老年男性动脉粥样硬化与雄激素水平的研究

目的:观察动脉粥样硬化(AS)时雄激素水平的变化,分析两者之间的关系.方法:彩色多普勒超声检查双侧颈动脉和双侧下肢动脉,明显动脉硬化伴多发粥样斑块甚至全程粥样斑块形成者为病例组,提示血管未见明显异常、血流通畅者为对照组.放射免疫法测定总睾酮(TT)、游离睾酮(FT)、雌二醇(E2),比色法测定高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)和甘油三酯(TG),双抗体夹心ELISA法测定血管内皮细胞生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、细胞间黏附分子-1(sICAM-1)水平.比较两组各因子水平的差异,组内分析FT与各因子的相关性.结果:病例组FT显著低于对照组,P<0.01,而TT、E2两组无明显差异,并且与FT无相关性.对照组HDL-C显著比病例组高,P<0.01,病例组TC、TG显著比对照组高,P<0.05,而LDL-C无显著差异.对照组HDL-C、LDL-C与FT分别呈正相关和负相关,病例组TC和TG均与FT呈负相关.病例组VEGF较对照组明显高,P<0.05,且VEGF与两组FT均呈负相关.病例组TNF-α、IL-6均比对照组高,P<0.05,并且与FT负相关,对照组sICAM-1水平明显低于病例组,P<0.01.结论:正常水平雄激素(主要是FT)对老年男性AS有保护作用,低FT水平同时伴有脂质代谢絮乱和炎症反应等危险因素,低FT水平很可能也是老年男性AS的一个独立危险因素.

Atherosclerosis and androgen levels in elderly males

OBJECTIVE: To observe the relation of androgen levels and atherosclerosis (AS) in elderly males. METHODS: Both carotid arteries and arteries of lower extremity were examined with Doppler ultrasonography. Those with arteriosclerosis and much atheromatous plaque were designated as case group, and those with normal results formed control group. Total testosterone (TT), free testosterone (FT) and estradiol (E2) were measure by radioimmunoassay, HDL-C, LDL-C, TC and TG were assayed by colorimetry, vascular endothelium growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), intercellular adhesion molecule (sICAM-1) were determined by ELISA. RESULT: FT was significantly lower in case group than in control group (P<0.01), no differences were found in TT, E2. HDL-C in control group was higher than that in case group (P<0.01), TC and TG were higher in case group than those in control group (P<0.05). HDL-C was correlated positively and LDL-C was negatively with FT level, while both TC and TG in case group had negative relation with FT. VEGF was higher in case group (P<0.05), and it had negative relation with FT in both groups. TNF-alpha and IL-6 were significantly higher in case group (P<0.05), and they had negative relation with FT. sICAM-1 was significantly lower in control group than it in case group (P<0.01). CONCLUSION: The normal androgen levels, especially FT, have beneficial effect in AS development in elderly males. Low FT level may be an independent risk factor in AS development.