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。     

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降低与腹型肥胖的相关性研究

<正>中老年男性睾酮水平低下是动脉粥样硬化和心血管事件的危险因素之一~([1]),同时,腹型肥胖与心血管疾病的发生发展密切相关~([2])。目前,国际上大多数报道认为男性睾酮水平与腹型肥胖密切相关~([3-4]),但针对中国人群的较大样本量的研究不多。因此,本研究旨在了解中国中老年男性人群中血清睾酮水平与腹型肥胖的相关关系,为临床上腹型肥胖的诊治提供依据。1资料与方法1.1调查对象选择2012年10月至2015年2月     

睾酮补充疗法对中老年男性前列腺的影响

中老年男性部分雄激素缺乏症(partial androgen deficiency in aging male，PADAM)，又称男性更年期，是指中老年男性睾酮部分降低或靶器官对睾酮或其活性代谢产物的敏感性降低的一种临床症状。包括精神心理、生理体能、性功能、血管舒缩等四方面症状。随着我国社会老龄化的进程及人们对生活质量要求的提高，今后我们必然需要面对更多的PADAM患者。     

贵州遵义市中老年男性血清雄激素水平与血脂代谢的相关性

目的:探究贵州遵义市中老年男性血清雄激素水平与血脂代谢的关系。方法:采用分层整群抽样方法在遵义市抽取437例年龄≥40岁的男性行问卷调查和体格检查,采集空腹肘静脉血样标本检测血清总睾酮(TT)、性激素结合球蛋白(SHBG)、黄体生成素(LH)、总胆固醇(TCH)、甘油三脂(TG)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL),计算游离睾酮(FT)、游离睾酮指数(FTI)和睾酮分泌指数(TSI)。结果:中年组SHBG、LH、HDL和LDL均低于老年组,FT、FTI、TSI高于老年组(P均0.05)。TT和SHBG与TG、TCH、HDL和LDL呈负相关,FT与TCH呈正相关,FTI与TG、TCH和LDL呈正相关,TSI与TCH、HDL和LDL呈正相关,LH与TG、TCH和LDL呈负相关(P均0.05)。多元线性回归分析显示TT和SHBG与TG、TCH、HDL、LDL仍呈负相关;LH与TCH、HDL和LDL呈负相关(P均0.05)。结论:中老年男性血清TT、SHBG和LH降低有增加患高TC血症和高LDL血症风险,TT和SHBG降低有增加患高TG血症风险,而TT、SHBG和LH升高有增加患低HDL血症风险。     

中老年男性血清同型半胱氨酸与代谢综合征的相关性研究

目的:探讨基于社区人群的中老年男性血清生殖激素及同型半胱氨酸(Hcy)水平与代谢综合征(MS)及其组分之间的相互关系。方法:以农村社区人口为基础,采用整群及年龄分层抽样相结合的方法,调查中老年男性948例。采用统一的结构式问卷进行调查,测量其基本身体参数,检测其血清生殖激素、Hcy浓度和代谢指标。本研究共获得有效问卷与血清样本868份。将研究对象按照是否患有MS,划分成MS组和非MS(NMS)组,并且按照1∶1设立对照组测定其血清Hcy浓度进行研究。结果:132例诊断为MS。经非参数检验,两组间年龄无统计学差异(P0.05),腰围(WC)、腰臀比(WHR)、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)均有显著性差异(P均0.05)。两组间实验室参数进行比较,其中总睾酮(t T)、性激素结合球蛋白(SHBG)、黄体生成素(LH)和游离睾酮指数(FTI)均有显著差异(P均0.05),但Hcy浓度无统计学差异(P0.05)。Hcy与MS危险因素的关联研究中,Hcy与BMI、SBP、DBP、FBG、TG、HDL-C均无相关性(P均0.05)。MS相关因素的Logistic回归分析显示Hcy对MS无显著影响。结论:血清Hcy与MS未见显著相关性,与MS各个组分也未见显著相关性。男性血清生殖激素与MS及其各个组分存在不同程度的显著相关性。     

