血清雄激素水平与男性动脉粥样硬化的关系

目的研究男性冠心病患者血清雄激素水平及颈动脉内膜—中膜厚度的变化,以及血清雄激素对血清脂蛋白、血糖、胰岛素抵抗的影响,探讨血清雄激素水平与男性动脉粥样硬化的关系。方法选择经冠状动脉造影证实的男性冠心病病人91例(冠心病组),根据血管病变情况分为单支病变组(n=30)、两支病变组(n=33)和三支病变组(n=28),同时选择冠状动脉造影正常男性43例作为对照组。入选病例均测定血清总睾酮、游离睾酮、去氢表雄酮,血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、脂蛋白a和空腹血糖、空腹胰岛素,以稳态模型评估胰岛素抵抗指数,超声测量颈动脉内膜—中膜厚度。结果冠心病组与对照组比较,血清总胆固醇、低密度脂蛋白、脂蛋白a、空腹胰岛素、空腹血糖、稳态模型评估胰岛素抵抗指数及颈动脉内膜—中膜厚度显著增高(P<0.05),血清高密度脂蛋白胆固醇、游离睾酮显著降低(P<0.001);游离睾酮冠心病各亚组与对照组比差异有显著性(P<0.001);颈动脉内膜—中膜厚度冠心病各亚组均高于对照组(P<0.001),单支病变组低于两支及三支病变组(P<0.01);空腹胰岛素及稳态模型评估胰岛素抵抗指数:冠心病各亚组均显著高于对照组(P<0.01),且三支病变组显著高于单支病变组。Pearson相关分析表明,内膜—中膜厚度与游离睾酮、高密度脂蛋白胆固醇呈显著负相关(r值均小于-0.5,P<0.001),与空腹胰岛素、稳态模型评估胰岛素抵抗指数、低密度脂蛋白胆固醇、脂蛋白a呈显著正相关(r值均大于0.5,P<0.001)。结论男性冠心病患者血清游离睾酮水平下降,游离睾酮通过影响血脂、血糖、胰岛素抵抗等因素参与男性动脉粥样硬化的形成。     

超重或肥胖的男性2型糖尿病患者性激素水平的研究

目的 观察超重或肥胖的男性2型糖尿病患者性激素水平及胰岛素抵抗、糖脂代谢的变化.方法 选择男性2型糖尿病患者112例,根据体重指数分为体重正常组(50例)和超重或肥胖组(62例).所有患者测定血糖、血脂、胰岛素及性激素水平,包括睾酮、性激素结合球蛋白(SHBG)、孕激素、催乳素、黄体生成素、卵泡刺激素、雌二醇、脱氢表雄酮,并计算得出游离睾酮、生物活性睾酮.比较两组性激素水平、糖脂代谢及胰岛素抵抗相关指标的差异.结果 与体重正常组相比,超重或肥胖组空腹血糖、HbA1c、尿酸、空腹胰岛素和餐后胰岛素水平显著升高(f=-4.58～-2.35,P均＜0.05);总睾酮、SHBG水平显著降低(t=2.17,2.06,P均＜0.05).Pearson相关性分析发现,体重指数、腰围与总睾酮(r =-0.40,-0.41,P均＜0.01)、SHBG(r =-0.33,-0.42,P均＜0.01)呈显著负相关.总胆固醇和甘油三酯与总睾酮(r =-0.28,-0.24,P均=0.01)、SHBG(r =-0.27,-0.37,P均≤0.01)呈负相关;空腹胰岛素、餐后胰岛素、稳态模型评估-胰岛素抵抗指数(HOMA-IR)与总睾酮(r=-0.30-0.21,P均=0.01)、SHBG水平(r=-0.29-0.20,P均≤0.05)呈负相关.结论 超重或肥胖的男性2型糖尿病患者常存在性腺功能减退症,并与胰岛素抵抗和脂代谢异常密切相关.     

