Houghton L A, Jackson N A, Whorwell P J, Morris J
Department of Medicine, University Hospital of South Manchester, West Didsbury, United Kingdom.
Am J Gastroenterol. 2000 Sep;95(9):2296-300. doi: 10.1111/j.1572-0241.2000.02314.x.
Irritable bowel syndrome (IBS) is more common in women and it is frequently assumed that being female may predispose to the development of this disorder. Alternatively, being male could offer some degree of protection and if so, this might be mediated by testosterone. The aim of this study was to assess whether male patients with IBS have lower levels of testosterone and related gonadotrophins than their unaffected counterparts and if this relates to rectal sensitivity.
Fifty secondary care, male outpatients with IBS (aged 19-71 yr) were compared with 25 controls (aged 22-67 yr). Each subject had serum testosterone, free testosterone, sex hormone-binding globulin, follicle stimulating hormone, and luteinizing hormone (LH) measured, together with rectal sensitivity to balloon distension. Anxiety and depression were also assessed.
The only difference in the hormone levels between patients and controls that reached statistical significance was the lower value for LH in the IBS patients (p = 0.014). Although patients were more anxious and depressed than the controls (p < 0.001), this could not solely account for the reduced level of LH, as adjusting for these (analysis of variance) still tended to show that LH values were lower in men with rather than without IBS [F(1,70) = 2.74; p = 0.10]. Men with IBS were more sensitive to balloon distension of the rectum, with the distension volumes required for "urgency" (p < 0.001) and "discomfort" (p = 0.001) significantly lower than controls. Paradoxically, the patient's sensory thresholds negatively correlated with levels of testosterone (p < 0.05) and free testosterone (p < 0.002), and positively with levels of sex hormone-binding globulin (p < 0.05). Finally, there was a tendency for IBS symptomatology to be inversely related to testosterone levels (p = 0.15).
These results support the need for further exploration of the role of male sex hormones in the pathophysiology of IBS.
肠易激综合征（IBS）在女性中更为常见，人们常常认为女性可能易患这种疾病。相反，男性可能具有一定程度的保护作用，如果是这样，这可能由睾酮介导。本研究的目的是评估患有IBS的男性患者的睾酮及相关促性腺激素水平是否低于未患病的男性，以及这是否与直肠敏感性有关。
将50名二级护理的IBS男性门诊患者（年龄19 - 71岁）与25名对照者（年龄22 - 67岁）进行比较。测量每位受试者的血清睾酮、游离睾酮、性激素结合球蛋白、促卵泡激素和黄体生成素（LH），同时测量直肠对气囊扩张的敏感性。还评估了焦虑和抑郁情况。
患者与对照者之间激素水平达到统计学显著差异的唯一指标是IBS患者的LH值较低（p = 0.014）。尽管患者比对照者更焦虑和抑郁（p < 0.001），但这并不能完全解释LH水平的降低，因为对这些因素进行调整（方差分析）后仍倾向于表明，患有IBS的男性的LH值低于未患病男性[F(1,70) = 2.74；p = 0.10]。患有IBS的男性对直肠气囊扩张更敏感，“急迫感”（p < 0.001）和“不适感”（p = 0.001）所需的扩张体积显著低于对照者。矛盾的是，患者的感觉阈值与睾酮水平（p < 0.05）和游离睾酮水平（p < 0.002）呈负相关，与性激素结合球蛋白水平呈正相关（p < 0.05）。最后，IBS症状学有与睾酮水平呈负相关的趋势（p = 0.15）。
这些结果支持进一步探索雄性激素在IBS病理生理学中的作用。
