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.     

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.     

雄激素及其受体和雌激素变化在老年男性高血压患者中的初步研究

目的探讨老年男性高血压患者的雄激素及其受体以及雌激素水平变化。方法选择172例老年男性高血压患者(高血压组)和104例同龄健康男性(健康组),检测所有入选者血清7种性激素,黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(TT)和雌二醇(E2)采用化学发光法检测;游离睾酮(FT),硫酸脱氢表雄酮(DHEA-s),性激素结合球蛋白(SHBG)采用酶联免疫吸附法检测。使用流式细胞技术测定外周淋巴细胞的雄激素受体(AR)含量(AR平均荧光强度)。结果(1)与健康组比较,高血压组体重指数(BMI),腰围,腰臀比,空腹血糖和E2/TT明显增高,TT明显下降(P<0.01)(。2)控制BMI因素影响后,与收缩压相关的性激素有TT(P=0.047)和E2/TT(P=0.001);与舒张压相关的因素有E2,E2/TT和AR荧光强度(P<0.05)。结论男性高血压患者TT明显下降、E2/TT明显升高。E2/TT与收缩压和舒张压呈正相关,E2和AR荧光强度与舒张压呈正相关。     

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。     

Endogenous sex hormones in men aged 40-80 years

OBJECTIVE: To determine the relationship between aging, life-style factors and health-related factors and endogenous sex hormone levels. DESIGN: Cross-sectional study of 400 independently living men between 40 and 80 Years of age. METHODS: After exclusion of subjects who were not physically or mentally able to visit the study center, 400 men were randomly selected from a population-based sample. Total testosterone (TT), bioavailable testosterone (BT) (i.e. not bound to sex hormone-binding globulin (SHBG)), SHBG, estradiol (E(2)) and dehydroepiandrosterone-sulfate (DHEA-S) were investigated for their relationship with age, body mass index (BMI), waist circumference, smoking, physical activity and general health status. Multivariate models using ANCOVA analyses were used to examine the contribution of life-style factors to sex hormone variability. RESULTS: TT, BT and DHEA-S decreased with age; 0.2, 0.7 and 1.2%/Year respectively. SHBG showed an increase with age of 1.1%/Year. No changes with age were found for E(2). General health status modified the association of TT and SHBG with age (P interaction 0.10 and 0.002 respectively). Increased BMI and waist circumference were associated with decreased TT, BT, SHBG and DHEA-S and increased E(2) (all P<0.01). Current smoking, lower alcohol intake and a higher physical activity score were associated with higher TT and SHBG levels. CONCLUSION: This study showed the important determinants of sex hormones were age, BMI, waist circumference, smoking, general health status and physical activity. Furthermore, it can be concluded that general health status modified the effect between sex hormones and age. For future observational studies it should be taken into account that the above-mentioned determinants may alter the association between sex hormones and diseases and related conditions.     

血清性激素水平与老年男性骨代谢指标及骨密度的关系

目的：探讨老年男性血清性激素表达水平与骨代谢指标及骨密度之间的关系。方法：收集老年男性患者230例,年龄65～95岁,分别测定雌二醇（E2）、睾酮、游离睾酮（FT）、性激素结合球蛋白（SHBG）、脱氢表雄酮（DHEA）、骨钙素、骨碱性磷酸酶（BALP）、25-羟维生素D3及尿Ⅰ型胶原交联氨基末端肽（NTX）等指标,同时利用双能X线分别测定髋关节及腰椎（L1～L4）的骨密度,分析老年男性骨密度、骨代谢指标与血清性激素以及年龄与骨密度的相关性。结果：血清E2、FT与腰椎及髋关节的骨密度呈正相关,而睾酮、SHBG、DHEA与骨密度无关。血清E2、FT与骨代谢指标NTX、BALP呈负相关,血清E2与25-羟维生素D3呈正相关,而睾酮、SHBG、DHEA与骨代谢指标NTX、BALP无关。年龄与腰椎L1、L2、L4、L1～4及髋部骨密度呈负相关,与腰椎L3骨密度无关。结论：老年男性骨密度的变化受性激素中FT、E2表达水平的影响,而受E2的影响程度超过雄激素。血清FT及血清E2的水平可作为老年男性骨质疏松症的独立观察指标。     

