中老年男性血清游离睾酮浓度的测定 --比较T、SHBG结合计算法和单一酶免法结果

评价用总睾酮(T)、性激素结合球蛋白(SHBG)结合计算法和单一酶免法测定中老年男子血清游离睾酮(FT)浓度的临床标准.本文对129例45岁以上健康男性,按年龄分为4组:(1)45岁～,31例;(2)60岁～,48例;(3)70岁～,27例;(4)80岁～,23例.收集血清标本-40℃冻存,酶标免疫方法同批测定FT,并测定T和SHBG代入Verrmeulen's公式计算:[FT]=([T]-N[FT])/Kt{[SHBG]-([T]-N[FT])}.N=23.43,Kt=109L/mol.数据用SPSS软件包分析处理.     

中老年男性血清睾酮、游离睾酮、双氢睾酮和性激素结合球蛋白含量的变化

目的 观察中老年男性血清睾酮(T)、游离睾酮(FT)、双氢睾酮(DUT)和性激素结合球蛋白(SHBG)的浓度,研究雄激素与增龄的关系。方法 129例45岁以上健康男性,可能有影响雄激素分泌的疾病和药物者已除外。按年龄分为4组。采用酶标免疫法测定T、FT、DHT和SHBG血清浓度。数据用SPSS软件包分析处理。结果 各年龄组之间,T的差别有显著性意义(P<0.05);而FT、DHT和SHBG的差别都具有非常显著性意义(P<0.01)。除了T(P>0.05),增龄与血清FT、DHT和SHBG浓度均明显相关(P<0.01)。结论 男性在中老年期随着年龄的增长,血清T浓度变化不明显,而FT和DHT浓度明显下降,SHBG浓度则明显上升。     

男性型秃发患者血清雄激素水平的测定

目的：探讨男性型秃发的发生与全身雄激素水平的关系。方法：在特定时间，由专人分别检测64例男女患者及80例同性别正常人群血清雄激素水平，然后进行统计学分析。结果：两组患者血清雄激素水平与同性别正常人群均无明显差异。结论：男性型秃发患者体内雄激素水平与正常人无差异，男性型秃发的发生与全身雄激素水平无关。     

Transdermal testosterone delivery: testosterone patch and gel

Testosterone replacement treatment is usually life-long. Fortunately, testosterone administration is relatively safe and until the age of 50 years few side effects are noted with normal doses of testosterone. After the age of 50 years when prostate disease becomes more prevalent, shorter-acting testosterone preparations, allowing a fast reduction of circulating testosterone levels, may be an advantage. Testosterone has an impact on sexual and non-sexual behaviour and short-acting testosterone preparations may be better suited for the initiation of long-term administration allowing the monitoring of behavioural effects. Testosterone can be delivered to the circulation through the intact skin, both genital and non-genital. Transdermal administration delivers testosterone at a controlled rate into the systemic circulation, avoiding hepatic first pass and reproducing the diurnal rhythm of testosterone secretion and without the peak and trough levels observed with the use of the traditional long-acting testosterone injections. In conclusion, both the testosterone patch and testosterone gel are valuable contributions to androgen replacement treatment meeting the requirements specified for testosterone replacement treatment.     

血清睾酮与老年男性原发性骨质疏松症的关系

目的 探讨血清睾酮与老年男性原发性骨质疏松的关系，为防治老年男性原发性骨质疏松症提供理论依据。方法 双能X线骨密度仪测定腰椎(L1-4)骨密度；全自动生化分析法测定尿钙、肌酐；AKP用比色法，Ca、Mg用MTB法，P用磷酸亚铁胺法；放射免疫法测定血清E2、T、BGP、CT、PTH-m。获得的参数骨质疏松组与正常对照组比较。结果 男性原发性骨质疏松组骨代谢生化指标与同年龄同性别的对照组比较，血清Ca、P、Mg、Cu以及PTH-m、E2、AKP、BGP两组差异无显著性；血清降钙素显著降低；尿钙与肌酐比值非常明显地增多；男性主导性激素睾酮骨质疏松组非常明显地低于对照组。结论 老年男性原发性骨质疏松的发病因素虽然是多方面的，但血清睾酮水平的降低是老年男性骨质疏松症发病的一个非常重要的原因。     

