内源性雄激素及雄激素受体水平与老年男性冠心病的相关性

目的 探讨内源性雄激素及雄激素受体(AR)水平与老年男性冠心病的相关性.方法 选择冠状动脉造影证实的老年男性冠心病患者237例,对照组59例.所有患者均检测血清中7种内源性性激素水平,包括游离睾酮(FT)、总睾酮(TT)、雌二醇(E2)、黄体生成素(LH)、卵泡雌激素(FSH)、性激素结合球蛋白(SHBG)及脱氢表雄酮(DHEA),并用流式细胞术检测外周血淋巴细胞AR水平.结果 冠心病组FT水平低于对照组[(24.1±22.2)×10-9mmol/L比(34.1±31.8)× 10-9mmol/L,P=0.06],其余激素水平差异均无统计学意义(均P＞0.05).两组AR阳性率也差异无统计学意义(56.3%±24.0%比57.1%±20.8%,P＞0.05).Logistic回归分析显示FT降低冠心病发病风险(OR=0.98,95%CI0.973～0.997,P=0.0049).FT与AR阳性率之间呈正相关,而年龄与FT和AR阳性率呈负相关.结论 内源性雄激素水平减低在老年男性人群的冠心病发病中有独立作用.FT和AR水平下降,可能与老年男性冠状动脉粥样硬化加速进展有关.

Abstract：

Objective To investigate the correlation of endogenous androgen and androgen receptor (AR) level with coronary artery diseases (CAD) in elderly males and elucidate the potential mechanism of gender difference in the prevalence of CAD. Methods A total of 296 male patients from different centers were divided into the CAD group ( n = 237 ) and the control group ( n = 59 ) according to the results of coronary angiography. Their mean ages were 68.6 ± 6. 8 and 66. 2 ± 6. 5 years old respectively. The serum levels of FT (free testosterone), TT (total testosterone), E2 (estradiol), LH (luteinizing hormone), FSH ( follicle-stimulating hormone ), SHBG ( sex hormone-binding globulin ) and DHEA (dehydroepiandrosterone) were measured in all participants. And the androgen receptors of peripheral lymphocytes were assessed by flow cytometry. Results The serum level of FT was lower in the CAD group than that in the control group[(24. 1 ±22. 2) × 10-9 mmol/L vs( 34. 1 ±31.8) × 10-9 mmol/l, P =0. 06]. But two groups showed no statistic differences in the levels of TT, E2 , LH, FSH, SHBG, DHEA and lymphocyte AR (56. 3% ± 24. 00 vs 57.1% ± 20. 8% ). As demonstrated by the logistic regression analysis, the level of FT was negatively correlated with the CAD risk ( OR = 0. 98, P = 0. 0049 ) and positively correlated with the peripheral lymphocyte AR level. However age was negatively correlated with the levels of FT and AR. Conclusion The deficiency of endogenous androgen contributes to a high prevalence of CAD in elderly males. The age-related decreases of FT and AR impair the physiological functions of androgen so as to accelerate the progression of coronary atherosclerosis.     

Gender and magnetic resonance imaging classification-related differences in clinical and biochemical characteristics of Cushing＇s disease： a single-centre study