Oestradiol is a protective factor for non-alcoholic fatty liver disease in healthy men

Visceral fat is a risk factor for non‐alcoholic fatty liver disease (NAFLD). A reduction in sex hormones is associated with increased abdominal fat. Thus, we investigated whether reduced testosterone (T) or oestradiol (E2) levels in men are associated with NAFLD and central obesity. The study involved a survey of 1,882 men between 20 and 60 years of age. We detected hepatic fat infiltration by ultrasound. Early morning serum was analyzed for total testosterone (TT), E2, sex hormone‐binding globulin (SHBG), follicle‐stimulating hormone (FSH) and luteinizing hormone (LH). Free testosterone (FT) was calculated using the Vermeulen method. In the studied population, the prevalence of NAFLD, FSH, LH and SHBG increased with age, TT and FT declined with age, and E2 remained stable. However, in the NAFLD group, TT remained stable, FT and E2 declined, and hepatic fat infiltration increased (P < 0.001 for both). Using multivariate analysis, a correlation was found between E2 and NAFLD, with an odds ratio of 0.954 (95% confidence interval: 0.946–0.967). E2 is one of the protective factors against NAFLD in healthy men. T has no significant correlation with NAFLD. Further investigation would be required to assess the clinical consequences of reduced E2 in men with NAFLD, particularly for men whose TT remained stable.     

老年男性心力衰竭患者雄激素水平与心血管危险因素的关系

目的探讨老年男性心力衰竭患者体内雄激素水平与心血管危险因素的相关性。方法选择临床诊断为慢性心力衰竭、超声心动图检查LVEF≤45%、年龄≥60岁的男性住院患者100例(心力衰竭组),另选400例年龄≥60岁同龄健康男性为正常对照组。检测总睾酮、游离睾酮、脱氢表雄酮硫酸酯、性激素结合球蛋白水平;同时详细记录心力衰竭组患者体重指数、血压、血糖、血脂、尿酸、吸烟等心血管危险因素情况,进行多元相关分析。结果与正常对照组比较,心力衰竭组患者总睾酮、游离睾酮、脱氢表雄酮硫酸酯明显降低,性激素结合球蛋白明显升高(P0.05,P0.01)。心力衰竭患者总睾酮与舒张压、TC、TG呈负相关,游离睾酮与舒张压、TC、LDL-C、尿酸呈负相关;性激素结合球蛋白与体重指数及吸烟呈正相关。结论老年男性心力衰竭患者雄激素水平低下可能对心血管危险因素产生不利影响,从而对心血管系统产生不利影响。     