血清雌二醇和游离睾酮与老年男性骨密度的相关性

目的探讨老年男性血清雌二醇(E2)和游离睾酮(FT)与骨密度(BMD)的关系。方法采用双能X线法检测192例老年男性骨密度,根据其骨密度值分为骨量正常组、骨量减少组和骨质疏松组;免疫放射法检测血清E2、睾酮(T)、FT、性激素结合球蛋白(SHBG)、脱氢表雄酮硫酸酯(DHEAS)水平。比较各组间激素的差异及分析激素与骨密度的关系。结果 3组间E2、FT水平存在明显差异(P0.05);经年龄、体质量和BMI校正后,E2与各部位BMD正相关,FT与各部位(腰椎和华氏三角除外)BMD正相关;E2四分位BMD,在第1和第4间距差异有统计学意义(P0.05),在第1、2之间,3、4之间无差异(P0.05)。结论血清E2、FT水平与老年男性骨密度呈正相关;E2对骨密度的影响存在阈值,检测血清E2、FT水平可预防老年男性的骨量丢失。     

老年男性的睾酮替代疗法

男性正常衰老过程伴随血清睾酮水平下降 ,但是尚不清楚它是否将导致许多男性的睾酮缺乏症。过去 10年中 ,越来越多的研究兴趣转向确认对那些睾酮缺乏的老年男性采用睾酮替代疗法 (TRT)是否有助于阻止或逆转衰老的某些方面。TRT有益效应相关的主要雄性激素靶器官包括 :骨、肌肉、脂肪组织、心血管系统和脑。与此同时 ,TRT对靶器官 (如前列腺 )的潜在不良反应仍需评估。本文的目的是总结有关老年男性TRT问题的最新认识。     

中老年男性性激素水平与认知功能关系的研究进展

生活条件和医疗水平的不断提高,使得人类的平均寿命不断延长,亦使越来越多的国家(包括中国)相继进入老龄化社会。关于中老年男性的身心健康、生活质量和生殖健康问题越来越受到人们的重视,其中关于中老年男性雄激素部分缺乏综合征(Partial Androgen Deficiency in Aging Male,PADAM)的研究更是热点之一;同样,认知年老化(指认知功能随年老而加速衰退的现象)亦是认知心理学研究领域的热点之一。     

睾酮与男性骨质疏松

男性骨质疏松的病因是多方面的 ,雄激素水平下降是很重要的一个因素。雄激素不仅在获得骨峰值及维持骨量中起重要作用 ,雄激素水平下降与随增龄而发生的骨丢失关系也很密切。雄激素通过雄激素受体影响成骨细胞功能 ,各种局部因子起调节作用。老年人部分睾酮替代治疗可提高骨密度 ,但其利弊需进一步观察。同时雌激素在男性骨质疏松中所起作用开始受到关注     

应用FRAX评估中老年男性人群骨折风险的多中心研究

目的探讨分别按照不同地区及人群、不同骨密度测量方法计算骨折风险评估工具(FRAX~)的多中心研究在评价男性中老年人骨折风险的预测价值。方法分别搜集中国医科大学航空总医院(本文简称HK)、北京密云区中医医院(本文简称MY)、山东省医学科学院颈肩腰腿痛医院(本文简称SD)行双能X线骨密度检查的中老年人男性病例共7095例,输入相关资料,应用FRAX~中国模式计算各研究对象10年内主要部位骨质疏松性骨折及髋部骨折的概率,应用统计学对比分析根据上述研究资料得到的FRAX值。结果三个中心研究对象10年内主要部位骨质疏松性骨折概率及髋部骨折概率分别行两两Mann-Whitney U检验,P0.05,差异均有统计学意义,分别对三个中心男性人群进行年龄分组,并进行两两对比,其中MY-SD对比组中50～59岁组及80～89组,P0.05,差异无统计学意义,其余MY-HK,HK-SD对比组P0.05,差异具有统计学意义。结论前臂骨密度及髋部骨密度代入FRAX后均能较好的预测未来10年男性人群骨折的风险概率;即使是不同地区人群及应用不同检测设备得到的前臂骨密度值代入FRAX后仍能较好的预测未来10年男性人群的骨折风险概率,且差异在某些年龄组无显著性,FRAX~工具对男性中老年人骨折风险预测极具价值。     

