Abstract：
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease, affecting one-fourth of the adult population worldwide. Recent data found an association between MASLD and hypogonadism, but this relation in patients with type 2 diabetes mellitus (T2DM) is still unclear.
OBJECTIVE: To evaluate in men with T2DM the association between total testosterone (TT) and noninvasive indices of hepatic steatosis (Fatty Liver Index [FLI], Hepatic Steatosis Index [HSI], Dallas Steatosis Index [DSI]) and fibrosis (AST to Platelet Ratio Index [APRI], Fibrosis-4 Index [FIB-4]), and their predictive cutoff values in identifying hypogonadism.
METHODS: Cross-sectional study on 189 men with T2DM, without history of liver diseases and alcoholism, recruited on an outpatient basis. Interventions were andrological evaluation, metabolic parameters, TT, and liver indices. The main outcome measures were comparison of steatosis and fibrosis indices with testosterone levels and presence of hypogonadism. Receiver operating characteristic curves were used to identify cutoff values of liver indices in predicting low testosterone (<12 nmol/L).
RESULTS: FLI, HSI, and DSI were negatively related with TT and were higher in the low-testosterone group than in the normal-testosterone group (FLI: 74.1 [61.4-93.5] vs 56.5 [32.1-78.2], P < .001; HSI: 41.5 [39.2-45.9] vs 40.1 [36.6-43.2], P = .005; DSI: 0.45 [-0.08-+1.04] vs -0.07 [-1.02-+0.58], P < .001). FLI and DSI also correlated with clinical symptoms of hypogonadism. No differences between groups were observed for APRI and FIB-4. FLI ≥63 was the best parameter as predictive index of low TT (sensitivity 73%, specificity 64%).
CONCLUSIONS: We found an association between noninvasive indices of steatosis and hypogonadism in patients with T2DM. These indices could be used to direct the patients to andrological evaluation.
OBJECTIVE: To evaluate in men with T2DM the association between total testosterone (TT) and noninvasive indices of hepatic steatosis (Fatty Liver Index [FLI], Hepatic Steatosis Index [HSI], Dallas Steatosis Index [DSI]) and fibrosis (AST to Platelet Ratio Index [APRI], Fibrosis-4 Index [FIB-4]), and their predictive cutoff values in identifying hypogonadism.
METHODS: Cross-sectional study on 189 men with T2DM, without history of liver diseases and alcoholism, recruited on an outpatient basis. Interventions were andrological evaluation, metabolic parameters, TT, and liver indices. The main outcome measures were comparison of steatosis and fibrosis indices with testosterone levels and presence of hypogonadism. Receiver operating characteristic curves were used to identify cutoff values of liver indices in predicting low testosterone (<12 nmol/L).
RESULTS: FLI, HSI, and DSI were negatively related with TT and were higher in the low-testosterone group than in the normal-testosterone group (FLI: 74.1 [61.4-93.5] vs 56.5 [32.1-78.2], P < .001; HSI: 41.5 [39.2-45.9] vs 40.1 [36.6-43.2], P = .005; DSI: 0.45 [-0.08-+1.04] vs -0.07 [-1.02-+0.58], P < .001). FLI and DSI also correlated with clinical symptoms of hypogonadism. No differences between groups were observed for APRI and FIB-4. FLI ≥63 was the best parameter as predictive index of low TT (sensitivity 73%, specificity 64%).
CONCLUSIONS: We found an association between noninvasive indices of steatosis and hypogonadism in patients with T2DM. These indices could be used to direct the patients to andrological evaluation.
摘要：
背景：代谢功能障碍相关的脂肪变性肝病（MASLD）是最常见的慢性肝病，影响到全世界四分之一的成年人口。最近的数据发现MASLD和性腺机能减退有关联，但2型糖尿病（T2DM）患者的这种关系仍不清楚。
目的：评估男性T2DM患者总睾酮（TT）与肝脂肪变性的非侵入性指标（脂肪肝指数[FLI]，肝脏脂肪变性指数[HSI]，达拉斯脂肪变性指数[DSI])和纤维化(AST与血小板比率指数[APRI]，纤维化-4指数[FIB-4]），以及它们在确定性腺机能减退中的预测临界值。
方法：对189名男性T2DM患者进行横断面研究，没有肝病和酗酒史，在门诊招募。干预是男性评估，代谢参数，TT,和肝脏指数。主要结果指标是比较脂肪变性和纤维化指数与睾酮水平和性腺功能减退的存在。受试者工作特征曲线用于确定预测低睾酮（<12nmol/L）的肝脏指数的截止值。
结果：FLI，HSI,DSI与TT呈负相关，低睾酮组高于正常睾酮组（FLI：74.1[61.4-93.5]vs56.5[32.1-78.2]，P<.001；恒生指数：41.5[39.2-45.9]vs40.1[36.6-43.2]，P=.005；DSI：0.45[-0.08-+1.04]vs-0.07[-1.02-+0.58]，P<.001)。FLI和DSI也与性腺功能减退症的临床症状相关。APRI和FIB-4在组间没有观察到差异。FLI≥63是低TT预测指标的最佳参数(灵敏度73%，特异性64%)。
结论：我们发现T2DM患者的脂肪变性和性腺功能减退的非侵入性指标之间存在关联。这些指标可用于指导患者进行雄激素评估。
目的：评估男性T2DM患者总睾酮（TT）与肝脂肪变性的非侵入性指标（脂肪肝指数[FLI]，肝脏脂肪变性指数[HSI]，达拉斯脂肪变性指数[DSI])和纤维化(AST与血小板比率指数[APRI]，纤维化-4指数[FIB-4]），以及它们在确定性腺机能减退中的预测临界值。
方法：对189名男性T2DM患者进行横断面研究，没有肝病和酗酒史，在门诊招募。干预是男性评估，代谢参数，TT,和肝脏指数。主要结果指标是比较脂肪变性和纤维化指数与睾酮水平和性腺功能减退的存在。受试者工作特征曲线用于确定预测低睾酮（<12nmol/L）的肝脏指数的截止值。
结果：FLI，HSI,DSI与TT呈负相关，低睾酮组高于正常睾酮组（FLI：74.1[61.4-93.5]vs56.5[32.1-78.2]，P<.001；恒生指数：41.5[39.2-45.9]vs40.1[36.6-43.2]，P=.005；DSI：0.45[-0.08-+1.04]vs-0.07[-1.02-+0.58]，P<.001)。FLI和DSI也与性腺功能减退症的临床症状相关。APRI和FIB-4在组间没有观察到差异。FLI≥63是低TT预测指标的最佳参数(灵敏度73%，特异性64%)。
结论：我们发现T2DM患者的脂肪变性和性腺功能减退的非侵入性指标之间存在关联。这些指标可用于指导患者进行雄激素评估。
