Oktenli C, Yesilova Z, Ozata M, Yaman H, Tuzun A, Dundar S, Sanisoglu S Y, Musabak U, Erbil M K, Dagalp K
Department of Internal Medicine, Gülhane Military Medical Academy, TR-06018 Etlik-Ankara, Turkey.
J Endocrinol. 2003 Oct;179(1):35-9. doi: 10.1677/joe.0.1790035.
The main objective of the present study was to examine the alterations in plasma total homocysteine (tHcy) concentrations during a testosterone-deficient state and after gonadotropin treatment for 6 Months in patients with idiopathic hypogonadotropic hypogonadism (IHH). Thirty-five newly diagnosed male patients with IHH (mean age 21.34+/-1.53 years) and 29 age- and body mass index-matched healthy males (mean age 21.52+/-1.77 years) were recruited into the study. Pretreatment levels of free testosterone (1.51+/-0.66 pg/ml), estradiol (21.37+/- 4.37 pg/ml), FSH (0.91+/-0.24 IU/l) and LH (1.25+/- 0.53 IU/l) were lower than controls (25.17+/-3.06 pg/ml, 31.00+/-4.96 pg/ml, 3.14+/-1.62 IU/l and 4.83+/-1.65 IU/l respectively) (P<0.001). They increased significantly after treatment (18.18+/-1.59 pg/ml, 27.97+/- 4.25 pg/ml, 2.41+/-0.27 IU/l and 2.79+/-0.19 IU/l respectively) (P<0.001). Patients with IHH had lower tHcy levels than controls (10.14+/-1.34 and 12.58+/- 2.29 micro mol/l respectively) (P<0.001). Plasma tHcy concentrations increased significantly (12.63+/-1.44 micromol/l) after 6 months of treatment (P<0.001). As compared with the controls, pretreatment levels of serum creatinine (63.54+/-13.01 vs 82.84+/-16.69 micromol/l), hemoglobin (12.98+/-0.56 vs 13.83+/-0.71 g/dl) and hematocrit (39.29+/-2.01 vs 41.38+/-1.95%) were significantly lower (P<0.001), and they increased significantly following treatment (80.24+/-11.93 micromol/l, 13.75+/-0.49 g/dl and 41.26+/-1.78% respectively) (P<0.001). The pretreatment folic acid and vitamin B(12) levels were significantly higher in patients when compared with controls (14.87+/-5.68 vs 12.52+/-4.98 nmol/l, P=0.034 and 289.75+/-92.34 vs 237.59+/-108.17 pmol/l, P=0.002 respectively). They decreased significantly after treatment (11.29+/-3.31 nmol/l and 228.51+/-54.33 pmol/l respectively) (P<0.001). The univariate and multivariate regression analysis results showed that only changes in creatinine, creatinine clearance, vitamin B12 and folic acid were independently associated with changes in tHcy levels in patients with IHH. In conclusion, the increase in plasma tHcy concentrations following gonadotropin treatment seems to be largely independent of changes in androgen levels.
本研究的主要目的是检测特发性低促性腺激素性性腺功能减退（IHH）患者在睾酮缺乏状态下以及促性腺激素治疗6个月后的血浆总同型半胱氨酸（tHcy）浓度变化。35例新诊断的男性IHH患者（平均年龄21.34±1.53岁）和29例年龄及体重指数匹配的健康男性（平均年龄21.52±1.77岁）被纳入研究。IHH患者治疗前的游离睾酮（1.51±0.66 pg/ml）、雌二醇（21.37±4.37 pg/ml）、促卵泡生成素（FSH）（0.91±0.24 IU/l）和促黄体生成素（LH）（1.25±0.53 IU/l）水平低于对照组（分别为25.17±3.06 pg/ml、31.00±4.96 pg/ml、3.14±1.62 IU/l和4.83±1.65 IU/l）（P<0.001）。治疗后这些指标显著升高（分别为18.18±1.59 pg/ml、27.97±4.25 pg/ml、2.41±0.27 IU/l和2.79±0.19 IU/l）（P<0.001）。IHH患者的tHcy水平低于对照组（分别为10.14±1.34和12.58±2.29 μmol/l）（P<0.001）。治疗6个月后血浆tHcy浓度显著升高（12.63±1.44 μmol/l）（P<0.001）。与对照组相比，IHH患者治疗前的血清肌酐（63.54±13.01 vs 82.84±16.69 μmol/l）、血红蛋白（12.98±0.56 vs 13.83±0.71 g/dl）和血细胞比容（39.29±2.01 vs 41.38±1.95%）水平显著更低（P<0.001），治疗后显著升高（分别为80.24±11.93 μmol/l、13.75±0.49 g/dl和41.26±1.78%）（P<0.001）。与对照组相比，IHH患者治疗前的叶酸和维生素B12水平显著更高（分别为14.87±5.68 vs 12.52±4.98 nmol/l，P = 0.034；289.75±92.34 vs 237.59±108.17 pmol/l，P = 0.002）。治疗后显著降低（分别为11.29±3.31 nmol/l和228.51±54.33 pmol/l）（P<0.001）。单因素和多因素回归分析结果显示，在IHH患者中，只有肌酐、肌酐清除率、维生素B12和叶酸的变化与tHcy水平的变化独立相关。总之，促性腺激素治疗后血浆tHcy浓度的升高似乎在很大程度上与雄激素水平的变化无关。