Nephrosclerosis and carotid atherosclerosis: lessons from kidney donor histology

Aim: Carotid artery intima media thickness (CA‐IMT) measurement has been shown to be a safe and reproducible method to assess severity of atherosclerosis. The association between nephrosclerosis and systemic atherosclerosis is not clear. In this study, we investigated the association between CA‐IMT and nephrosclerosis in a group of kidney transplant donors. Methods: Forty seven potential kidney transplant donors were included. CA‐IMT was measured by B‐Mode ultrasonography. Kidney allograft biopsy samples were obtained during the transplantation operation and chronic glomerular, vascular and tubulointertitial changes were semiquantitatively scored according to the Banff classification. Results: Mean age was 52 ± 12 years and 55% of the cases were younger than 55 years. Mean CA‐IMT was 0.74 ± 0.19 mm and 48% had IMT values > 0.75 mm. Chronicty index was ≥5 in 55% of the cases. Chronicity index was higher in cases older than 55 years. Age and CA‐IMT were significantly correlated with chronic vascular changes and chronicity index. CA‐IMT > 0.75 mm had a 46% sensitivity and 90% specificity to predict nephrosclerosis. Positive and negative predictive values were 85% and 57%, respectively. Conclusion: Aging leads to detrimental changes in every part of the vasculature of the human body. CA‐IMT is correlated with the level of nephrosclerosis. Measurement of CA‐IMT reflects nephrosclerosis especially in older patients.     

The relationship between calcification inhibitor levels in chronic kidney disease and the development of atherosclerosis

AimWe aimed to investigate the factors affecting the development of atherosclerosis and the role of calcification inhibitors fetuin-A, matrix-Gla protein (MGP), osteoprotegerin (OPG) in atherosclerosis progress.Material and methodsThe study was planned to investigate the relationship of serum OPG, MGP and fetuin-A levels with the development of atherosclerosis in the stage 2–3–4–5 chronic kidney disease (CKD) patients who did not require dialysis treatment.Results32 (17 female, 15 male) healthy individuals and 92 (49 females, 43 males) CKD patients were included. The mean carotid intima-media thickness (CIMT), C-reactive protein (CRP), fetuin-A, OPG and MGP of the two groups were compared statistically. In CKD patients, age, body mass index (BMI), CRP, triglyceride, urea, systolic blood pressure (SBP), fasting blood sugar have a positive linear relationship, fetuin-A, OPG, GFR have a negative linear relationship with CIMT. The mean CIMT, right CIMT, left CIMT, blood urea, CRP, urinary albumin excretion creatinine and age show a negative linear relationship with fetuin-A.ConclusionFetuin-A levels begin to decline from the early stages of CKD and are significantly lower in patients with atherosclerosis as expressed with CIMT. This suggests that fetuin-A may be used as an early marker in CKD for increased cardiovascular risk. Early recognition of these risk factors is important and large-scale studies on vascular calcification inhibitors are needed.     

Vitamin D insufficiency and subclinical atherosclerosis in non-diabetic males living with HIV

Introduction

Vitamin D insufficiency (VDI) has been associated with increased cardiovascular risk in the non-HIV population. This study evaluates the relationship among serum 25-hydroxyvitamin D [25(OH)D] levels, cardiovascular risk factors, adipokines, antiviral therapy (ART) and subclinical atherosclerosis in HIV-infected males.

Methods

A cross-sectional study in ambulatory care was made in non-diabetic patients living with HIV. VDI was defined as 25(OH)D serum levels <75 nmol/L. Fasting lipids, glucose, inflammatory markers (tumour necrosis factor-α, interleukin-6, high-sensitivity C-reactive protein) and endothelial markers (plasminogen activator inhibitor-1, or PAI-I) were measured. The common carotid artery intima-media thickness (C-IMT) was determined. A multivariate logistic regression analysis was made to identify factors associated with the presence of VDI, while multivariate linear regression analysis was used to identify factors associated with common C-IMT.

Results

Eighty-nine patients were included (age 42±8 years), 18.9% were in CDC (US Centers for Disease Control and Prevention) stage C and 75 were on ART. VDI was associated with ART exposure, sedentary lifestyle, higher triglycerides levels and PAI-I. In univariate analysis, VDI was associated with greater common C-IMT. The multivariate linear regression model, adjusted by confounding factors, revealed an independent association between common C-IMT and patient age, time of exposure to protease inhibitors (PIs) and impaired fasting glucose (IFG). In contrast, there were no independent associations between common C-IMT and VDI or inflammatory and endothelial markers.

Conclusions

VDI was not independently associated with subclinical atherosclerosis in non-diabetic males living with HIV. Older age, a longer exposure to PIs, and IFG were independent factors associated with common C-IMT in this population.     

