迟发性性腺功能减退症病人血清雄激素及其相关代谢指标水平城乡差异分析
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摘要
目的探讨上海社区迟发型性腺功能减退症(late-onset of hypogonadism, LOH)病人与浙江农村社区LOH病人血清雄激素及其相关代谢指标水平的差异。方法采用整群及年龄分层随机抽样,抽取上海社区与浙江农村社区共3000例有固定性伴侣的40～80岁中老年男性作为研究对象,对其进行老年男性症状(AMS)量表、中老年男性雄激素缺乏(ADAM)量表调查并收集一般资料,检测其生化指标(血糖、胆固醇)以及性激素指标[总睾酮(TT)、游离睾酮(FT)、性激素结合球蛋白(SHBG)]水平,并计算生物活性睾酮(Bio-T)。比较2个社区LOH病人雄激素及其各项代谢相关指标水平的差异。结果共获得2673例完整研究资料,问卷有效率为891%,其中上海社区人群977例,浙江社区人群1696例。浙江农村社区LOH的患病率为1421%,显著低于上海社区的2221%,差异有统计学意义(P<005)。上海社区LOH病人的胆固醇水平较浙江农村社区LOH病人增高(P<005),而FT及Bio-T水平均低于浙江农村社区LOH病人(P<005或P<001),并以60～69岁年龄段病人间差异为最明显。结论上海社区LOH病人的健康状况较浙江农村社区LOH病人差,饮食结构差异、营养过剩及缺少运动可能是其主要原因。
Objective To analyze the association between the testosterone hormone and metabolic parameters among late-onset hypogonadism(LOH) males living in the urban and rural communities.Methods A cross-sectional randomized study of 3000 males aged 40 to 80 years were investigated under structured questionnaires including aging males symptoms(AMS) and androgen deficiency in aging men(ADAM) in Shanghai community and Zhejiang rural community. The levels of biochemical indexes[fasting blood glucose(FBG), cholesterol], and androgen [total testosterone(TT), free testosterone(FT) and sex hormone-binding globulin(SHBG)] were measured in two communities, and bioavailable testosterone(Bio-T) was calculated. The levels of androgen and metabolic related indexes were compared bewteen LOH patients in two communities. Results A total of 2673 cases of complete research datawere obtained, and the effective rate was 89. 1%. Among them, 977 cases were in Shanghai communityand 1696 cases were in Zhejiang rural comunity. The prevalence of LOH in Zhejiang rural community was14. 21%, which was significantly lower than that in Shanghai community(22. 21%). The cholesterollevel of LOH patients in Shanghai community was higher than that in Zhejiang rural community(P<0. 05), while the levels of FT and Bio-T were much lower(P<0. 05 orP<0. 01), especially in 60-69 years old group. Conclusions The health status of Shanghai community is worse than that in Zhejiangrural community. The overnutrition, less exercises may be the factors for LOH.
Objective To analyze the association between the testosterone hormone and metabolic parameters among late-onset hypogonadism(LOH) males living in the urban and rural communities.Methods A cross-sectional randomized study of 3000 males aged 40 to 80 years were investigated under structured questionnaires including aging males symptoms(AMS) and androgen deficiency in aging men(ADAM) in Shanghai community and Zhejiang rural community. The levels of biochemical indexes[fasting blood glucose(FBG), cholesterol], and androgen [total testosterone(TT), free testosterone(FT) and sex hormone-binding globulin(SHBG)] were measured in two communities, and bioavailable testosterone(Bio-T) was calculated. The levels of androgen and metabolic related indexes were compared bewteen LOH patients in two communities. Results A total of 2673 cases of complete research datawere obtained, and the effective rate was 89. 1%. Among them, 977 cases were in Shanghai communityand 1696 cases were in Zhejiang rural comunity. The prevalence of LOH in Zhejiang rural community was14. 21%, which was significantly lower than that in Shanghai community(22. 21%). The cholesterollevel of LOH patients in Shanghai community was higher than that in Zhejiang rural community(P<0. 05), while the levels of FT and Bio-T were much lower(P<0. 05 orP<0. 01), especially in 60-69 years old group. Conclusions The health status of Shanghai community is worse than that in Zhejiangrural community. The overnutrition, less exercises may be the factors for LOH.
引文
[1]刘星辰,彭程,刘伟,等.迟发性性腺功能减退症的研究进展[J].中国男科学杂志, 2016, 30(8):65-68.
[2] Corona G, Rastrelli G, Maggi M. Diagnosis and treatment oflate-onset hypogonadism:systematic review and meta-analysis of TRT outcomes[J]. Best Pract Res ClinEndocrinol Metab, 2013, 27(4):557-579.
[3]吴旻,梁国庆,王波,等.男性性功能症状评分联合游离睾酮水平预测迟发性性腺功能减退症的研究[J].实用老年医学, 2014, 28(3):221-225.
[4]高丰衣,李国平.中老年男性迟发型性腺功能减退症的研究进展[J].中华老年医学杂志, 2017, 36(11):1267-1270.
[5]杜杰平,李芳萍,郑晓彬,等.迟发性性腺功能减退症诊断标准的初步研究[J].中华男科学杂志, 2016, 22(11):979-983.