Endogenous sex hormones and metabolic syndrome in aging men

BACKGROUND: Sex hormone levels in men change during aging. These changes may be associated with insulin sensitivity and the metabolic syndrome. METHODS: We studied the association between endogenous sex hormones and characteristics of the metabolic syndrome in 400 independently living men between 40 and 80 yr of age in a cross-sectional study. Serum concentrations of lipids, glucose, insulin, total testosterone (TT), SHBG, estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S) were measured. Bioavailable testosterone (BT) was calculated using TT and SHBG. Body height, weight, waist-hip circumference, blood pressure, and physical activity were assessed. Smoking and alcohol consumption was estimated from self-report. The metabolic syndrome was defined according to the National Cholesterol Education Program definition, and insulin sensitivity was calculated by use of the quantitative insulin sensitivity check index. RESULTS: Multiple logistic regression analyses showed an inverse relationship according to 1 sd increase for circulating TT [odds ratio (OR) = 0.43; 95% confidence interval (CI), 0.32-0.59], BT (OR = 0.62; 95% CI, 0.46-0.83), SHBG (OR = 0.46; 95% CI, 0.33-0.64), and DHEA-S (OR = 0.76; 95% CI, 0.56-1.02) with the metabolic syndrome. Each sd increase in E2 levels was not significantly associated with the metabolic syndrome (OR = 1.16; 95% CI, 0.92-1.45). Linear regression analyses showed that higher TT, BT, and SHBG levels were related to higher insulin sensitivity; beta-coefficients (95% CI) were 0.011 (0.008-0.015), 0.005 (0.001-0.009), and 0.013 (0.010-0.017), respectively, whereas no effects were found for DHEA-S and E2. Estimates were adjusted for age, smoking, alcohol consumption, and physical activity score. Further adjustment for insulin levels and body composition measurements attenuated the estimates, and the associations were similar in the group free of cardiovascular disease and diabetes. CONCLUSIONS: Higher testosterone and SHBG levels in aging males are independently associated with a higher insulin sensitivity and a reduced risk of the metabolic syndrome, independent of insulin levels and body composition measurements, suggesting that these hormones may protect against the development of metabolic syndrome.     

男性胆囊胆固醇结石患者血浆脂联素、性激素水平与体脂分布的关系

目的探讨男性胆囊胆固醇结石患者血浆脂联素、性激素水平与体脂分布的关系。方法对30名男性胆囊胆固醇结石患者与30名健康志愿者，分别测定其血浆脂联素、雌二醇（E2）、游离睾酮（FT）、总睾酮（TT）水平，同时监测血压、腰围（WC）、体重指数（BMI）、腰／臀比（WHR），并进行比较。结果（1）结石组血浆FT、TT、脂联素水平较对照组低（P〈0．05），控制BMI、WC、WHR后，结石组脂联素水平仍较对照组低（P〈0．05），而E2值差异无统计学意义（P〉0．05）。结石组WC、WHR、BMI较对照组高（P〈0．01），均具统计学意义。（2）男性胆囊胆固醇结石血浆脂联素水平与WC呈负相关，TT水平与BMI呈负相关，FT水平与BMI、WHR、WC呈负相关，（P〈0．05）。（3）多因素分析提示WHR、TT水平为男性胆囊胆固醇结石发病的危险因素。结论（1）男性胆囊胆固醇结石患者血浆脂联素、TT、FT水平同时降低，TT水平是男性胆囊胆网醇结石发病的危险因素。（2）男性胆囊胆固醇结石患者存在体脂分布异常，雄激素在男性胆囊胆固醇结石病人脂联素水平的降低中似乎未参与调节，脂联素、雄激素水平同时降低可能是由于体脂分布异常所致，体脂分布异常是男性胆囊胆固醇结石发病的危险因素。     

绝经后女性糖尿病足患者性激素变化及与预后的相关性

目的 分析绝经后女性糖尿病足溃疡（DFU）患者内源性性激素水平与病情严重程度的相关性,探讨性激素水平对绝经后女性DFU预后的影响.方法 选取2012年1月至2013年1月在瑞金医院糖尿病足中心住院治疗的绝经后女性DFU患者158例和高危DFU患者162例,收集其基本临床资料,评估足溃疡严重程度,测定这些患者入院后48 h内静脉血中卵泡刺激素（FSH）、黄体生成素（LH）、催乳素（PRL）、雌二醇（E2）、孕酮（P）、睾酮（T）、游离睾酮（FT）、硫酸脱氢表雄酮（DHEAS）、雄烯二酮（AD）和性激素结合球蛋白（SHBG）水平,采用多元线性回归分析不同严重程度的DFU患者体内性激素指标的变化;随访观察DFU患者6个月溃疡愈合、复发及非致死性心脑血管事件的发生情况,采用logistic回归探讨性激素相关指标与DFU预后的关系.结果 随着Wagner级别增加,绝经后女性糖尿病足病患者体内E2、T、FT水平上升（t值分别为4.47、2.03、2.16;趋势P值分别为＜0.0001、0.041、0.035）;随着DFU感染程度加重,E2呈上升趋势（t值为2.41,趋势P值为0.02）;E2水平与非致死性心脑血管事件的发生呈正相关（OR=1.019,95％CI：1.002～1.037,P＜0.05）.结论 绝经后女性DFU患者内源性E2、T/FT水平与病情、感染程度相关,E2水平对心脑血管事件的发生具有一定提示意义.     

