迟发型性腺功能减退症对机体的影响与干预

迟发型性腺功能减退症(late-onset hypogonadism,LOH)亦称为年龄相关的睾酮缺乏综合征(testosterone deficiency syndrome,TDS),是一种以性欲减退、勃起功能障碍(erectile dysfuction,ED)、晨勃频率下降为主要表现,同时伴有血清睾酮水平低下的年龄相关性综合征。LOH可对骨骼、肌肉、情绪和认知功能、心血管系统等造成一定的不良影响[1]。     

男性迟发性性腺功能减退症：指南与争议

迟发性性腺功能减退症(LOH)是一种年龄相关的睾酮缺乏综合征。随着社会老龄化的日益加剧, LOH已严重影响中老年男性的生活质量。尽管近年来国内外诊疗指南陆续发布, LOH的管理策略逐渐规范, 但在诊断标准、睾酮替代治疗(TRT)的利弊以及治疗目标等方面仍存在较多争议。本文将在比较各版指南的基础上, 对LOH的年龄界限、特异性症状及体征、睾酮的诊断切点、TRT治疗的获益以及非睾酮治疗等方面进行详细讨论。     

雄激素替代治疗对糖尿病合并男性迟发性性腺功能减退症的疗效

目的观察雄激素替代治疗(TST)对糖尿病合并男性迟发性性腺功能减退症(LOH)患者的疗效。方法 60例合并LOH的2型糖尿病患者随机分为观察组和对照组,各30例,两组患者均给予相应的降糖治疗,观察组给予十一酸睾酮注射液250 mg肌肉注射,每月1次;对照组给予甲钴胺注射液500μg肌肉注射,每月1次,两组疗程均为6个月。比较两组患者治疗前后的老年男子症状量表(AMS量表)评分,血清性激素水平和糖尿病相关代谢指标。结果观察组治疗后AMS量表评分明显下降,与对照组差异显著(P0.05);两组患者治疗后总睾酮(TT)、游离睾酮(FT)、卵泡刺激素(FSH)和黄体生成素(LH)均有明显上升,且两组比较差异显著(P0.05)。治疗后观察组患者体质指数(BMI)、糖化血红蛋白(Hb A1c)、颈动脉内中膜厚度(IMT)、腰椎和髋骨骨密度(BMD)水平均有明显改善,对照组上述指标无明显改变。两组患者治疗过程中均未发生明显不良反应。结论 TST糖尿病合并男性LOH安全有效,且有利于纠正患者的代谢紊乱,减少心血管患病风险。     

糖尿病合并男性性腺功能减退症的识别与处理

男性性腺功能减退症是指一组不仅出现性功能障碍,而且同时伴有性激素水平减少的临床综合征.男性性腺功能减退症的比例在糖尿病患者中明显高于非糖尿病患者,且与胰岛素抵抗及高血糖密切相关.临床上,需要注意观察糖尿病患者有无性腺功能减退症的临床表现,适时检测患者的性激素水平,尽早识别糖尿病合并男性性腺功能减退症,并予以性激素替代治疗,从而提高患者的生活质量.     

男性特发性低促性腺激素型性腺功能减退症治疗进展

男性特发性低促性腺激素型性腺功能减退症是由于先天性下丘脑功能障碍导致的一类以雄激素缺乏和不育为主要特点的疾病.此类患者在婴幼儿期、儿童期、青春期、成年期所需达到的治疗目的和相应的治疗措施各不相同.不同人生阶段的特发性低促性腺激素型性腺功能减退症患者应选择及时合理的治疗方案.     

男性特发性低促性腺激素型性腺功能减退症87例临床分析

目的探讨男性特发性低促性腺激素型性腺功能减退症(idiopathic hypogonadotropic hypogonadism,IHH)临床特点。方法回顾性分析1985年5月至2006年2月解放军总医院收治的87例男性IHH患者临床资料。结果87例IHH患者就诊年龄平均(18.8±4)岁,其中25例伴有嗅觉减退或消失。87例染色体核型为46,XY。检测甲状腺、肾上腺功能正常,黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)基础值低,促性腺激素释放激素[戈那瑞林(GnRH)或促黄体生成素释放激素(LHRH)]兴奋试验LH峰值较基础值升高。18例患者LH脉冲分泌呈现多种异常形式,86.2%(75/87)IHH患者骨龄落后于实际年龄,头颅CT或磁共振成像检查排除下丘脑-垂体区占位性器质性病变。结论根据性发育异常患者合并的各种先天异常、病史、体格检查、染色体核型分析、性激素水平、GnRH或LHRH兴奋试验,必要时行LH脉冲分析、骨龄测定、头颅CT或磁共振成像,可进行IHH的诊断与鉴别诊断。     

甲状腺功能异常与男性性腺功能减退症

甲状腺在维持性腺功能方面起着极为重要的作用.甲状腺功能异常可引起性激素结合球蛋白及性激素水平的变化,进而对男性性功能产生危害,尤其在性激素水平、睾丸功能和性行为方面.当甲状腺功能恢复正常时,性激素及性功能异常即可显著改善.     