20~35岁青年肥胖男性游离睾酮指数与胰岛功能指标的关联性分析

目的分析20~35岁青年肥胖男性游离睾酮指数与胰岛功能之间的关系。方法选取2019年2月至10月于肥胖门诊就诊的82例青年肥胖男性作为研究对象,按照游离睾酮指数三分位数分为3个亚组。对研究对象进行口服葡萄糖耐量试验并测定其血糖和胰岛素水平,以稳态模型评估的胰岛素抵抗指数(HOMA-IR)、稳态模型评估的胰岛β细胞功能指数(HOMA-β)、胰岛素分泌指数及胰岛素敏感指数(Matsuda指数)作为胰岛细胞功能评价指标,分析游离睾酮指数与胰岛功能之间的关系。结果青年肥胖男性人群中,随着游离睾酮指数水平升高,总睾酮、性激素结合球蛋白、Matsuda指数水平均升高,而腰围、体重指数、餐后1 h胰岛素、餐后2 h胰岛素、HOMA-IR水平则降低(均P<0.05);游离睾酮指数与HOMA-IR呈负相关(r=-0.386,P=0.016),且经校正年龄、性别、体重指数、腰围后,相关性仍有线性趋势(P_趋势=0.034);游离睾酮指数与Matsuda指数呈正相关(r=0.280,P=0.004),但经校正上述因素后,关联性消失(P_趋势=0.623)。进一步回归分析显示,经校正后,HOMA-IR每升高1个单位,游离睾酮指数降低14.1%(OR=0.869,95%CI0.767~0.984,P=0.028)。结论游离睾酮指数是青年男性肥胖人群胰岛素抵抗状态的预测指标,但其和胰岛素敏感性之间的关联可能是由肥胖引起。     

GnRH脉冲治疗对男性HH患者体脂分布和胰岛素抵抗的影响

目的 研究促性腺激素释放激素(GnRH)脉冲治疗对男性低促性腺激素性性腺功能减退症(HH)患者体脂分布和胰岛素抵抗的影响.方法 选取2013年2月至2015年1月在安徽医科大学第一附属医院就诊的20例男性HH患者为研究对象,测定GnRH脉冲治疗前、后患者性激素、血脂、空腹血糖、空腹胰岛素(FINS)、性激素结合球蛋白(SHBG)等生化指标,计算稳态模型评估-胰岛素抵抗指数(HOMA-IR),并运用双能X线骨密度仪检测全身、躯干及大腿脂肪量和瘦体重,计算所占各自总质量的百分比.结果 经GnRH脉冲治疗6个月后,男性HH患者骨骺闭合人数、卵泡刺激素、黄体生成素、总睾酮、游离睾酮、总瘦体重百分比和躯干瘦体重百分比水平较治疗前增加,FINS、HOMA-IR、总脂肪量百分比和躯干脂肪量百分比水平较治疗前降低(t=-4.169～3.630,P均＜0.05).Pearson相关性分析提示,HOMA-IR与总睾酮(r=-0.676,P=0.032)、游离睾酮(r=-0.731,P=0.016)、躯干瘦体重百分比(r=-0.750,P=0.012)呈负相关,与FINS(r =0.937,P=0.000)、躯干脂肪量百分比(r =0.750,P=0.012)呈正相关.结论 GnRH脉冲治疗可减轻男性HH患者的胰岛素抵抗,改变其体脂分布;睾酮水平和躯干瘦体重百分比的升高、FINS水平和躯干脂肪量百分比的降低可能与胰岛素抵抗的改善有关.     

雄激素及其受体与老年男性冠状动脉粥样硬化性心脏病的相关性研究

目的 观察老年男性冠状动脉粥样硬化性心脏病(冠心病)患者性激素及雄激素受体水平的变化及相关性. 方法 横断面调查老年男性539例,其中健康人(对照组)400例,年龄62～92岁,平均(71.4±5.2)岁;冠心病患者139例,年龄60～88岁,平均(73.6±6.4)岁.测定总睾酮、游离睾酮、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,同时采用流式细胞术检测外周血雄激素受体(AR)水平. 结果 老年男性冠心病患者DHAES、总睾酮、SHBG、游离睾酮、AR荧光强度均低于对照组(均为P<0.01),而FSH、E2高于对照组(均为P<0.01).年龄与总睾酮、游离睾酮呈负相关(r分别为-0.28、-0.17,P<0.01和P<0.05);与E2、SHBG呈正相关(r分别为0.33、0.14,P<0.01和P<0.05).AR荧光强度与收缩压呈负相关(r=-0.12,P<0.01).Logistic回归分析显示,总睾酮(OR=1.065,95%CI:1.012～1.121,P<0.05)、SHBG(OR=0.994,95%CI:0.990～0.998,P<0.01)和AR(OR=0.971,95%CI:0.956～0.986,P<0.01)与老年男性冠心病相关. 结论 老年男性冠心病患者存在低水平的DHEAS、总睾酮、SHBG、游离睾酮、AR,同时存在高水平的FSH、E2;低水平总睾酮、SHBG和AR可能是老年男性冠心病独立的危险因素.     