Difficulties in measuring the effect of testosterone replacement therapy on muscle function in older men

Muscle wasting in older men may be related to androgen deficiency. We have assessed the effect of testosterone replacement therapy on muscle function in the upper and lower limbs of older (age > 60 years) men with blood testosterone levels < 14 nmol/L. Subjects (n = 7 per group) received testosterone enanthate 200 mg i.m. or placebo every 2 weeks in a double blind study over a 12-week period and underwent muscle testing every 4 weeks. A significant increase in blood levels of testosterone and a reduction in levels of sex hormone binding globulin occurred in the treatment group. Total body mass, haemoglobin and packed cell volume also increased significantly (p < 0.05). No improvements in handgrip strength, isometric strength of knee flexors and extensors or leg extensor power were seen in either group. Wide variability in all measures of muscle function were observed in these elderly men suggesting that very large study groups would be required to determine potential treatment benefits on muscle function.     

Influence of haemodialysis on early markers of atherosclerosis

Introduction: End-stage renal disease (ESRD) patients treated by haemodialysis (HD) have impaired endothelium-dependent vasodilatation and increased intima-media thickness (IMT) of the carotid artery The aim of the study was to analyse the relationships between parameters of chronic HD treatment and non-invasive assessments of preclinical atherosclerosis (endothelial dysfunction and carotid IMT) in ESRD patients on HD. Methods: Fifty-two (19 females, 33 males) adult patients on chronic maintenance (4.65 ± 3.29 years) HD aged 59.88 ± 15.49 years were investigated. Ultrasonographic studies were performed with a 7.5 MHz high-resolution probe. The common carotid artery IMT was measured. Brachial artery diameter was analysed to the rest. In order to assess flow-mediated dilatation (FMD), hyperaemia was induced by a pneumatic cuff, and an analysis of the diameter was performed 1, 2, 3 and 4 min after cuff deflation. Results: Significant differences were found in the average carotid IMT value between subjects with delivered dialysis dose (Kt/V) ≥1.2 and <1.2 (0.89 ± 0.21 vs 1.04 ± 0.11, P = 0.0045). A correlation between Kt/V and IMT (r = 0.366, P = 0.004) was demonstrated. FMD values of the brachial artery did not correlate with Kt/V. A correlation between low molecular weight heparin per kg of body mass and maximal percent of FMD was demonstrated (r = −0.242, P = 0.049). The maximal percent of brachial FMD was correlated with absolute difference between pre- and postdialysis pulse pressure values (r = −0.265, P = 0.033). In a partial correlation with haemoglobin as control, a variable significant correlation between total erythropoietin dose and maximal carotid IMT (r = −0.262, P = 0.036) was found. In a multiple linear regression model, Kt/V was independently correlated with carotid IMT values (β = −0.227, P = 0.0335). Conclusion: This study has demonstrated the association between HD procedure and early atherosclerosis markers. HD treatment has to be considered as potential modifying factor in atherosclerosis development.     

Carotid artery intima-media thickness correlates with oxidative stress in chronic haemodialysis patients with accelerated atherosclerosis.

BACKGROUND: Accelerated atherosclerosis is the major cause of mortality in patients on chronic haemodialysis (HD). Increased oxidative stress might be the major factor leading to high cardiovascular mortality rate in HD patients. The aim of our study was to clarify effects of uraemia and dialysis on oxidative stress parameters and explore the relation between oxidative stress markers and carotid artery intima-media thickness (CIMT) as an indicator of atherosclerosis. METHODS: Twenty chronic HD patients, 20 predialytic uraemic patients and 20 healthy subjects were included in the study. Serum thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCO) and nitrite/nitrate levels were determined as oxidative stress markers. Serum vitamin E, plasma sulfhydryl (P-SH), erythrocyte glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities were measured as antioxidants. CIMT was assessed by carotid artery ultrasonography. RESULTS: Both chronic HD and predialytic uraemic patients had enhanced oxidative stress indicated by higher levels of nitrite/nitrate, TBARS and PCO, and lower levels of P-SH, SOD, CAT and GPx compared to controls. HD patients had significantly higher CIMT and nitrite/nitrate while significantly lower P-SH,vitamin E, SOD, CAT and GPx compared to predialytic uraemic patients. There was a significant positive correlation between CIMT and TBARS (r = 0.38, P = 0.003) and nitrite/nitrate levels (r = 0.41, P = 0.001), while there was a significant negative correlation between CIMT and SOD (r = -0.35, P = 0.01), CAT (r = -0.65, P < 0.001) and P-SH levels (r = -0.50, P < 0.001). A linear regression analysis showed that TBARS were still significantly and positively correlated with CIMT (P = 0.001), while CAT and P-SH were significantly and negatively correlated with CIMT (P = 0.002 and P = 0.048, respectively). CONCLUSIONS: HD exacerbates oxidative stress and disturbances in antioxidant enzymes in uraemic patients. We propose that serum TBARS and nitrite/nitrate can be used as positive determinants, while erythrocyte SOD, CAT and P-SH may be used as negative determinants of atherosclerosis assessed by CIMT in uraemic and HD patients.     