老年前列腺癌患者去势后性激素水平变化及对凝血和纤溶系统的影响

目的探讨老年前列腺癌患者去势后性激素水平变化及对血液凝血和纤溶系统活性的影响。方法27例早期前列腺癌经手术去势的患者作为研究组,39例非前列腺癌老年患者作为正常对照组。分别测定黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(TT)、游离睾酮(FT)、雌激素(E2)、部分凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fib)、凝血酶原活动度(PA)、纤溶酶原(PLG)活性、α2-抗纤溶酶(α2-PI)活性、抗凝血酶-Ⅲ(AT-Ⅲ)活性、二磷酸腺苷(ADP)活性、D-二聚体(DD)含量、血小板聚集率和黏附率、组织型纤溶酶原激活剂(t-PA)及组织型纤溶酶原激活剂抑制物(PAI-1)抗原浓度。结果研究组中患者TT、FT、E2水平显著降低,E2降低幅度小于TT,LH、FSH、FT/TT、E2/TT显著升高;PT、APTT显著缩短,Fib及DD含量显著增加,血小板聚集率、黏附率及ADP活性均显著升高,PLG、α2-PI活性显著增强,t-PA抗原含量及t-PA/PAI-1显著下降,PAI-1含量显著增加。AT-Ⅲ活性无显著变化。结论前列腺癌患者去势后性激素比例严重失调;血小板活性及血液凝血活性显著增强,纤溶活性显著抑制,提示去势患者存在发生动脉硬化的高度危险性。     

Prevalence of hypogonadism in patients with type 2 diabetes mellitus among the Indian population

ObjectivesTo determine the prevalence of hypogonadism among Indian men with and without type 2 diabetes mellitus (T2DM) and evaluate its association with various metabolic parameters.MethodsOne hundred fifty consecutive men with T2DM, aged 25–70 years, and one hundred age-matched healthy men without diabetes were included. The free testosterone (FT) level was calculated using the total testosterone (TT), sex hormone-binding globulin (SHBG), and albumin levels in serum. Patients with a calculated FT level <6.35 ng/dL and a positive response on the androgen deficiency in aging male questionnaire (ADAM) were diagnosed with hypogonadism.ResultsThe prevalence of hypogonadism was 17.3% and 10% in men with and without T2DM, respectively. The body mass index (BMI) and the mean levels of follicle-stimulating hormone (FSH), TT, SHBG, Triglycerides (TG), and FT were significantly different between the groups. The mean BMI and TG levels were significantly higher in patients with T2DM than in those without. Both groups showed a significant negative correlation between the BMI and SHBG level.ConclusionThe hypogonadism prevalence was higher in patients with T2DM than in those without, although the difference did not reach statistical significance.     