恶性消化道肿瘤晚期患者血TNF-α与胰岛素抵抗和胰岛素分泌的功能关系

目的:证明恶性消化道肿瘤晚期患者血浆肿瘤坏死因子α(TNF-α)与胰岛素抵抗和胰岛素分泌功能相关性,阐明恶性消化道肿瘤晚期患者糖代谢障碍机制.方法:测定40例恶性消化道肿瘤晚期患者和40例正常人员血浆TNF-α和空腹血糖、胰岛素、乳酸含量,并计算稳态模式评估法胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β).结果:恶性消化道肿瘤晚期患者血浆TNFα、空腹血糖、空腹胰岛素、空腹乳酸、HOMA-IR和HOMA-β均明显高于正常对照组(3.27±0.92vs1.23±0.36,P＜0.01;5.19±0.75vs4.05±0.28,P＜0.01;14.24±6.52vs8.27±4.84,P＜0.01;7.11±0.69vs3.27±0.41,P＜0.01;3.48±0.85vs1.55±0.77,P＜0.01;181±39vs326±47,P＜0.01),但空腹血糖仍在正常参考范围内.恶性消化道肿瘤晚期患者血TNFα与空腹血糖、空腹胰岛素、空腹乳酸明显正相关(r=0.4352,P＜0.05;r=0.3136,P＜0.05;r=0.7893,P＜0.01),与HOMA-IR明显正相关(r=0.6531,P＜0.01),与HOMA-β明显负相关(r=-0.5874,P＜0.01).结论:恶性消化道肿瘤晚期患者血浆TNFα在胰岛素抵抗和胰岛素分泌功能下降及糖代谢障碍中发挥重要作用.     

多囊卵巢综合征患者性激素结合球蛋白和总睾酮与胰岛素抵抗的相关性

目的 了解性激素结合球蛋白(SHBG)和总睾酮在预测多囊卵巢综合征(PCOS)患者胰岛素抵抗和生殖内分泌以及糖脂代谢紊乱中的作用.方法 选择2004年6月至2006年5月在复旦大学附属妇产科医院就诊的344例PCOS患者为病例组,年龄12～35岁,平均年龄(23±5)岁.选择同期月经规律、基础体温双相的100名妇女作为对照组,比较PCOS患者SHBG和总睾酮与对照组的差异,并用Spearman相关分析法分别分析SHBG和总睾酮与其他指标的相关性,Logistic回归分析胰岛素抵抗的风险因子并做SHBG对胰岛素抵抗的受试者操作特征(ROC)曲线,获得预测胰岛素抵抗的风险值,比较不同水平SHBG患者的糖脂代谢紊乱的程度.结果 PCOS患者SHBG为(114±88)mmol/L,与对照组[(201±106)mmol/L]比较差异有统计学意义(t=-5.60,P<0.01),总睾酮为(2.8±1.0)nmol/L,与对照组[(1.7±0.6)nmol/L]比较差异有统计学意义(t=7.73,P<0.01);SHBG与空腹胰岛素、胰岛素释放试验曲线下面积、口服葡萄糖耐量试验(OGTT)的葡萄糖曲线下面积、胰岛素抵抗指数、甘油三酯和腰围/臀围比呈负相关(r值分别为:-0.30、-0.26、-0.29、-0.19、-0.20、-0.29、-0.22,均P<0.01);总睾酮与空腹胰岛素(r=0.14,P<0.01)、胰岛素释放试验(1、2、3 h的r值分别为0.15、0.12、0.11,均P<0.05)以及相应的曲线下面积(r=0.15,P<0.05)、胰岛素抵抗指数(r=0.11,P<0.05)呈正相关.Logistic回归分析发现SHBG是PCOS患者胰岛素抵抗的独立危险因素(OR=3.741).由ROC曲线得到SHBG预测胰岛素抵抗的大致风险值为88 mmol/L(95%CI为0.668～0.774).在低SHBG(<88 mmol/L)患者中,空腹胰岛素、胰岛素释放试验相应的曲线下面积、胰岛素抵抗指数、空腹血糖、OGTT的葡萄糖曲线下面积与高SHBG(≥88 mmoL/L)患者比较差异有统计学意义(t值分别为-6.45、-5.08、-6.19、-3.16、-3.66,均P<0.01),甘油三酯也高于高SHBG患者(t=-2.06,P<0.05).结论 PCOS患者总睾酮水平高于对照组,SHBG低?     