Predictors of serum testosterone and DHEAS in African-American men

There are few reported data on biochemical and functional correlates of androgen levels in African-American men. This study aimed at reporting physical and biochemical correlates of serum total testosterone (total T), bioavailable testosterone (BT) and dehydroepiandrosterone-sulphate (DHEAS) levels in community-dwelling, African-American men aged 50-65 years. Home-based physical examinations and health status questionnaires were administered to randomly sampled men. Body composition (dual-energy X-ray absorptiometry), lower limb and hand-grip muscle strength, and neuropsychological functions were assessed. Levels of serum total T, BT, DHEAS, oestradiol (E2), adiponectin, leptin, triglycerides and glucose were measured. Multiple linear regression models were constructed to identify factors independently associated with androgen levels. DHEAS levels declined from age 50 to 65 years (p < 0.0001), but total T and BT levels remained constant. Independent of other associated factors, higher total T levels were associated with lower serum triglyceride levels (beta = -0.142, p = 0.049); higher BT was associated with better performance on the trail-making tests (TMT-B:TMT-A ratio: beta = -0.118, p = 0.024) and higher DHEAS levels were associated with lower adiponectin (beta = -0.293, p = 0.047) and higher mini-mental state examination (MMSE) score (beta = 0.098, p = 0.008). Multiple regression models predicted 21, 18 and 29% of variance in total T, BT and DHEAS, respectively. Higher total T levels were associated with serum metabolic markers, particularly lower triglycerides, whereas higher BT was associated with better cognitive and muscle function and DHEAS with lower adiponectin and higher MMSE scores.     

血清睾酮雌二醇比值变化对精子缺陷及生育力的影响

目的 了解血清睾酮(T)/雌二醇(E2)比值变化对精子缺陷程度及男性生育能力的影响.方法对90例已婚育龄男性进行血清T、E2、卵泡刺激素(FSH)、黄体生成素(LH)、催乳素和精液参数、精子形态测定,计算血清T/E2和精子多重缺陷指数.根据血清T/E2分为≤10(1组)、＞10(2组)及＞20(3组)分别比较.结果 1、2、3组精子密度和精子活动力分别为(66.8±39.6)×106、(57.6±33.9)×106、(77.4±26.0)×106/ml和(46.6±16.4)%、(44.9±16.0)%、(53.9±14.4)%,3组间差异无统计学意义(P均＞0.05).1组头部缺陷精子为(81.4±9.4)%,明显高于3组的(74.0±10.7)%(t=2.482,P=0.016);1、2组颈部缺陷精子为(16.9±8.6)%和(12.7±9.8)%,均明显高于3组的(7.1±3.9)%(t=4.113、2.050,P=0.000、0.046);1、2、3组尾部缺陷精子分别为(22.6±14.6)%、(14.6±9.0)%和(6.5±5.7)%,组间差异有统计学意义(t=2.722、3.996、3.110,P=0.008、0.000、0.003).2组精子畸形指数(SDI)(1.4±0.3)明显高于1组(1.3±0.2,t=2.293,P=0.025);2、3组畸形精子指数(TZI)分别为1.6±0.3和1.6±0.2,明显高于1组的1.4±0.2(t=2.285、2.727,P=0.025、0.009).1、2、3组中配偶有生育或妊娠经历者分别为13、16、6例,组间差异无统计学意义(x2=3.285、0.854、0.199,P=0.070、0.355、0.655),但2、3组相对危险度分别为1组的2.4倍和1.8倍.1、2、3组中特发性不育病例分别为25、15、7例,组间差异均无统计学意义(x2=0.735、0.200、0.038,P=0.391、0.655、0.845),1组相对危险度分别为2、3组的1.5倍和1.3倍.相关性分析结果发现,血清T/E2与头、颈和尾部缺陷精子比率呈显著负相关(r=-0.209、-0.316、-0.335,P=0.048、0.002、0.001).结论血清T/E2与精子头、颈及尾部缺陷呈显著负相关,其下降与男性生育概率降低有关,但并不影响精子密度及活动力,表明男性体内维持较高比例的T/E2水平对于精子发生过程中的精子形成阶段及受精能力有重要意义.