Association between sex steroids and cognition in elderly men

Objective To examine the association of cognitive function with sex steroid and sex hormone binding globulin (SHBG) levels among elderly men. Design Prospective cohort study, The Osteoporotic Fractures in Men Study (MrOS), consisting of 5995 US community dwelling men of 65 years or older. Patients One thousand six hundred and two men were chosen randomly from MrOS cohort for sex steroid level measurements by Mass Spectrometry (MS) at baseline. Two thousand six hundred and twenty‐three MrOS participants with sex steroids measured using RIA were also examined. Measurements Baseline and follow‐up (4·5 years later) performance on two cognitive tests: Trails B (executive function and motor speed) and 3MS (global cognitive function). Baseline total testosterone and oestradiol were measured by MS. Free testosterone (free‐T) and free oestradiol (free‐E) were calculated. SHBG was measured by radioimmunoassay. Data were analysed using linear regression. Results Baseline free‐T and free‐E levels were not associated with cognitive performance or change in cognition, following adjustment for age, education, race, health status and alcohol use. Baseline SHBG levels were inversely associated with follow‐up trails B (P = 0·03) and 3MS performance (P = 0·02). Higher SHBG was associated with an increased risk of cognitive decline. Total sex steroid levels were not associated with cognitive performance. Conclusions Despite large numbers of participants and rigorous sex steroid measurements, we did not observe an association between cognition and either testosterone or oestradiol levels. We conclude that endogenous sex steroids in the normal range are not related to executive function or global cognitive function in elderly men. High SHBG deserves further examination as a risk factor for cognitive decline.     

Circadian variations in serum levels of LH, FSH, estradiol, testosterone and sex hormone binding globulin in acromegalic women with menstrual disturbances before and after transsphenoidal adenectomy

Day/night profiles of serum GH, PRL, IGF-I, LH, FSH, testosterone (TT and FT), estradiol (E2) and SHBG were estimated in 12 acromegalic women with GH- and PRL-producing pituitary adenomas and 13 patients with GH-secreting pituitary tumors before and 3 months after transsphenoidal adenectomy. All the subjects studied have had irregular menstrual cycles. Blood for profile determinations was drawn from a peripheral vein at 3 h intervals for three 24 h periods (starting at 08.00). Before surgery all acromegalic women had high mean 24 h GH and IGF-I levels (with irregular peaks) even in the absence of hyperprolactinemia. Postoperative mean 24 h GH level was still high only in 5 out of 25 women studied, and that of IGF-I in 10 of these patients. In 12 acromegalic women with preoperative hyperprolactinemia and disturbed 24 h fluctuations postoperative 24 h mean level of PRL and its circadian rhythm were normal. Before surgery, the circadian variations of pituitary-sex hormone levels and SHBG capacity in serum were not impaired. However, mean 24 h levels of LH, FSH, TT, FT E2 and SHBG were altered mainly in patients with mixed type of GH and PRL producing adenomas. This may be related to the increased activity of GH/IGF-I axis on the one hand and to the excess of PRL on the other. The postoperative normalization of pituitary-sex hormone levels and SHBG capacity in serum was noted only in women with normal 24 h circadian variations of IGF-I levels.     

Sex steroids versus lipid profile and the degree of coronary artery stenosis in men with angiographically documented coronary artery disease

The aim of the study was to assess the correlations between the levels of sex hormones and blood lipid profile as well as indexes of coronary artery stenosis in men with angiographically documented coronary artery disease. 111 men, aged 36-73 yrs (av. 55) were studied. In all the patients levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), estradiol (E), SHBG, LH and FSH were measured. The level of bioavailable testosterone (BT) was calculated knowing SHBG level. Total cholesterol (TCh), HDL-cholesterol, LDL-cholesterol and triglycerides (TG) levels were estimated as well as the degree of coronary artery stenosis was estimated by means of modified indexes. For statistics R-Spearman test was used. Summing coronary stenosis index correlated significantly with T-Ch and LDL-Ch levels. Positive correlation was found between blood level of E and TCh as well as between E and LDL-Ch. BT correlated partially with LDL-Ch level. No correlations were found between the levels of T, SHBG, DHEA-S, FSH, LH and lipid profile. The level of DHEA-s revealed negative correlation with age, while the level of SHBG increased with ageing leading to the decrease of the value of BT but not total T. None of studied hormones correlated with coronary indexes. Our results suggest that estradiol and BT may promote the formation of atherogenic lipid profile leading to atherosclerosis in men.     