血游离脂肪酸与不稳定心绞痛病人胰岛素抵抗的关系

目的探讨无糖尿病的不稳定心绞痛患者血浆游离脂肪酸(freefattyacids,FFA)与胰岛素抵抗(insulinresistance,IR)的关系。方法不稳定心绞痛组为经冠状动脉造影确诊不稳定型心绞痛的无糖尿病患者42例,对照组为经冠状动脉造影排除了冠心病患者30例,行75g葡萄糖口服耐量试验,分别测定空腹、餐后30min、120min血糖、胰岛素及FFA水平。结果伴IR患者在不稳定心绞痛组26例(26/42),对照组为12例(12/30),(P=0.066);在不稳定心绞痛组,伴IR患者空腹和餐后120min,FFA分别为(0.63±0.16)mmol/L和(0.16±0.07)mmol/L;高于无IR患者,空腹和餐后120min值为(0.48±0.21)mmol/L和(0.07±0.06)mmol/L(P<0.05);稳态模型评估胰岛素抵抗(homeostasismodelassay-insulinresistanceindex,HOMA-IR)增高(0.50±0.20与0.36±0.22,P<0.05),胰岛素敏感指数(insulinsensitivityindex,HOMA-ISI)降低(-1.96±0.20与-1.71±0.22,P<0.05);不稳定心绞痛组和对照组伴IR患者比较,FFA明显高于对照组,分别为[(0.63±0.16)mmol/L与(0.48±0.22)mmol/L,P<0.05,(0.16±0.07)mmol/L与(0.08±0.03)mmol/L,P<0.01]。相关分析显示HOMA-IR与体重指数呈正相关(r=0.51,P<0.01);餐后30minFFA与HOMA-IR呈正相关(r=0.44,P<0.05);餐后120minFFA分别与空腹胰岛素(r=0.55,P<0.05)、餐后120min血糖呈正相关(r=0.432,P<0.05);游离脂肪酸曲线下面积(FFAAUC)与HOMA-IR(r=0.492,P<0.05)、体重指数(r=0.94,P<0.0001)、腰围(r=0.41,P<0.05)、臀围(r=0.40,P<0.05)和餐后120min胰岛素(r=0.90,P<0.0001)呈正相关。多重逐步回归分析显示,HOMA-IR与体重指数、餐后120minFFA呈正相关。结论FFA与无糖尿病的不稳定心绞痛患者胰岛素抵抗存在密切关系,餐后120minFFA有可能作为评价这类患者胰岛素抵抗的间接辅助诊断指标。     

男性2型糖尿病患者合并低促性腺激素性性腺功能减退的临床观察

目的探讨男性T2DM患者性腺功能减退的原因。方法选择男性T2DM患者156例,分为低睾酮(TT)组(n=59)和正常TT组(n=97),测定血压、血糖、血脂、胰岛β细胞功能,以及性激素[包括血清TT、性激素结合球蛋白(SHBG)、孕激素(P)、催乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)、脱氢表雄酮(DHEA)],比较两组性激素、糖脂代谢指标及胰岛素等的差异,并分别按BMI及LH进行分组,比较各组间TT水平。结果与正常TT组比较,低TT组BMI、FIns、2 hIns及胰岛素抵抗指数(HOMA-IR)升高(￡=3.76,2.03,2.68,2.13,P0.05),低TT组LH、FSH、SHBG、E2降低(t=-2.94,-2.16,-3.08,-3.50,P0.05);与高体重组比较,低体重组TT增加(P0.05);与低LH组相比,高LH组TT增加(P0.05)。相关分析显示,TT与BMI、FIns及HOMA-IR呈负相关(r=-0.33,-0.18,-0.17,P0.05),与LH、FSH、E2呈正相关(r=0.14,0.16,0.28,P0.05)。结论男性T2DM患者往往会合并低促性激素性性腺功能减退症。     