Abstract：

Objective To study the effect of the serum testosterone/estradiol ratio (T/E2) alteration on sperm defect and fertility. Methods The testosterone, estradiol, FSH, LH, PRL,sperm parameters and sperm morphology of 90 men were analyzed and the T/E2 and multiple anomalies index (MAI) were calculated. The patients were divided into 3 groups; T/E2≤10 (Ⅰ), T/E2＞10 (Ⅱ), and T/E2＞20 (Ⅲ). Results The sperm concentration and motility among the 3 groups were not significantly different (P＞0. 05). The percentages of the sperm whose head, neck and tail were abnormal declined gradually with the increase of the T/E2 in serum. The percentage of sperm head defeet of group Ⅰ was significantly higher than that of group Ⅲ (t=2. 482, P=0. 016) and that of sperm neck defect of groups Ⅰ and Ⅱ were significantly higher than that of group Ⅲ (t=4.113, 2. 050, P=0.000, 0. 046, respectively). The percentage of sperm tail defect among 3 groups was significantly different (t=2. 722, 3. 996, 3. 110, P=0. 008, 0. 000, 0. 003, respectively). The SDI of group Ⅱ was significantly higher than that of group Ⅰ (t= -2. 293, P= 0. 025). But the TZI increased gradually with the increase of the serum T/E2 and the TZI of groups Ⅱ and Ⅲ were significantly higher than that of group Ⅰ (t=2. 285, 2. 727, P=0. 025, 0. 009, respectively). The percentage of the men in group Ⅰ whose partners became pregnant was 29. 5% and those of groups Ⅱ and Ⅲ were 50% and 42.9%, respectively. Although the percentage among three groups was not different statistically (x2 = 3. 285, 0. 854, 0. 199, P= 0. 070, 0. 355, 0. 655, respectively), the relative risks of groups Ⅱ and Ⅲ were 2.4 and 1.8 times of that of group Ⅰ. There were 25, 15, 7 cases of idiopathic infertility among the 3 groups, respectively. The relative risk of I group was 1.5 and 1.3 times of that of Ⅱ and Ⅲ groups. The correlation analysis showed that the T/E2 in serum had significantly negative correlation with the percent of the sperm head or neck or tail defects (r= -0. 209, -0. 316 and -0. 335,respectively and P= 0. 048, 0. 002 and 0. 001, respectively). Conclusions The decrease of T/E2 in serum was correlative with the decrease of fertility probability, but it did not alter the sperm density and the sperm motility. It showed that the level of the T/E2 in serum was important for spermatogenesis and sperm fertilizing capability.     

女性酒渣鼻患者血清睾酮、二醇和月经的关系

为了探讨女性酒渣鼻患者血清睾酮、雌二醇水平及月经周期改变情况，作者用放射免疫分析法测定了２５例患者及２０例正常对照者血清睾酮及雌二醇水平，并调查了２５０例患者及１００例正常对照者月经周期变化情况。结果显示，患者血清中睾酮的平均值为５．２７ｎｍｏｌ／Ｌ，明显于对照组（ｔ＝２．９１，ｐ＜０．０１）。雌二醇平均值为５７４．６ｎｍｏｌ／Ｌ，与对照组无明显差异（ｔ＝０．１１，ｐ＞０．０５）。患者月经紊乱率为６９．６％，明显高于对照组（χ２＝３５．５５，ｐ＜０．０１）。可见，女性酒渣鼻患者血清睾酮升高，雌二醇正常，且多伴月经周期紊乱。     

Calculated free testosterone and radioimmunoassay free testosterone as a predictor of subnormal levels of total testosterone

Purpose

To evaluate the relationship among aFT, cFT, and total testosterone (TT) and the best method in diagnosing subnormal levels of TT.