他达那非联合十一酸睾酮治疗中老年男性勃起功能障碍伴迟发性性腺功能减退症的研究

目的观察他达那非联合十一酸睾酮治疗中老年男性勃起功能障碍（ED）伴迟发性性腺功能减退症（LOH）患者的临床疗效。方法将符合标准的45例患者分为2组,研究组23例,采用他达那非联合十一酸睾酮的治疗方案,对照组22例,单用他达那非治疗。4周后,应用国际勃起功能指数评分-5（IIEF-5）、老年男性症状问卷（AMS）比较2组的治疗效果。结果2组治疗后IIEF-5评分较治疗前增加（P均〈0．05）,研究组AMS评分均较治疗前降低（P〈0．05）,研究组治疗后2项评分较对照组明显改善（P均〈0．05）。结论在中老年ED伴LOH患者的治疗申．联合应用他达那非和十一酸睾酮的治疗效果优于单用他达那非的效果．     

甲状腺功能减退症的诊断与治疗

综合新近的文献资料，对甲状腺功能减退症的病因、分型、临床表现、诊断及治疗作了较系统地介绍，希望对临床医师提供参考。     

十一酸睾酮治疗对老年男性迟发性性腺功能减退症患者血清性激素结合球蛋白水平的影响

目的探讨十一酸睾酮治疗对老年迟发性性腺功能减退症(LOH)患者血清性激素结合球蛋白(SHBG)水平的影响并进行预后因素的(COX)分析。方法将门诊收治的89例老年男性LOH患者随机分为对照组(44例)和观察组(45例),均给予十一酸睾酮连续治疗4 w,仅观察组加用他达拉非治疗,分析两组治疗前、4 w后的国际勃起功能指数评分5(IIEF-5)、血清睾酮(T)、游离睾酮(FT)、双氢睾酮(DHT)、雌二醇(E2)及SHBG水平和前列腺功能。同时记录治疗期间的不良反应,并采用多因素COX分析影响治疗效果的因素。结果两组治疗后的IIEF-5评分、血清激素、SHBG及前列腺特异性抗原(PSA)水平均优于治疗前(均P<0.05)。观察组治疗后的IIEF-5评分高于对照组(均P<0.05);与对照组治疗后相比,观察组的血浆T、FT、DHT、E2、总PSA(T-PSA)和游离PSA(F-PSA)水平升高,SHBG降低(均P<0.05);两组治疗后的前列腺功能及不良反应发生率的差异均无统计学意义(P>0.05)。COX分析发现影响十一酸睾酮治疗对老年LOH的因素有年龄、治疗前T水平、治疗前IIEF-5评分、勃起功能障碍及治疗方案。结论十一酸睾酮对老年男性LOH的治疗效果较好,可同时改善症状并降低血清SHBG水平,对前列腺的功能无影响,但联合他达拉非与否是影响十一酸睾酮疗效的因素。     

男性迟发性性腺功能减退的诊断、治疗及监测——ISA、ISSAM、EAU、EAA及ASA推荐

ISA、ISSAM、EAU、EAA及ASA关于男性迟发性性腺功能减退的诊断、治疗及监测的推荐指南,为临床医师诊断、治疗成人发病、年龄相关的睾酮缺乏提供了以临床研究为基础的证据.     

Diagnosis and treatment of hypogonadism in men

Androgen deficiency is diagnosed by ascertainment of characteristic signs and symptoms and consistently low testosterone levels, measured preferably in the morning using a reliable assay. The clinical presentation of androgen deficiency varies with the age of its onset, genetic factors, prior treatment, and other host factors. Androgen deficiency can be treated using any one of the approved testosterone formulations after consideration of pharmacokinetics, patient preference, cost, and potential formulation-specific adverse effects. Prostate and breast cancer, erythrocytosis, untreated severe obstructive sleep apnea, congestive heart failure, recent myocardial infarction, and severe lower urinary tract symptoms are contraindications for testosterone therapy. Testosterone therapy should be accompanied by a standardized monitoring plan that includes periodic ascertainment of symptomatic improvement and lower urinary tract symptoms, measurements of testosterone level, hematocrit, and PSA, digital prostate examination, and general health evaluation. While the benefit to risk ratio is generally favorable in healthy young men with classical hypogonadism due to diseases of the testes, pituitary and the hypothalamus, neither the clinical benefits of testosterone therapy on patient-important outcomes nor its long-term risks in older men with age-related decline in testosterone level are known.     