[6] Bhasin S, Brito JP, Cunningham GR, et al. Testosteronetherapy in men with hypogonadism:An endocrine societyclinical practice guideline[J]. J Clin Endocrinol Metab,2018, 103(5):1715-1744.
[7] Antonio L, Wu FC, O.Neill TW, et al. Low free testosteroneis associated with hypogonadal signs and symptoms in menwith normal total testosterone[J]. J Clin Endocrinol Metab,2016, 101(7):2647-2657.
[8] Nieschlag E. Current topics in testosterone replacement ofhypogonadal men[J]. Best Pract Res Clin EndocrinolMetab, 2015, 29(1):77-90.
[9] Huhtaniemi I. Late-onset hypogonadism:current conceptsand controversies of pathogenesis, diagnosis and treatment[J]. Asian J Androl, 2014,16(2):192-202.
[10]吴旻,李建辉,于晓华,等.浙江省一农村社区迟发性性腺功能减退症的调查研究[J].中华男科学杂志, 2013,19(6):522-526.
[11] Camacho EM, Huhtaniemi IT, O.Neill TW, et al. Age-asso-ciated changes in hypothalamic-pituitary-testicular functionin middle-aged and older men are modified by weight changeand lifestyle factors:longitudinal results from the EuropeanMale Ageing Study[J]. Eur J Endocrinol, 2013, 168(3):445-455.
[12] Liu ZY, Zhou RY, Lu X, et al. Identification of late-onsethypogonadism in middle-aged and elderly men from a com-munity of China[J]. Asian J Androl, 2016, 18(5):747-753.
[13]梁国庆,李建辉,郑俊彪,等.症状性迟发性型性腺功能减退合并勃起功能障碍患者血清生殖激素分析[J].上海交通大学学报:医学版, 2016, 36(11):1613-1616, 1621.
[14]梁国庆,孙建明,李建辉,等.男性迟发性性性腺功能减退症患者血清性激素分析[J].实用老年医学, 2016, 30(9):723-725.
[15] Rastrelli G, Giovannini L, Calogero AE, et al. Predictorsand clinical consequences of starting androgen therapy inmen with low testosterone:results from the SIAMO-NOI reg-istry[J]. J Endocrinol Invest, 2016, 39(6):695-708.
[2] Corona G, Rastrelli G, Maggi M. Diagnosis and treatment oflate-onset hypogonadism:systematic review and meta-analysis of TRT outcomes[J]. Best Pract Res ClinEndocrinol Metab, 2013, 27(4):557-579.
[3]吴旻,梁国庆,王波,等.男性性功能症状评分联合游离睾酮水平预测迟发性性腺功能减退症的研究[J].实用老年医学, 2014, 28(3):221-225.
[4]高丰衣,李国平.中老年男性迟发型性腺功能减退症的研究进展[J].中华老年医学杂志, 2017, 36(11):1267-1270.
[5]杜杰平,李芳萍,郑晓彬,等.迟发性性腺功能减退症诊断标准的初步研究[J].中华男科学杂志, 2016, 22(11):979-983.
[6] Bhasin S, Brito JP, Cunningham GR, et al. Testosteronetherapy in men with hypogonadism:An endocrine societyclinical practice guideline[J]. J Clin Endocrinol Metab,2018, 103(5):1715-1744.
[7] Antonio L, Wu FC, O.Neill TW, et al. Low free testosteroneis associated with hypogonadal signs and symptoms in menwith normal total testosterone[J]. J Clin Endocrinol Metab,2016, 101(7):2647-2657.
[8] Nieschlag E. Current topics in testosterone replacement ofhypogonadal men[J]. Best Pract Res Clin EndocrinolMetab, 2015, 29(1):77-90.
[9] Huhtaniemi I. Late-onset hypogonadism:current conceptsand controversies of pathogenesis, diagnosis and treatment[J]. Asian J Androl, 2014,16(2):192-202.
[10]吴旻,李建辉,于晓华,等.浙江省一农村社区迟发性性腺功能减退症的调查研究[J].中华男科学杂志, 2013,19(6):522-526.
[11] Camacho EM, Huhtaniemi IT, O.Neill TW, et al. Age-asso-ciated changes in hypothalamic-pituitary-testicular functionin middle-aged and older men are modified by weight changeand lifestyle factors:longitudinal results from the EuropeanMale Ageing Study[J]. Eur J Endocrinol, 2013, 168(3):445-455.
[12] Liu ZY, Zhou RY, Lu X, et al. Identification of late-onsethypogonadism in middle-aged and elderly men from a com-munity of China[J]. Asian J Androl, 2016, 18(5):747-753.
[13]梁国庆,李建辉,郑俊彪,等.症状性迟发性型性腺功能减退合并勃起功能障碍患者血清生殖激素分析[J].上海交通大学学报:医学版, 2016, 36(11):1613-1616, 1621.
[14]梁国庆,孙建明,李建辉,等.男性迟发性性性腺功能减退症患者血清性激素分析[J].实用老年医学, 2016, 30(9):723-725.
[15] Rastrelli G, Giovannini L, Calogero AE, et al. Predictorsand clinical consequences of starting androgen therapy inmen with low testosterone:results from the SIAMO-NOI reg-istry[J]. J Endocrinol Invest, 2016, 39(6):695-708.