对诊断PADAM的游离睾酮指数的评估

目的 评价诊断中老年男子部分雄激素缺乏综合征（PADAM）的游离睾酮指数（FTI）.方法 对129例45岁以上健康男性的FTI进行年龄相关分析.以推算的游离睾酮（CFT）值为依据,对FTI进行有效性检验.结果 男子在中老年期FTI与增龄呈明显的负相关.FTI敏感性97.78%,特异性58.33%.结论 计算简单的FTI可用于PADAM病人的筛选和随访,尤其对70岁以上男子是血清FT较为有效的参数.     

十一酸睾酮与佳蓉片联合治疗PADAM的疗效观察

随着我国人口逐渐进入老年社会，中老年男子部分雄激素缺乏综合征(PADAM)的问题也逐渐引起人们的重视。据有关资料统计PADAM多发生于40岁以上男子，并随年龄增加而上升。日前治疗PADAM的药物主要是十一酸睾酮替代治疗。我所自l997年2月至今对男科门诊67例PADAM患者使用十一酸睾酮作为替代治疗，同时联合佳蓉片作为辅助治疗，结果报告如下。     

中老年男子部分性雄激素缺乏综合征(PADAM)的诊断和治疗研究进展

一、ＰＡＤＡＭ的界定当 1939年ｗｅｒｎｅｎ提出“男子更年期综合征”时 ,只是根据 5 0岁以上男子出现的症状和妇女更年期综合征相似 ,并无血浆睾酮水平改变的证据。随着微量检测技术的进步 ,近 2 0年来许多学者纷纷从不同的角度证明血浆睾酮水平确实随年龄老化而减低 ,其中比     

仪征市282例中老年男性PADAM和ED发病情况调查

目的研究本市中老年男性部分睾酮缺乏（PADAM）和勃起功能障碍（ED）的发生情况及相关影响因素。方法282例46-69周岁男性，按年龄分为3组，采用国际勃起功能指数（IIEF-5）和PADAM症状评分表进行问卷调查，测定血清睾酮（T）、游离睾酮（FT）。数据用SPSS软件包处理。结果3个年龄组之间T均数无明显差异（P〉0．05），而FT均数有非常显著性差异（P〈0．005）；ED、PADAM发病率有非常显著性差异（P〈0．001，P〈0．005）；PADAM组ED发病率高于对照组（P〈0.005）。结论中老年男性随着年龄的增长血清T变化不明显，FT下降明显，ED和PADAM发病率均明显升高，PADAM的发病率与FT下降关系密切，中老年男性ED的发病与年龄、内分泌关系密切。     

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。     

PADAM发病机制的研究进展

随着医学领域的飞速发展,医疗水平不断提高,全世界范围内的人口平均寿命普遍延长,老年人比例在上升,世界正在步入老龄化时代,估计世界上60岁以上的人口将从1999年的5.93亿(约占总人口的10%)增加到2050年的19.7亿(约占总人口的22%)。随着老龄化,老年人群中各种疾病发病率增高,关注老年疾病,以提高老年人生活质量,延长寿命,这已成为全球关注的医学重要课题。     

PADAM动物模型进行同种异体睾丸间质细胞移植的研究

目的老年SD大鼠进行同种异体睾丸间质细胞移植探讨中老年男性雄激素部分缺乏症(PADAM)动物模型的可行性和疗效。方法选10只符合PADAM模型标准的老年SD大鼠作为受体，用成年SD大鼠的睾丸进行体外分离和培养，将获得的高纯度和高活力的睾丸间质细胞移植到老年SD大鼠的大腿内侧肌群内，定期检查其移植前后血清睾酮和游离睾酮的水平变化，并观察移植部位的情况。结果未应用免疫抑制剂，移植后的睾丸间质细胞保持良好的分泌功能，老年SD大鼠的血清睾酮和游离睾酮水平均显著升高，并大约于移植后的7～12d开始稳定在一定的水平，可持续27d以上。移植部位未见异常。结论睾丸问质细胞同种异体移植安全、有效、无明显排斥反应。     