Background Cushing＇s disease （CD） presents a remarkable preponderance in female gender,and a significant minority of patients with CD presented with negative magnetic resonance imaging （MRI） findings.The aim of this study was to evaluate gender-related and MRI classification-related differences in clinical and biochemical characteristics of CD.Methods We retrospectively studied 169 patients with CD,comprising 132 females and 37 males,and 33 patients had no visible adenoma on MRI.Results We observed that male and MRI-positive patients presented with high adrenocorticotropic hormone （ACTH） values （P ＜0.05）.Female patients presented with higher prevalence of hirsutism and hyperpigmentation and lower prevalence of purple striae （P ＜0.05）.The prevalence of buffalo-hump and hypertension was greater in MRI-negative patients （P ＜0.05）.In addition,male patients with CD presented at a younger age compared with females （P ＜0.05）.Patients with fatigue and hypokalaemia presented significantly higher urinary-free cortisol,ACTH and cortisol levels compared with patients without these symptoms （P ＜0.05）.The prevalence of LH reduction,hyper total cholesterol （TC） and hyper low-density lipoprotein was more frequent in MRI-positive patients （P ＜0.05）.Hyper-TC levels and PRL reduction were more frequent in males （P ＜0.05）.T3,T4 and FT3 levels negatively correlated with age at diagnosis （r=-0.310,P ＜0.01; r=-0.191,P ＜0.05; r＝-0.216,P ＜0.05）.T3,T4,FT3 and FT4 levels significantly negatively correlated with 8-am plasma cortisol levels （r=-0.328,P ＜0.01; r=-0.195,P ＜0.05; r=-0.333,P ＜0.01; r＝-0.180,P ＜0.05）.Females presented higher total protein level （P ＜0.01） and lower blood urea nitrogen and serum creatinine levels （P ＜0.01）,compared with male patients.Conclusions Carefulness and caution are required in all patients with CD,because of the complexity of clinical and biochemical characteristics in CD patients of different gender and MRI cl     

Association of Bisphenol A Exposure with Circulating Sex Hormone Concentrations in Men and Postmenopausal Women

<正>A total of 1 116 middle-aged and elderly men and 1 442 postmenopausal women were recruited in this study.Whether bisphenol A exposure was associated with circulating sex hormone concentrations was studied.Univariate analysis revealed that the urinary bisphenol A concentration was negatively correlated with the serum levels of luteinizing hormone(β=-0.061,P0.0001)and follicle-stimulating hormone(β=-0.086,P0.0001)in men,     

Expression of toll-like receptor 9 in peripheral blood mononuclear cells from patients with different hepatitis B and C viral loads

The aim of the present study was to investigate the expression of toll-like receptors （TLR） 9 in peripheral blood mononuclear cells （PBMC） of patients with chronic hepatitis B and C with different virus copies. The study group included 90 patients （60 with chronic hepatitis B, and 30 with chronic hepatitis C）, and 20 healthy people served as control group. The protein and mRNA levels of TLR9 were detected by using flow cytometry and real-time PCR. The serum viral copies of HBV and HCV were measured in all patients, and the correlation between HBV-DNA copies or HCV-RNA copies and the TLR9 expression was analyzed. Our results demonstrated that HBV or HCV infection led to a decreased expression of TLR9 mRNA and protein compared to the control group （P〈0.05）. The TLR9 protein and mRNA levels were negatively correlated with serum viral copies of HBV and HCV （r=-0.632, r=-0.909, P〈0.01）. It was concluded that TLR9 mRNA and protein are down-regulated in PBMC of HBV-infected or HCV-infected patients, and they are negatively correlated with serum viral copies and play an important role in detecting viral replication of HBV and HCV.     

Studies on Androgen Receptor mRNA expression in Pancreas, Hypothalamus and Ovary of Androgen Sterilized Rats

Objective To investigate the androgen receptor （AR） mRNA expression in pancreas, hypothalamus and ovary of androgen sterilized rats （ASR）.Methods ASR model was established by subcutaneous injection of testosterone propionate to SD female rats at the age of 9 days. Around the age of 106 days （proestrus）, all rats were killed, serum Δ4-andronestedione （Δ 4-A）, total testosterone （TT）, free testosterone （FT）, insulin （Ins） and C-peptide （C-P） were measured by radioimmunoassay （RIA）. Total RNA in pancreas, hypothalamus and ovary were extracted and the amount of AR mRNA was quantitatedly analyzed by RT-PCR with single base mutant template as inner standard. Results Serum concentrations of Δ4-A, TT, FT, Ins and C-P in ASR model rats were significantly higher than those in control group （P〈0.05, P〈0.01）. The expression of AR mRNA in pancreas, hypothalamus and ovary increased significantly （P〈0. 05, P〈0.01） of model rats as compared with control group. Conclusion The elevated serum androgen levels in ASR model could enhance the expression of AR mRNA levels in pancreas, hypothalamus and ovary, which further induce hyperinsulinemia and anovulation.     