肥胖患者血清游离胰岛素样生长因子Ⅰ及其结合蛋白水平与代谢因素的关系

目的 观察肥胖患者血清游离胰岛素样生长因子Ⅰ(IGF-Ⅰ)、胰岛素样生长因子结合蛋白1(IGFBP-1)及IGFBP-3水平,分析其与年龄、性别、体重指数(BMI)、糖代谢、脂代谢等指标的关系。方法应用ELSA法测定97例肥胖患者和84例正常人血清游离IGF-Ⅰ、IGFBP-3、IGFBP-1、真胰岛素和血脂水平。结果 肥胖组与对照组比较,IGFBP-3明显增高(P<0.01),IGFBP-1下降(P<0.05),而游离的IGF-Ⅰ水平差异无显著性。游离IGF-Ⅰ水平与年龄呈显著负相关(正常组r=-0.26,P<0.05;肥胖组r=-0.42,P<0.01)。在肥胖组,游离IGF-Ⅰ水平与空腹血糖(r=-0.31,P<0.01)、低密度脂蛋白(r=-0.23,P<0.05)及IGFBP-1(r=-0.24,P<0.05)呈负相关,IGFBP-1与BMI(r=-0.41,P<0.01)、空腹胰岛素(FINS)(r=-0.35,P<0.01)和Homa-IR指数呈负相关(r=-0.31,P<0.01),IGFBP-3与FINS呈正相关(r=0.26,P<0.05)。结论 游离IGF-Ⅰ水平随年龄的增长有下降的趋势,并可能参与糖代谢及脂代谢的调节。IGFBP-1浓度可能反映胰岛素抵抗状态。     

Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes

Type 2 diabetes is associated with lower total testosterone (T) levels in cross-sectional studies. However, it is not known whether the defect is primary or secondary. We investigated the prevalence of hypogonadism in type 2 diabetes by measuring serum total T, free T (FT), SHBG, LH, FSH, and prolactin (PRL) in 103 type 2 diabetes patients. FT was measured by equilibrium dialysis. FT was also calculated by using T and SHBG (cFT). Hypogonadism was defined as low FT or cFT. The mean age was 54.7 +/- 1.1 yr, mean body mass index (BMI) was 33.4 +/- 0.8 kg/m(2), and mean HbA1c was 8.4 +/- 0.2%. The mean T was 12.19 +/- 0.50 nmol/liter (351.7 +/- 14.4 ng/dl), SHBG was 27.89 +/- 1.65 nmol/liter, and FT was 0.250 +/- 0.014 nmol/liter. Thirty-three percent of patients were hypogonadal. LH and FSH levels were significantly lower in the hypogonadal group compared with patients with normal FT levels (3.15 +/- 0.26 vs. 3.91 +/- 0.24 mIU/ml for LH and 4.25 +/- 0.45 vs. 5.53 +/- 0.40 mIU/ml for FSH; P < 0.05). There was a significant inverse correlation of BMI with FT (r = -0.382; P < 0.01) and T (r = -0.327; P < 0.01). SHBG correlated inversely with BMI (r = -0.267; P < 0.05) but positively with age (r = 0.538; P < 0.001) and T (r = 0.574; P < 0.001). FT correlated strongly with cFT (r = 0.919; P < 0.001) but not with SHBG. LH levels correlated positively with FT (r = 0.287; P < 0.05). We conclude that hypogonadotropic hypogonadism occurs commonly in type 2 diabetes.     

健康成年男子性激素水平调查

目的调查健康成年男子的性激素水平。方法2002年5月～2003年5月在北京、上海、西安和重庆检查20岁以上健康成年男子1080例,按年龄分为5组,进行了全面体检,并在次晨07:30～08:30肘静脉采血测定黄体生成激素(LH),卵泡刺激激素(FSH),总睾酮(TT),雌二醇(E2)和性激素结合球蛋白(SHBG),计算游离睾酮(cFT)。结果 随着年龄的老化,血清LH,FSH,E2和SHBG水平逐渐增高,cFT逐渐下降,TT无显著变化。以20-39岁值作为基础,单侧下限正常值范围cFT为0.276 nmol/L,TT为11.659 nmol/L。结论 我们的调查揭示了健康成年男子性激素随年龄老化的变化规律,提出了睾酮水平降低的参考界限值。     