血清睾酮、游离睾酮、双氢睾酮浓度与男性年龄关系的研究

为研究T,FT,DHT水平与年龄之间的关系以指导临床工作,我们随机选择了602例男性,排除了(1)使用性激素者;(2)性腺或肾上腺机能异常者;(3)严重疾病者.采用放射免疫法测定血清T、FT、DHT浓度.结果提示从整体上看,随着年龄的增长,T、FT、DHT呈逐渐下降,即年龄与T、FT、DHT分别呈负相关性关系(P＜0.01),但降低程度存在个体差异.年龄段的数据和血清中T、FT、DHT浓度与年龄的相关性在生理上和病理上都是有价值的,这个结果能指导临床工作.     

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.     

唾液游离睾酮测定的临床应用

借鉴国内外文献报告的方法，建立了唾液游离睾酮的测定方法，可替代血游离睾酮的测定。本法批内变异系数５．７５％，批间变异系数８．４５％，提取回收率９４％，最小检出量（灵敏度）１２．３０ｐｇ（９５％可信限）。唾液游离睾酮与血清总睾酮之间有极好的相关性（ｒ＝０．９８４，Ｐ＜０．００１）。唾液游离睾酮测定方法实用、可靠，在临床应用中取得满意结果，加之取材容易，病人易于接受，具有很好的社会和经济效益。     

血清游离睾酮在多囊卵巢综合征患者中诊断高雄激素血症的价值

目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者雄激素指标总睾酮(total testosterone,TT)和游离睾酮(free testosterone,FT)诊断PCOS患者高雄激素血症的敏感性和准确性,并分析雄激素指标与胰岛素抵抗(Insulin resistance,IR)的相关性。方法纳入符合鹿特丹标准、未经治疗的PCOS患者365例,测定身高、体重、基础生殖内分泌激素、FT,空腹血糖(FPG)和空腹胰岛素(FINS)。比较TT和FT的相关性和差异性,并对比TT和FT与IR的相关性。结果 FT与TT存在线性相关,(r=0.660,r2=0.448,P0.001);TT和FT的诊断率分别是14.61%和22.75%,且差异具有统计学意义(P0.05);与TT相比,FT和体重指数(BMI)、IR的相关性更大。结论 FT在PCOS诊断高雄激素血症上有较高的检出率,减少漏诊率,而且更能反映PCOS患者IR的水平,指导临床治疗。     

Comparative pharmacokinetics of testosterone enanthate and testosterone cyclohexanecarboxylate as assessed by serum and salivary testosterone levels in normal men

The pharmacokinetics of 2 testosterone esters, testosterone enanthate and testosterone cyclohexanecarboxylate, were compared in a single blind crossover study in healthy young men. Their effects on serum and salivary levels of testosterone, as well as on the serum levels of LH, FSH and prolactin were measured after the injection of doses equivalent to 140 mg free testosterone. Both preparations yielded supraphysiological testosterone levels in serum and saliva as early as 2 h following injection, reaching peak levels 4 to 5 times above basal between 8 and 24 h. LH and FSH levels were suppressed as long as serum testosterone levels were elevated. Nine days after injecting testosterone enanthate and 7 days after giving testosterone cyclohexanecarboxylate, serum and salivary levels of testosterone had returned to basal. The longer activity of testosterone enanthate was also evidenced from more extended suppression of gonadotrophin levels. Although neither preparation is ideal because of the initial supraphysiological peaks, testosterone enanthate appears preferable for clinical use because of its slightly longer duration of action.     