Postoperative pituitary hormonal disturbances and hormone replacement therapy time and dosage in children with craniopharyngiomas

Background The proliferative activity and penetration into the hypothalamic structures in children craniopharyngiomas （CP） often make radical resection difficult. Therefore, complete resection of CP often results in permanent multiple pituitary hormone deficiency （MPHD）. This study aimed to elucidate the postoperative pituitary hormonal disturbances, and hormone replacement therapy （HRT） time and dosage in children with CP.
Methods Twenty patients with growth retardation and CP after resection, comprising 14 boys and 6 girls, with a mean age of （10.63±3.18） years （Group A） and 10 male patients of group A aged 〉10 years （Group B） were entolled. Thirty age-, sex- and Tanner stage-matched normal children （control Group A）, and 44 male older children 〉10 years （control Group B） served as controls. The serum concentrations of insulin-like growth factor-1 （IGF-1）, growth hormone （GH）, free thyroxine （FT4）, thyroid-stimulating hormone （TSH）, adrenocorticortropic hormone （ACTH）, cortisol （COR）, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, prolactin （PRL）, testosterone （T） and estradiol （E2） were measured in the CP patients after resection and in controls. The appropriate time and dosage of HRT were investigated. Linear correlation analysis was made between levothyroxine （L-T4） dosage and primary FT4 in CP patients after resection.
Results All cases had MPHD. The serum peak GH, IGF-1, FT4 and COR levels of Group A were significantly lower than that of the control Group A. The serum IGF-1 concentration increased to the normal level after 3 months of rhGH therapy; the serum FSH, LH, and T levels were significantly decreased （P 〈0.001）; however, E2 and PRL were significantly increased （P 〈0.001） in Group B compared with the control Group B; 18 cases were found to have central diabetes insipidus （DI） by water deprivation test and MRI. There was a significant negative linear regression （r=-0.8, P 〈0.001     

Plasma Levels of the Anti-inflammatory Cytokine IL-10 and Inflammatory Cytokine IL-6 in Patients with Unstable Angina

The plasma levels of inflammatory cytokine interleukin-6 （IL-6） and anti-inflammatory cytokine interleukin-10 （IL-10） in the patients with unstable angina or stable angina were determined and compared. In 30 patients with unstable angina and 22 patients with stable angina, plasma levels of IL-10 and IL-6 were detected by ELISA and plasma lipid parameters by lipid research clinical methods respectively. The results showed plasma levels of IL-10 were significantly lower in unstable angina group than in stable angina group （P=0. 005）, while those of IL-6 were significantly increased in unstable angina group as compared with those in stable angina group （P= 0. 039）. There was a significantly negative correlation between IL-10 and IL-6 in patients with unstable angina （r=-0.41, P=0. 003）. In the unstable angina group, IL-6 levels were obviously positively correlated with TC （r=0. 314, P=0. 023）, but not with TG and HDL. There were no significant correlations between IL-10 and plasma lipid parameters. It was suggested that the decreased IL-10 and increased IL-6 might be associated with the atheromatous plaque stability and progression of coronary heart diseases. IL-10 may play an important role in preventing coronary vascular lesions.     

Changes of atrial natriuretic peptide and antidiuretic hormone in children with postural tachycardia syndrome and orthostatic hypertension: a case control study

Background The abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children.This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children,and their associations with the changes in heart rate and blood pressure in head-up test.Methods Twenty-one postural tachycardia syndrome patients （（12±2） years） and 26 healthy children （（12±1） years） were included.According to blood pressure changes in head-up test,the postural tachycardia syndrome patients were divided into two subgroups：postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension.The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.Results The plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control （P=0.004）,whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant （P=0.222）.The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension （P ＜0.05）.In postural tachycardia syndrome patients,the updght max heart rate was positively correlated with the plasma atrial natriuretic peptide level （r=0.490,P＜0.05） and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels （r=0.472,P ＜0.05）.Conclusions There was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.     