Methods

A total of 213 men were analyzed. Fasting blood samples were drawn for the determination of the lipid profile as well as of plasmatic glucose and serum levels of albumin, TT, aFT, and sex hormone-binding globulin (SHBG). The values of cFT were determined by Vermeulen??s formula.

Results

No correlation between aFT and cFT was observed (r?=?0.062; P?=?0.368), except after controlling for confounders (r?=?0.188; P?=?0.007). Only 44.8% of hypogonadal men (TT????300?ng/dL) were classified by aFT, whereas 72.4% of hypogonadal men were classified by both TT and cFT. Sensitivity, specificity, positive and negative predictive values, and positive likelihood ratio were greater in cFT when compared with aFT.

Conclusions

Our results suggest that cFT is more accurate in diagnosing subnormal levels of TT. Furthermore, we do not recommend using aFT due to its lack of accuracy. Further studies should be performed in order to evaluate the correlation between aFT and cFT with clinical signs and symptoms of androgen deficiency.     

Therapeutic monitoring of tacrolimus concentrations in blood of renal and liver transplant recipients: comparison of microparticle enzyme immunoassay and enzyme multiplied immunoassay methods

Monitoring of tacrolimus blood concentrations is of utmost importance in the management of organ transplant recipients due to narrow therapeutic index of the drug and its considerable interpatient variability in pharmacokinetics. Thus therapeutic monitoring of tacrolimus plays a crucial role not only in the evaluation of the drug efficacy but also in the control of possible side effects. We compared immunoassay-based methods, quantitative enzyme multiplied immunoassay (EMIT) with quantitative microparticle enzyme immunoassay (MEIA), using blood samples from renal and liver transplant recipients (n = 40) treated with tacrolimus. Blood samples were obtained for diagnostic routine measurements. The tacrolimus concentrations measured by EMIT for all the transplant patient samples were higher (2.8 to 28.5 ng/mL) than results obtained in MEIA (3.0 to 25.0 ng/mL). The mean difference expressed in percentage was 13.94% and correlation coefficient EMIT versus MEIA was 0.97. The tacrolimus concentrations measured by EMIT for renal graft recipients (n = 8) were higher (6.0 to 13.3 ng/mL) than those measured by MEIA (6.1 to 12.2 ng/mL), mean difference expressed in percentage was 14.1% and correlation coefficient was 0.85. The tacrolimus concentrations for liver transplant recipients (n = 32) measured by EMIT (2.8 to 28.5 ng/mL) were higher than results obtained in MEIA (3.0 to 25.0 ng/mL), the mean difference expressed in percentage was 13.89%, and the correlation coefficient was 0.98. The results obtained in the study show an insignificant difference in specificity of both methods used to determine the concentration of an active drug. Thus both methods, EMIT and MEIA, seem to have similar diagnostic value.     

男性骨质疏松症与睾酮关系的研究进展

随着老龄人口的增加,男性骨质疏松症和睾酮缺乏越来越常见。近年来研究表明,睾酮水平与男性骨质疏松症的发生密切相关,睾酮缺乏的患者发生骨质疏松症及骨折的风险增加。睾酮可通过雄激素受体和雌激素受体调节骨代谢,且睾酮替代治疗可以有效增加男性骨密度,降低发生骨质疏松症的风险。本文回顾最近的文献,就睾酮与骨质疏松症的关系做一综述。