男性2型糖尿病患者性腺功能减退相关因素分析

目的探讨男性2型糖尿病（T2DM）患者血清总睾酮（TT）水平与肥胖、胰岛素抵抗（IR）、血糖、血脂间的关系。方法对120例男性T2DM患者进行性激素、FPG、Fins、FC—P、HbA，c、血脂水平测定。根据稳态模型评估法（HOMA）评价IR程度。结果120例男性T2DM患者中1vr低下者占14％，IR占71％，BMI≥23kg／m2者占52％。TT与BMI、Fins及WHR成负相关（r=-0．335，-0．307，-0．232，P〈0．01），与年龄、病程、血糖、FC-P、HbAtc水平等无相关性。BMI与WHR、Fins、FC-P及InHO—MA-IR成正相关（r=0．489，0．348，0．356，0．301P％0．01或P〈0．05），年龄与黄体生成素、卵泡刺激素成正相关（r=0．310，0．442，P〈0．01）。结论肥胖是男性T2DM患者TT水平低下的主要影响因素，通过肥胖的介导，TT与IR及脂代谢紊乱相关。     

Low free testosterone is an independent risk factor for Alzheimer's disease

The purpose of this study was to assess pituitary gonadotropins and free testosterone levels in a larger cohort of men with Alzheimer's disease (AD, n=112) and age-matched controls (n=98) from the Oxford Project to Investigate Memory and Ageing (OPTIMA). We measured gonadotropins (follicle stimulating hormone, FSH, and luteinizing hormone, LH), sex hormone binding globulin (SHBG, which determines the amount of free testosterone) and total testosterone (TT) using enzyme immunoassays. AD cases had significantly higher LH and FSH and lower free testosterone levels. LH, FSH and SHBG all increased with age, while free testosterone decreased. Low free testosterone was an independent predictor for AD. Its variance was overall explained by high SHBG, low TT, high LH, an older age and low body mass index (BMI). In controls, low thyroid stimulating hormone levels were also associated with low free testosterone. Elderly AD cases had raised levels of gonadotropins. This response may be an attempt to normalize low free testosterone levels. In non-demented participants, subclinical hyperthyroid disease (a risk factor for AD) which can result in higher SHBG levels, was associated with low free testosterone. Lowering SHBG and/or screening for subclinical thyroid disease may prevent cognitive decline and/or wasting in men at risk for AD.     

Relationship of level of sex hormone and sex hormone receptor with development of metabolic syndrome in elderly men

Objective The sex hormone and the corresponding receptor may play some roles in the development of the metabolic syndrome （MS） in the elderly men. This study was designed to examine the relationship of level of the sex hormone and androgen receptor with MS in elderly men, thus to investigate the possible pathogenesis of MS. Methods This cross sectional study enrolled 587 elderly men, including 400 healthy controlls aged 62-92 years and 187 MS patients aged 60-87 years in Wan Shou Lu area of Beijing city. Dehydroepiandrosterone sulfate （DHAE-S）, total testosterone （TT）, sex hormone binding globulin （SHBG）, free testosterone （FT）, follicle-stimulating hormone （FSH）,Estradiol （E2）,luteinizing hormone（LH） and androgen receptor （AR） in blood were tested. Statistical analyses included the comparison analysis of variables and independent variables, correlation analysis using multi-factor linear regression, and multiple logistic regression analysis. Results DHAE-S, TT, SHBG, FT and AR fluorescence intensity in healthy control group were higher than those in MS group, however, FSH and E2 levels were lower in healthy group. Age was negatively correlated with diastolic blood pressure （DBP） and FT, but positively correlated with systolic blood pressure （SBP） and E2. AR fluorescence intensity was negatively correlated with SBP and LH. The logistic regression equation showed the negative correlation between DHEA-S, SHBG and the development of MS. Conclusions There are low levels of DHEA-S, TT, SHBG, FT and AR in the elderly patients with MS. On the contrary, FSH and E2 concentration are higher. It can be suggested that low levels of DHEA-S and SHBG may be the potential risk factors of MS in elderly men.     

