the exercise intensity that elicits maximal fat oxidation[J]. Med Sci Sports Exerc，2002，34(1)：92-97.

[29] 林文弢. 運(yùn)動(dòng)生物化學(xué)[M]. 北京：人民體育出版社，1999：50-51.

[30] Dean T M，Perreault L，Mazzeo R S，et al. No effect of menstrual cycle phase on lactate threshold[J]. J Appl Physiol，2003，95(6)：2537-2543.

[31] Smekal G，von Duvillard S P，F(xiàn)rigo P，et al. Menstrual cycle: No effect on exercise cardiorespiratory variables or blood lactate concentration[J]. Med Sci Sports Exerc，2007，39(7)：1098-1106.

[32] Campbell S E，Angus D J，F(xiàn)ebbraio M A. Glucose kinetics and exercise performance during phases of the menstrual cycle：Effect of glucose ingestion[J]. Am J Physiol Endocrinol Metab，2001，281(4)：E817-825.

[33] Horowitz J F，Klein S. Lipid metabolism during endurance exercise[J]. Am J Clin Nutr，2000，72(2 Suppl)：558S-563S.

[34] Friedlander A L，Jacobs K A，F(xiàn)attor J A，et al. Contributions of working muscle to whole body lipid metabolism are altered by exercise intensity and training[J]. Am J Physiol Endocrinol Metab，2007，292(1)：E107-116.

[35] Venables M C，Achten J，Jeukendrup A E. Determinants of fat oxidation during exercise in healthy men and women: a cross-sectional study[J]. J Appl Physiol，2005，98(1)：160–167.

[36] Achten J，Venables M C，Jeukendrup A E. Fat oxidation rates are higher during running compared with cycling over a wide range of intensities[J]. Metabolism，2003，52(6)：747-752.

[37] Valdes C T，Elkind-Hirsch K E. Intravenous glucose tolerance test-derived insulin sensitivity changes during the menstrual cycle[J]. J Clin Endocrinol Metab，1991，72(3)：642-646.

[38] Magkos F，Patterson B W，Mittendorfer B. No effect of menstrual cycle phase on basal very-low-density lipoprotein triglyceride and apolipoprotein B-100 kinetics[J]. Am J Physiol Endocrinol Metab，2006，291(6)：E1243-1249.

[39] Diamond M P，Jacob R，Connolly-Diamond M，et al. Glucose metabolism during the menstrual cycle. Assessment with the euglycemic, hyperinsulinemic clamp[J]. J Reprod Med，1993，38(6)：417-421.

[40] Toth E L，Suthijumroon A，Crockford P M，et al. Insulin action does not change during the menstrual cycle in normal women[J]. J Clin Endocrinol Metab，1987，64(1)：74-80.

[41] Escalante Pulido J M，Alpizar Salazar M. Changes in insulin sensitivity, secretion and glucose effectiveness during menstrual cycle[J]. Arch Med Res，1999，30(1)：19-22.

[42] Horowitz J F. Exercise-induced alterations in muscle lipid metabolism improve insulin sensitivity[J]. Exerc Sport Sci Rev，2007，35(4)：192-196.

[43] Braun B，Mawson J T，Muza S R，et al. Women at altitude：carbohydrate utilization during exercise at 4,300 m[J]. J Appl Physiol，2000，88(1)：246-256.

[44] Engdahl J H，Veldhuis J D，F(xiàn)arrell P A. Altered pulsatile insulin secretion associated with endurance training[J]. J Appl Physiol，1995，79(6)：1977-1985.

[45] Bailey S P，Zacher C M，Mittleman K D. Effect of menstrual cycle phase on carbohydrate supplementation during prolonged exercise to fatigue[J]. J Appl Physiol，2000，88(2)：690-697.

[46] Kjaer M，F(xiàn)arrell P A，Christensen N J，et al. Increased epinephrine response and inaccurate glucoregulation in exercising athletes[J]. J Appl Physiol，1986，61(5)：1693-1700.

[47] Marliss E B，Simantirakis E，Miles P D，et al. Glucose turnover and its regulation during intense exercise and recovery in normal male subjects[J]. Clin Invest Med，1992，15(5)：406-419.

[48] Botcazou M，Gratas-Delamarche A，Allain S，et al. Influence of menstrual cycle phase on catecholamine response to sprint exercise in the woman[J]. Appl Physiol Nutr Metab，2006，31(5)：604-611.

[49] Galliven E A，Singh A，Michelson D，et al. Hormonal and metabolic responses to exercise across time of day and menstrual cycle phase[J]. J Appl Physiol，1997，83(6)：1822-1831.

[50] Kanaley J A，Boileau R A，Bahr J M，et al. Cortisol levels during prolonged exercise：the influence of menstrual phase and menstrual status[J]. Int J Sports Med，1992，13(4)：332-336.

[51] Wideman L，Weltman J Y，Hartman M L，et al. Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings[J]. Sports Med，2002，32(15)：987-1004.

[52] Sartorio A，Agosti F，Marazzi N. Gender-, age-, body composition-and training workload-dependent differences of GH response to a discipline-specific training session in elite athletes: a study on the field[J]. J Endocrinol Invest，2004，27(2)：121-129.

[53] Godfrey R J，Madgwick Z，Whyte G P. The exercise-induced growth hormone response in athletes[J]. Sports Med，2003，33(8)：599-613.

[54] Kanaley J A，Boileau R A，Bahr J A，et al. Substrate oxidation and GH responses to exercise are independent of menstrual phase and status[J]. Med Sci Sports Exerc，1992，24(8)：873-880

[編輯：鄭植友]