Association among plasma interleukin-18 levels, carotid intima- media thickness and severity of obstructive sleep apnea

Background Epidermic studies have suggested a pathophysiological link between obstructive sleep apnea hypopnea syndrome （OSAHS） and atherosclerosis （AS）; for which carotid intima-media thickness （IMT） has been considered as an early marker. The pathogenesis by which OSAHS can induce AS has not been elucidated. This study was conducted to investigate the association among plasma interleukin-18 （IL-18） levels, carotid IMT and the severity of OSAHS.
Methods Based on the apnea hypopnea index （AHI） during sleep monitored by polysomnography, 52 male patients with OSAHS were recruited as the OSAHS group which was further divided into mild OSAHS （n=16）, moderate OSAHS （n=18）, and severe OSAHS （n=18） subgroups. Eighteen healthy subjects were selected as the control group. Of all OSAHS patients, 20 with moderate-to-severe OSAHS underwent continuous positive airway pressure （CPAP） treatment for 90 days. HDL5000 color Doppler ultrasonography was used to measure carotid IMT. Plasma IL-18 levels were measured bv ELISA.
Results Compared with the plasma IL-18 levels in the control group （（250.27±76.48） pg/ml）, there was a significant increase in the mild OSAHS subgroup （（352.08±76.32） pg/ml）, the moderate subgroup （（600.17±83.91） pg/ml）, and the severe OSAHS subgroup （（9797.64 ± 109.83） pg/ml） （all P〈0.01）. Moreover, there was a significant difference in plasma IL-18 levels among the three OSAHS subgroups （P〈0.01）. Carotid IMT was significantly greater in the severe OSAHS subgroup than in the mild OSAHS subgroup （P〈0.01）. Before CPAP treatment, plasma IL-18 levels were positively correlated with carotid IMT （r=0.486, P 〈0.001） and with AHI （r=0.865, P〈0.001）. On day 90 of CPAP treatment, plasma IL-18 levels were significantly declined but carotid IMT was not changed significantly.
Conclusions In untreated OSAHS patients carotid IMT and plasma IL-18 were positively correlated and were significantly higher than in normal controls; the elevation of plasma IL-18 levels was correlated with the severity of OSAHS. Inflammatory response associated with OSAHS may be related to the development of AS. By improving AHI, miniSaO2, and reducing plasma IL-18 levels, CPAP treatment may slow down or prevent the development of AS in OSAHS patients.     

中年男性2型糖尿病患者性激素水平与颈动脉内膜中层厚度的关系

目的:分析糖尿病患者性激素水平及颈动脉内膜中层厚度(IMT),研究性激素水平及与IMT之间的关系。方法:对100例中年男性糖尿病患者和100例中年健康男性(作为对照组)采集其晨起静脉血,低温离心后取血清,测定总睾酮、游离睾酮(FT)、脱氢表雄酮硫酸酯(DHEAS)、性激素结合球蛋白(SHBG)、雌二醇、黄体生成素(LH)、卵泡刺激素(FSH)水平,并行颈动脉超声检查,测定内膜中层厚度平均值及斑块厚度,并行血糖及血脂等检查。结果:(1)糖尿病患者总睾酮、FT、DHEAS明显降低(P<0.01),SHBG水平显著增加(P<0.01)。(2)糖尿病患者内膜中层较对照组明显增厚(P<0.05),斑块检出率显著增高(P<0.05)。(3)FT水平与IMT呈显著负相关(r=-0.516,P=0.023)。结论:中年男性2型糖尿病患者雄激素水平显著降低,且FT水平与IMT呈负相关。     

内源性雄激素与男性冠心病及血脂关系的研究

目的:探讨内源性雄激素与男性冠心病及血脂之间的关系。方法:用断面调查的方法收集200例行择期冠状动脉造影的男性患者作为研究对象,根据冠状动脉造影结果分为冠心病组104例,对照组96例,用放免法检测血清游离睾酮、总睾酮、去氢表雄酮、去氢表雄酮硫酸酯、雌二醇和性激素结合球蛋白。结果:校正体重指数、血压及血脂因素的影响后,冠心病组血清游离睾酮、总睾酮、总睾酮/雌二醇及性激素结合球蛋白水平显著低于对照组(P<0.01或P<0.05);冠心病组与对照组血清去氢表雄酮、去氢表雄酮硫酸酯及雌二醇水平无显著性差异(均P>0.05)。冠心病患者血清游离睾酮、总睾酮及总睾酮/雌二醇与总胆固醇、甘油三酯及低密度脂蛋白胆固醇显著负相关(P<0.01或P<0.05);与高密度脂蛋白胆固醇显著正相关(P<0.01或P<0.05);性激素结合球蛋白与总胆固醇及甘油三酯显著负相关(P<0.01或P<0.05)。多元Logistic回归分析结果显示血清游离睾酮与冠心病的发生独立负相关。结论:男性冠心病患者血清睾酮水平降低,对血脂代谢具有不利影响,血清游离睾酮水平减低可能是冠心病的独立预测因子。     