Androgen replacement in men with hypogonadism and erectile dysfunction

The prevalence of hypogonadism and erectile dysfunction (ED) increases with age. Hypogonadism also is frequently associated with decreased libido and ED. Testosterone replacement therapy for hypogonadal ED is effective in restoring sexual desire and erectile function, especially in younger and healthy men. It appears to be less effective in older men with comorbid diseases that may cause ED. Therapy should be individualized, considered carefully, and closely monitored because of potential risks, especially in older men. The FDA has approved several testosterone delivery systems. These include a buccal testosterone tablet, intramuscular injections, transdermal and subcutaneous forms. There also are several promising experimental androgens under investigation including non-steroidal selective androgen receptor modulators (SARMs).     

Letrozole normalizes serum testosterone in severely obese men with hypogonadotropic hypogonadism

BACKGROUND: Morbid obesity is associated with increased estradiol production as a result of aromatase-dependent conversion of testosterone to estradiol. The elevated serum estradiol levels may inhibit pituitary LH secretion to such extent that hypogonadotropic hypogonadism can result. Normalization of the disturbed estradiol-testosterone balance may be beneficial to reverse the adverse effects of hypogonadism. AIM: To examine whether aromatase inhibition with Letrozole can normalize serum testosterone levels in severely obese men with hypogonadotropic hypogonadism. PATIENTS AND METHODS: Ten severely obese men, mean age 48.2 +/- 2.3 (s.e.) years and body mass index 42.1 +/- 2.6 kg/m(2), were treated with Letrozole for 6 weeks in doses ranging from 7.5 to 17.5 mg per week. RESULTS: Six weeks of treatment decreased serum estradiol from 120 +/- 20 to 70 +/- 9 pmol/l (p = 0.006). None of the subjects developed an estradiol level of less than 40 pmol/l. LH increased from 4.5 +/- 0.8 to 14.8 +/- 2.3 U/l (p < 0.001). Total testosterone rose from 7.5 +/- 1.0 to 23.8 +/- 3.0 nmol/l (p < 0.001) without a concomitant change in sex hormone-binding globulin level. Those treated with Letrozole 17.5 mg per week had an excessive LH response. CONCLUSION: Short-term Letrozole treatment normalized serum testosterone levels in all obese men. The clinical significance of this intervention remains to be established in controlled, long-term studies.     

Features of steroidogenesis in men with hypogonadism and type 2 diabetes

BACKGROUNDBACKGROUND: Type 2 diabetes mellitus (DM2) in men is associated with a high incidence of hypogonadism. Testosterone is a steroid hormone and one of the final metabolites of steroidogenesis, which causes interest in assessing the content of key steroid hormones, their precursors and metabolites in hypogonadal and eugonadal men with T2DM.AIMSAIMS: Assessment of the features of steroidogenesis in men with hypogonadism in T2DM using tandem mass spectrometry.MATERIALS AND METHODSMATERIALS AND METHODS: A full-design, cross-sectional, screening, single-center, non-interventional study included men with T2DM, who were he was treated in Endocrinology Research Centre, Moscow. The study was conducted from October 2021 to January 2022. Medical history assessment, physical examination with determination of body mass index (BMI), measurement of key steroid hormones, their precursors and metabolites by isotope dilution liquid chromatography/tandem mass spectrometry, glycated hemoglobin (HbA1c) were performed. The groups were compared using the Mann-Whitney U-test for quantitative indicators and χ² with Yates’ correction for qualitative ones. Correlation analysis was performed by the Spearman correlation method. When determining the criterion of statistical significance, the Bonferroni correction was applied.RESULTSRESULTS: Patients with hypogonadism had statistically significantly more pronounced obesity compared with eugonadal men. In a comparative analysis of patients, depending on the presence of hypogonadism, there were statistically significantly lower levels of androgen precursors 17-hydroxypregnenolone and 17-hydroxyprogesterone in hypogonadal men. At the same time, a positive statistically significant correlation was found between total testosterone and 17-hydroxyprogesterone. In addition, 17-hydroxyprogesterone, although to a lesser extent, but positively correlated with other androgens - androstenedione (r=0,328; p<0,001) and dehydroepiandrosterone (r=0,183; p=0,004). >< 0,001) and dehydroepiandrosterone (r=0,183; p=0,004).CONCLUSIONSCONCLUSIONS: In this investigation the prevalence of male hypogonadism in type 2 diabetes, determined by high-precision tandem mass spectrometry, was 69,5%. There was no effect of the disease on the mineralocorticoid and glucocorticoid links of adrenal steroidogenesis. Hypogonadism was associated with decreased levels of a number of testosterone precursors. The most significant of them was 17-hydroxyprogesterone, which can be considered as a marker of testicular steroidogenesis.     

拓宽支气管哮喘的治疗

支气管哮喘（简称哮喘）是一种气道的慢性炎症性疾病。多数哮喘患者对吸人糖皮质激素（ICS）高度有效，使ICS成为哮喘的一线控制药物。但是，仍有相当数量的哮喘患者对ICS治疗反应较差，这部分患者被称为难治性哮喘。对于这部分哮喘患者国内外近几年出现了一些新的治疗药物和方法，本文对这一新的治疗动向进行综述。