背景:在患有终末期肾病的男性中,生化性腺功能减退症是一个常见的发现。睾酮和性激素结合球蛋白(SHBG)与胰岛素抵抗有关,尿毒症的一种众所周知的疾病。本研究的目的是探讨男性慢性血液透析患者血清睾酮和SHBG水平与胰岛素抵抗的关系。
方法:在一项横断面研究中,我们招募了接受慢性血液透析治疗的男性,他们没有急性疾病或其他内分泌疾病,以及原发性性腺机能减退,也没有住院。糖尿病,糖尿病肾病或既往移植并不是排除标准.作为对照,我们使用了一组年龄和体重指数(BMI)相匹配的健康男性。我们从体重和身高评估BMI(kg/m2),通过生物电阻抗和血清睾酮(ng/ml),用标准办法测定SHBG(nmol/L)和雌二醇(pg/ml)。睾酮<3.25ng/ml定义的生化性腺功能减退症。在非糖尿病男性中,我们计算了稳态模型评估指数(HOMA-R),对胰岛素抵抗的估计,从血清空腹胰岛素和葡萄糖。
结果:纳入了27名接受慢性血液透析(治疗时间29.1±14.4个月)的男性(年龄54.4±19岁)和51名健康男性(年龄47.1±9.6岁)。在血液透析与男性健康男性血清SHBG水平升高(40.9±26.9vs.27.6±11.9nmol/L;p=0.031),生化性腺机能减退的频率显着提高(22.2vs.3.9%;p=0.011)。在没有糖尿病的情况下(n=22),一方面在HOMA-R(r=-0.586,p=0.004)与空腹胰岛素水平(r=-0.650,p=0.001)之间观察到显着相关性。另一方面,血清SHBG水平。
结论:我们的发现证实了慢性血液透析男性中生化性腺功能减退症的患病率增加。在非糖尿病病例中,血清SHBG水平与血清胰岛素和胰岛素抵抗相关。
BACKGROUND: In males with end stage renal disease biochemical hypogonadism is a frequent finding. Testosterone and sex hormone binding globulin (SHBG) have been associated with insulin resistance, a well-known condition in
uremia. The aim of the present study was to investigate in males on chronic hemodialysis the relationship of testosterone and SHBG serum levels with insulin resistance.
METHODS: In a cross-sectional study we enrolled men treated with chronic hemodialysis who did not suffer from an acute illness or other endocrinopathy, as well as primary hypogonadism, and were not hospitalised. Diabetes mellitus, diabetic nephropathy or previous transplantation were not exclusion criteria. As controls we used a community-based group of healthy males matched for age and Body Mass Index (BMI). We assessed the BMI (kg/m2) from body weight and height, the body fat content (%) by bioelectrical impedance and serum testosterone (ng/ml), SHBG (nmol/L) and estradiol (pg/ml) by standard methods. Testosterone < 3.25 ng/ml defined biochemical hypogonadism. In non-diabetic males, we calculated the homeostasis model assessment index (HOMA-R), an estimate of insulin resistance, from serum fasting insulin and glucose.
RESULTS: 27 men (age 54.4 ± 19 years) on chronic hemodialysis (treatment duration 29.1 ± 14.4 months) and 51 healthy men (age 47.1 ± 9.6 years) were included. In men on hemodialysis vs. healthy men there were increased serum levels of SHBG (40.9 ± 26.9 vs. 27.6 ± 11.9 nmol/L; p = 0.031) and a significantly enhanced frequency of biochemical hypogonadism (22.2 vs. 3.9%; p = 0.011). In cases without diabetes (n = 22) a significant correlation was observed between the HOMA-R (r = -0.586, p = 0.004) and the fasting insulin levels (r = -0.650, p = 0.001) on the one hand and the serum SHBG levels on the other.
CONCLUSIONS: Our findings confirm enhanced prevalence of biochemical hypogonadism in males on chronic hemodialysis. In non-diabetic cases the serum levels of SHBG correlated with serum insulin and insulin resistance.