Graves病性激素与甲状腺激素的关系

目的：探讨Ｇｒａｖｅｓ病（ＧＤ）患者性激素及性激素结合球蛋白（ＳＨＢＧ）变化与甲状腺素的关系。方法：采用ＧＤ组与正常对照组及ＧＤ组治疗前后对比研究。结果：治疗前男性ＧＤ患者结合睾酮（ＴＴ）、ＳＨＢＧ,女性ＧＤ患者雌二醇（Ｅ２）、ＳＨＢＧ均高于正常对照组（Ｐ〈０．０５～Ｐ〈０．０１）,且与甲状腺素（Ｔ４）呈正相关（Ｐ〈０．００１）,男性ＧＤ患者游离睾酮（ＦＴ）降低,但与Ｔ３、Ｔ４无相关（Ｐ〉０．０５     

青春期多囊卵巢综合征胰岛素抵抗及其与生殖内分泌代谢异常的相关性分析

目的：分别比较青春期多囊卵巢综合征（PCOS）与青春期健康人群、青春期PCOS胰岛素抵抗（IR）与非IR患者的生殖内分泌指标,认识青春期PCOS的IR及其与生殖内分泌代谢异常的相关性,为该疾病的早期诊断和治疗提供循证医学依据。方法青春期PCOS患者（青春期PCOS组）88例,青春期健康对照人群（对照组）87例,并根据胰岛素抵抗稳态模型指数（HOMA- IR）将青春期PCOS患者分为IR组（40例）和非IR组（48例）。测定LH、FSH、硫酸脱氢表雄酮（DHEAS）、性激素结合蛋白（SHBG）、总睾酮（TT）、FBG、空腹胰岛素（FINS）、瘦素（LEP）和脂联素（ADPN）水平,并加以对照研究。结果（1）青春期PCOS组与对照组的比较：青春期PCOS组LH、LH/FSH、DHEAS、TT、FAI、FINS、HOMA- IR、LEP均明显高于对照组,SHBG明显低于对照组,两组间FBG、ADPN未见有统计学差异。（2）青春期PCOS IR组与非IR组的比较：IR组LH明显低于非IR组,而DHEAS、FAI均明显高于非IR组,两组间LH/FSH、TT无统计学差异。IR组SHBG明显低于非IR组,且SHBG与BMI （r=-0.31,P＜0.05）、血DHEAS （r=-0.225,P＜0.05）均呈明显负相关。IR组FINS、FBG、HOMA- IR均明显高于非IR组,且FBG与BMI呈明显正相关（r=0.348,P＜0.05）。IR组LEP水平明显高于非IR组,而ADPN明显低于非IR组,且LEP水平与BMI呈明显正相关（r=0.605,P＜0.05）,ADPN水平与BMI呈明显负相关（r=-0.418,P＜0.05）。结论 PCOS在青春期即出现不同程度的胰岛素敏感性下降,IR发病率增高,并与高雄激素血症、肥胖相互作用,形成内分泌代谢的恶性循环,促进PCOS疾病进展,使得代谢综合征等远期并发症风险增高。脂肪因子ADPN和LEP或可成为机体胰岛素敏感性的预测指标,但还需进一步大样本研究。     