Comparative study on evaluation methods for serum testosterone level for PADAM diagnosis

The International Society for the Study of the Aging Male (ISSAM) recommends that a diagnosis be based on a patient's total testosterone (TT), calculated free testosterone (cFT), or calculated bioavailable testosterone (cBT) for partial androgen deficiency of the aging male (PADAM). The purpose of this study was to confirm whether hypogonadism of patients with PADAM is related to symptoms and clarify which criteria of testosterone recommended by ISSAM is suitable for Japanese patients. A total of 90 patients with PADAM symptoms were included in this study. Endocrinologic profiles were reviewed as appropriate, and PADAM symptoms were judged by means of several questionnaires. Laboratory values and symptoms were compared between patients with and without hypogonadism. Even when any criterion of testosterone was used for diagnosis of hypogonadism, AMS (total and subscales), IIEF-5, or SDS scores of PADAM symptoms did not differ significantly between patients classified as having and not having hypogonadism. No other endocrinologic variables than testosterone differed significantly between them, either. PADAM symptoms are not related to testosterone level and it is still obscure whether ISSAM's criterion can be adopted for Japanese patients with PADAM. Other pathology needs to be addressed for evaluation and diagnosis of PADAM in Japan.     

The relationship between total and free serum testosterone and the risk of prostate cancer and tumour aggressiveness

OBJECTIVE

To analyse the relationship between the levels of total and free serum testosterone and the risk of prostate cancer and tumour aggressiveness.

PATIENTS AND METHODS

Total and free serum testosterone were determined in 478 patients consecutively assessed by transrectal ultrasonography‐guided prostate biopsy because of an abnormal digital rectal examination and/or serum prostate‐specific antigen (PSA) level of >4.0 ng/mL. Tumour aggressiveness was assessed according to serum PSA level, biopsy Gleason score and clinical stage in the subset of 216 patients with cancer (45.2%). We also compared prostate cancer risk and tumour aggressiveness in 80 hypogonadal patients (16.7%) and 398 eugonadal patients (83.3%).

RESULTS

The median total serum testosterone level in patients without and with prostate cancer was 466.0 and 466.5 ng/dL, respectively (P > 0.05); the median levels of free serum testosterone were 9.9 and 10.0 pg/mL, respectively (P > 0.05). The cancer detection rate in hypogonadal patients was 41.3% (33/80) and 46.0% in eugonadal patients (183/398) (P > 0.05). The median level of total testosterone was 433 ng/dL in patients with low‐risk prostate cancer, 467 ng/dL in those with intermediate‐risk tumours and 468 ng/dL in those with high‐risk tumours (P > 0.05); the median levels of free testosterone were 9.4, 9.8 and 10.3 pg/mL, respectively (P > 0.05).

CONCLUSIONS

Prostate cancer risk and tumour aggressiveness are not related to serum levels of total and free testosterone, but hypogonadal patients do not have a greater risk of prostate cancer and tumour aggressiveness.     

Testosterone concentrations in human seminal plasma and saliva and its correlation with non-protein-bound and total testosterone levels in serum

A sensitive, specific and precise non-chromatographic method for the radio-immunoassay of testosterone in human seminal plasma and saliva from adult and pubertal males is described, and the values compared to total and non-protein-bound testosterone levels in serum. There was a significant correlation between salivary and serum-free levels of testosterone (r = 0.75, P < 0.001, n = 67) whilst the correlation of serum levels of total testosterone with free as well as with salivary testosterone levels was weaker (r = 0.63 and 0.64, respectively). The salivary and serum levels of free testosterone showed better correlation with the stage of puberty than did the serum levels of total testosterone. Further evidence for a correlation between salivary and serum levels of free testosterone was obtained following oral administration of testosterone undecanoate, as this treatment increased the mean concentration of serum total testosterone after 3 h by 82%, but increased salivary and serum levels of free testosterone by only 30% and 20%, respectively. The coefficient of correlation between serum levels of total testosterone and seminal plasma testosterone was 0.73 ( P < 0.001), whilst the correlation between levels of serum-free testosterone with both salivary and seminal plasma levels of testosterone was statistically non-significant. Our observations on salivary testosterone are in accordance with the diffusion of non-protein-bound steroids into peripheral tissues, and consequently into their secretions. This model, however, does not appear to be applicable to the sex accessory glands.