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?     

Age-related changes of serum sex hormones, insulin-like growth factor-1 and sex-hormone binding globulin levels in men: cross-sectional data from a healthy male cohort

The age-dependent decline of the gonadal and somatotopic axis has been causally linked to frailty in the elderly by their effects on muscle mass and bone mineral density. However, for healthy men data on serum oestrogens and androgens, as well as IGF-1, as a common outcome measure covering the whole adult age range are scarce. We therefore studied healthy, nonobese male subjects between 20 and 80 years of age to asses their morning concentrations of total (T), free (FT), bioavailable testosterone (bT), oestradiol (E2), bioavailable oestradiol (bE2), oestrone (E1), sex-hormone binding globulin (SHBG), and insulin-like growth factor 1 (IGF-1). Five hundred and seventy-two male healthy volunteers with a BMI < 30 kg/m2 recruited from regular blood donors and senior sports clubs participated in the study. Serum samples were obtained during morning hours and T, FT, E2, E1, SHBG, albumin and IGF-1 were measured by radio-immunoassay systems. In addition, bT and bE2 were calculated. A potential relationship between sex hormones and IGF-1 was tested by multiple regression analysis including age and BMI. Ageing was negatively related to serum levels of sex steroids and IGF-1 (both P < 0.0001) with a mean decrease (youngest vs. oldest) of 51% for T, 64% for FT, 78% for bT, 32% for E2, 62% for bE2, 29% for E1 and 51% for IGF-1 starting in early adulthood whereas SHBG increased after the 5th decade of life (ANOVA P < 0.001). The decline of sex hormones and IGF-1 remained relatively unchanged after adjustment for BMI. Multiple regression analysis revealed an age-and BMI- independent association between oestradiol and IGF-1. In contrast to the female situation sex hormones in healthy, nonobese men decline continuously with age. This process has already started in the third decade, and is paralleled by a decline of IGF-1 serum levels leading to a substantial proportion of elderly men with markedly lowered serum levels of bioavailable sex hormones and IGF-1 compared to the young adult male range. With the recent demonstration of beneficial effects of androgen replacement therapy in healthy males on general well being, muscle mass and bone mineral density the present data may underline the importance of more detailed studies on the biological significance of hormonal changes in men with age.     

Quantitating genetic and nongenetic factors that determine plasma sex steroid variation in normal male twins

We have observed that familial factors have a decided influence on the plasma content of sex steroids in men both in the general population and in men of families with prostatic cancer. The contribution of genetic and nongenetic familial factors on the variation of plasma sex steroid content and action has now been investigated in 75 pairs of normal male monozygotic (MZ) twins and 88 pairs of dizygotic (DZ) twins. Zygosity was determined by measuring ten blood proteins and enzymes. The mean plasma values for testosterone (T), dihydrotestosterone (DHT), estradiol (E2), estrone (E1), and 3 alpha-androstanediol glucuronide (3 alpha-diol G), free T, LH, FSH, SHBG, age, and degree of adiposity were all similar between the groups of twins. Familial factors (P less than 0.01) accounted for 50% or more of the variation in plasma hormone levels in MZ twins (3 alpha-diol G, 84%; T/DHT, 70%; T, 63%; E1, 63%; free T, 61%; E2, 57%; DHT, 56%; LH, 55%; and FSH, 54%) except for SHBG, which was 30%. The familial influence was greater in MZ twins than in DZ twins for all measurements except for SHBG. The heritability of the variation of hormone levels in plasma was determined from the equation: 2[rMZ(intraclass correlation) - rDZ]. Genes regulate 25% to 76% of the total variation of plasma content of the hormones except for DHT (12%) and SHBG (less than 1%). Genetic regulation of tissue DHT formation was suggested by observing a 48% genetic effect on the plasma content of 3 alpha-diol G.(ABSTRACT TRUNCATED AT 250 WORDS)