Low testosterone level of middle-aged Japanese men - the association between low testosterone levels and quality-of-life

Background

Late-onset hypogonadism (LOH) is due to age-related steep declines in free testosterone levels in middle age. LOH can induce a variety of signs and symptoms that deteriorate the quality-of-life (QOL) of middle-aged men. This study examined the circadian rhythm of salivary testosterone levels in three age cohorts: 20s-30s, 40s-50s, and 60s+ to investigate the association between QOL and testosterone levels in adult Japanese men.

Subjects and Methods

Eighty-one healthy male Japanese volunteers and 20 LOH patients in their 40s-50s were recruited. Their salivary testosterone levels were measured as were independent variables including Body Mass Index (BMI) and smoking rates. The SF-36 v2 was used as the health-related questionnaire to evaluate QOL. Saliva samples were collected at 2-hour intervals between 9:00 am and 9:00 pm. Salivary testosterone levels were determined using an enzyme-linked immunosorbent assay (ELISA: Demeditec Diagnostics, Germany).

Results

There were no significant differences in BMI and smoking rates among the three healthy groups. However, scores from the SF-36 related to body pain were significantly lower in the 40s-50s cohort than in the 20s-30s group. The mean salivary testosterone levels in the 40s-50s group were the lowest at any point of time, except for 9:00 am among all healthy cohorts, and were similar to those of LOH patients. A circadian rhythm was seen in salivary testosterone levels in the 20s-30s and 40s-50s groups, whereas it was lost in the 60s+ group and in LOH patients.

Conclusion

Middle-aged Japanese men had the lowest levels of salivary testosterone and the worst QOL scores in relation to body pain, which may affect their overall QOL.     

血清睾酮水平和代谢综合征的关联分析

目的:探讨男性血清睾酮水平和代谢综合征(MS)的关联。方法:2008年11月至2009年2月对北京社区1006例30～60岁男性进行调查,分别检测腰围、血压、空腹血糖、甘油三酯、高密度脂蛋白胆固醇(HDL-C)、血清睾酮等。采用《2007中国成人血脂异常防治指南》推荐的MS诊断标准,分为MS组和非代谢综合征(NMS)两组,比较两组间各项指标水平差异,分析引起MS不同危险因素中血清睾酮水平以及血清睾酮和MS的相关性。结果:两组之间年龄无统计学差异(P>0.05),腰围、收缩压、舒张压、空腹血糖、甘油三酯、HDL-C、血清睾酮比较有显著性差异(P<0.001)。MS成分增多,血清睾酮水平则明显降低(P<0.01)。血清睾酮水平和年龄、腰围、收缩压、甘油三酯呈负相关(P<0.05)。结论:低血清睾酮水平在一定程度上能预示MS的发展。     

Relationship between serum testosterone and sex hormone-binding globulin in adult men with intact or absent gonadal function

Serum levels of testosterone and sex hormone-binding globulin (SHBG) were determined in 80 apparently healthy men aged 25-85 years and in 23 patients with prostatic carcinoma (CAP) aged 60-75 years before and 6 months after orchidectomy. Serum levels of testosterone and SHBG were correlated positively in healthy men, in all subjects overall as well as within different age groups, and in CAP patients before, but not after, orchidectomy. These data are not consistent with the classical theory regarding SHBG regulation and also speak against an influence of SHBG binding on testosterone metabolism as a mechanism behind the observed positive association between testosterone levels and SHBG.