温州地区儿童甲状腺激素和性激素水平分析

目的：分析本实验室儿童促甲状腺激素（TSH）、甲状腺素（T4）、三碘甲状腺素（T3）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、黄体生成素（LH）、促卵泡生成素（FSH）、孕酮（PROG）、泌乳素（PRL）、雌二醇（E2）和睾酮（T）的性别、年龄分布规律,探索其生物参考区间。方法：从2018年8月至2021年12月来温州医科大学附属第二医院儿童保健科体检的人群中筛选出1～18岁的健康个体,按幼儿前男、女组（1～3 岁）,幼儿女组（4～8 岁）、幼儿男组（4～10 岁）,青少年女组（9～18 岁）、青少年男组（11～18 岁）分成6组;剔除离群值,获合格例数783例。采用SIEMENS ADVIA Centaur XP System化学发光分析仪测定其血清激素水平,组间比较采用t 检验、近似t 检验或Kruskal-Wallis检验,相关性分析采用Spearman分析。结果：FT3、LH、FSH、PRL、E2、T水平在不同年龄组男女间差异有统计学意义（P ＜0.05）。男童T3、T4与年龄呈负相关（r =-0.419、-0.347,P ＜0.05）,LH、FSH、PROG、T与年龄表现出较强正相关（r =0.768、0.678、0.535、0.703,P ＜0.05）;女童T3、T4、FT3 与年龄呈负相关（r =-0.486、-0.318、-0.424,P ＜0.05）,LH、FSH、PROG、E2、T与年龄呈正相关性（r =0.811、0.335、0.574、0.584、0.744,P ＜0.05）。青少年男、女组中Tanner分期与LH、FSH、PRL、PROG、E2、T的相关系数分别为0.641、0.204、0.308、0.479、0.604、0.686和0.664、0.399、0.436、0.485、0.621、0.649,均呈正相关（P ＜0.01）。基于各年龄组不同性别儿童的甲状腺激素和性激素水平,初步拟定温州地区1～18岁儿童11项激素的参考区间。结论：本研究对儿童甲状腺激素和性激素11项水平的初步调查结果和目前本科室所使用的欧洲参考区间之间存在差异,建立本地区的参考区间具有临床意义。     

男性甲亢性低钾周瘫患者血清甲状腺激素及性激素水平的变化

目的　观察男性甲亢性低钾周瘫（THPP）患者血清甲状腺激素、黄体生成素（LH）、卵泡刺激素（FSH）、催乳素（PRL）、孕酮（P）、总睾酮（T）、雌二醇（E2）的水平变化。方法分析了38例男性甲亢患者血清钾、总三碘甲腺原氨酸（TT3）、游离三碘甲腺原氨酸（FT3）、总甲状腺素（TT4）、游离甲状腺素（FT4）、促性腺激素与性激素的水平,其中THPP患者19例,无THPP的甲亢患者19例。结果（1）甲亢患者中THPP组血清TT3、FT3、TT4及T水平明显高于无THPP组（P均＜0．01）。血清LH、FSH、PRL、P及E2水平两组无显著差异性。（2）血清TT3、TT4、FT3及T与血清钾水平呈负相关关系,血清TT3与T水平呈正相关关系。结论男性甲亢患者血清甲状腺激素水平明显升高者易发生THPP;伴有THPP的男性甲亢患者T水平升高,其原因尚有待进一步研究。     

原发性骨质疏松症患者重组人甲状旁腺素治疗前后性激素结合球蛋白水平分析

目的：观察原发性骨质疏松症患者重组人甲状旁腺素[rhPTH（1-34）]治疗前后血清性激素结合球蛋白（SHBG）水平的变化,并分析其与rhPTH（1-34）治疗骨质疏松症效果的相关性。方法收集老年原发性骨质疏松症患者20例及健康体检者30例,原发性骨质疏松症患者进行rhPTH（1-34）治疗。分别于治疗前及治疗1年后检测血清SHBG水平、生化指标、性激素水平及腰椎（L2－4）骨密度（BMD）,并对各项检测指标进行相关性分析。结果经rhPTH（1-34）治疗后,腰椎（L2－4）BMD值、T值较治疗前明显增加（P＜0.05或0.01）,血磷、碱性磷酸酶（ALP）及雌二醇（E2）水平明显增高（P＜0.05或0.01）;血钙、促卵泡生成素（FSH）、睾酮（TT）、促黄体生成素（LH）、甘油三酯（TG）和胆固醇（TC）等指标治疗前后均无显著变化（均P＞0.05）。原发性骨质疏松症患者SHBG水平与正常对照组比较明显增高（P＜0.05）,经rhPTH（1-34）治疗1年后SHBG水平明显降低（P＜0.05）。SHBG与BMD值、T值、E2水平变化呈明显负相关（r=-0.78、-0.67、-0.53,均P＜0.01）。结论原发性骨质疏松症患者经rhPTH（1-34）治疗后,血清SHBG水平显著下降,推测SHBG参与原发性骨质疏松症的形成过程,并在rhPTH（1-34）治疗中发挥重要作用。     