Lack of linear relationship between hyperinsulinaemia and hyperandrogenism

OBJECTIVE: Because of continued debate about the role of insulin in the development of hirsutism and in the induction of the polycystic ovary syndrome, we have evaluated the hormonal pattern in a group of hirsute patients. PATIENTS: Fifty-four hirsute patients (age range 18-39 years) of whom 26 patients were obese (O) (BMI 28-53 kg/m2 and W/H greater than 0.85), 12 with ultrasonographic evidence of polycystic ovaries (O PCO) and 14 with normal ovaries. Twenty-eight patients were within normal weight range, and, of these, 14 presented ultrasonographic evidence of polycystic ovaries and 14 had normal ovaries. Two groups of age-matched subjects (obese and normal weight), normally menstruating, without hirsutism or history of endocrinopathies or ultrasonographic evidence of polycystic ovaries, served as controls. MEASUREMENTS: Androstenedione and testosterone were evaluated in all patients by RIA, following ether extraction, DHEAS, LH, FSH and insulin were evaluated directly by RIA. SHBG was evaluated by the concanavalin method. Free testosterone (FT%) was calculated according to the formula FT = 4.038-1.607 log SHBG. Integrated areas under the response curve were calculated for LH and insulin respectively following i.v. administration of GnRH (100 micrograms) or oral administration of glucose (75 g). RESULTS: Results (mean +/- standard deviation) showed comparable values of androstenedione in all groups of obese patients and in obese controls (7.3 +/- 2.6 in patients with polycystic ovaries, 7.1 +/- 2.9 in non-polycystic ovary patients and 7.4 +/- 2.6 nmol/l in obese controls, respectively), regardless of baseline and area insulin, the presence or absence of polycystic ovaries, or hirsutism. SHBG levels showed a similar pattern (24 +/- 10, 23.8 +/- 7.9 and 36 +/- 19 nmol/l) as did the percentage of free testosterone, regardless of the presence or absence of hirsutism. Regression analysis of the insulin and LH values (baseline and area) against the androgens and SHBG plasma levels showed that only LH area correlated positively with testosterone (r = 0.36, P less than 0.03), androstenedione (r = 0.44, P less than 0.02), % free testosterone (r = 0.53, P less than 0.001), testosterone/SHBG ratio (r = 0.39, P less than 0.03) and inversely with SHBG (r = -0.57, P less than 0.001). CONCLUSIONS: These results showed (1) no linear relationship between high levels of insulin, ovarian androgen production or free hormone availability, and (2) make it very doubtful that insulin plays a primary role in polycystic ovarian syndrome or hirsutism.     

性激素和雄激素受体与老年男性糖尿病的相关性研究

目的 研究老年男性糖尿病患者的性激素和雄激素受体水平的变化,探讨老年男性糖尿病患者性激素和雄激素受体与糖尿病的相关性. 方法横断面调查老年男性492例,其中健康对照组104例,平均年龄(71.4±5.2)岁;非糖尿病对照组259例,平均年龄(71.5±5.0)岁;糖尿病组129例,平均年龄(73.0±6.3)岁.测定总睾酮(TT)、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(E_2)、黄体生成素(LH)、卵泡刺激素(FSH)水平,采用流式细胞术检测外周血白细胞雄激素受体(AR)水平. 结果糖尿病组TT水平显著低于两对照组,分别为(17.1±6.1)、(15.8±6.0)nmol/L和(13.8±4.7)nmol/L(P<0.01),FT、SHBG、AR阳性率、AR荧光强度健康对照组、非糖尿病对照组和糖尿病组3组间呈下降趋势.但差异无统计学意义.多元回归分析町见TT、E_2,E_2/T,SHBG与血糖水平呈负相关;SHBG与糖尿病病程呈正相关.TT和AR阳性率与糖尿病病程呈负相关.Logistic多元同归分析示年龄、腰臀围比、FSH、SHBG、AR阳性率是糖尿病的危险因素. 结论低水平的TT、SHBG和AR可能是糖尿病的危险因素,在老年男性糖尿病的发生和发展中起到一定作用.     

老年男性心力衰竭患者性激素水平调查及与同龄健康男性的比较

目的了解老年男性心力衰竭(心衰)患者性激素水平及与心功能之间的关系。方法临床诊断为慢性心衰的男性住院患者共100例,年龄在60~87(70.35±8.63)岁,超声心动图检查左室射血分数≤0·45,同时观察健康老年男性400例[(71.25±6.81)岁]作为正常对照。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,并在同龄心衰患者及健康男性之间进行比较。结果(1)心衰患者DHEAS水平随着年龄的增加降低(P<0.05),而SHBG、LH、FSH水平则随着年龄的增加而增加(P<0.05,P<0.01)。(2)与同龄健康男性相比,心衰患者总睾酮、FT、雌二醇、DHEAS明显降低(P<0.01),LH、FSH差异无统计学意义。SHBG水平显著增加(P<0.01)。(3)FT水平与左室射血分数呈显著正相关(r=0.279,P=0.034)。结论老年男性心衰患者的雄激素水平显著降低,且FT水平与心衰程度呈负相关。