血清睾酮水平与2型糖尿病合并骨质疏松症的相关性研究

目的 探讨血清睾酮水平与2型糖尿病(type 2 diabetes mellitus, T2DM)合并骨质疏松症的相关性.方法 回顾性分析2015年9月至2016年5月于四川大学华西医院住院的T2DM合并骨质疏松症患者53例(DO组)、单纯性骨质疏松症患者60例(OP组)和骨量正常者42例(N组),分析比较3组患者之间的骨密度、血清总睾酮(TT)、性激素结合球蛋白(SHBG)和血清游离睾酮(FT)水平.结果 与N组比较,DO组和OP组患者腰椎(L1-L4)、股骨颈部、W-三角和粗隆的骨密度均降低,差异有统计学意义(P<0.05);血清SHBG水平显著降低,差异有统计学意义(P<0.05);血清总睾酮和游离睾酮水平无明显改变,差异无统计学意义(P>0.05).与OP组比较,DO组患者骨密度、血清TT、SHBG和FT水平比较,差异均无统计学意义(P>0.05).线性回归分析发现,性别与总睾酮(r=-21.339,P<0.001)和游离睾酮(r=-22.8,P<0.001)呈负相关.亚组分析发现,女性DO患者FT水平明显高于女性OP患者,差异有统计学意义(P<0.05);但骨密度比较,差异无统计学意义(P>0.05).男性DO患者Ward-三角及粗隆骨密度明显升高,差异有统计学意义(P<0.05);血清TT水平DO组高于OP组,差异有统计学意义(P<0.05).结论 血清睾酮水平与2型糖尿病合并骨质疏松的关系可能存在性别差异.对于男性可能是保护因素,对于女性则可能是危险因素.     

2型糖尿病男性患者睾酮水平与代谢指标相关性分析

目的探讨2型糖尿病男性患者睾酮水平与血糖、血脂、尿酸及胰岛素等代谢性指标的相关性。方法选择2型糖尿病男性患者205例,根据总睾酮水平,分为正常睾酮（TT）组（TT≥12 nmol/L,n=135）和低TT组（TT<12 nmol/L,n=70）,测定一般指标〔体质量、腰围、体质量指数（BMI）〕、生化指标〔血糖、血脂、血尿酸（SUA）、胰岛素〕,以及性激素指标〔包括总睾酮、黄体生成素(LH)、卵泡刺激素（FSH）、雌二醇（E2）、性激素结合球蛋白(SHBG)〕,并计算得出稳态模型评估胰岛素抵抗指数(HOMA-IR）,比较两组一般指标和生化指标的差异,并根据HOMA-IR及SUA水平,分别采用四分位法分组,比较各组的性激素指标的差异。结果与正常TT组相比,低TT组年龄、SUA、BMI、腰围及HOMA-IR升高,两组间比较差异有统计学意义（P<0.05）。随着HOMA-IR上升,TT、LH、SHBG水平下降（P<0.05）;随着SUA水平升高,TT、LH、FSH、SHBG水平降低（P<0.05）。Logistic回归分析显示,SUA升高（比值比=0.996）和BMI增加（比值比=0.872）是发生性腺功能减退症（TT<12 nmol/L）的危险因素,而年龄、收缩压不是其危险因素（P>0.05）。结论2型糖尿病男性患者发生性腺功能减退症与SUA水平及肥胖相关。