Chen R Y T, Wittert G A, Andrews G R
Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Diabetes Obes Metab. 2006 Jul;8(4):429-35. doi: 10.1111/j.1463-1326.2005.00532.x.
Although androgen deficiency in men has been linked with obesity and the metabolic syndrome, whether it predisposes to, or is a consequence of, type 2 diabetes mellitus (T2DM) is still unclear.
To determine the relationship between plasma androgen levels, obesity, metabolic status and T2DM in men of 70 years or older.
A sample of 195 men from the Australian Longitudinal Study of Ageing with a mean age of 76.2 +/- 0.3 years were followed up for 8 years. Total testosterone (TT), fasting plasma glucose (FPG), urate, serum creatinine, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TG), blood pressure (BP), body mass index (BMI), waist circumference (WC) and diabetic status were assessed at baseline. Self-reported diabetic status was obtained after 8 years. Metabolic syndrome was diagnosed based on the Third National Cholesterol Education Program Adult Treatment Panel clinical criteria.
TT levels were lower in diabetic men compared with non-diabetic men (12.1 +/- 0.7 vs. 14.2 +/- 0.4 nmol/l, p = 0.026). TT levels in healthy, non-diabetic men over 80 years of age were lower (11.9 +/- 0.8 vs. 15.0 +/- 0.5 nmol/l, p = 0.002) than TT levels in those aged 70-79 years, inversely related to BMI (r = -0.26, p = 0.001), WC (r = -0.30, p < 0.001) and TG (r = -0.22, p = 0.005) and positively related to LDL-C (r = 0.25, p = 0.002). Men with the metabolic syndrome had significantly lower levels of TT and HDL-C, and higher values of BP, FPG, TG, BMI and WC, compared with those without. However, no significant difference in plasma TT levels was noted between men with incident T2Dm and healthy men. Stepwise linear regression analysis revealed that only LDL-C and WC related significantly to the variance of TT. Multiple logistic regression revealed FPG to be the only independent predictor of incident diabetes (odds ratio = 60.2, p = 0.003).
Testosterone levels continue to decline even in healthy men over the age of 80 years. Although TT levels were inversely related to visceral obesity and several components of the metabolic syndrome, our data do not support a predictive or causative role for decreasing TT levels in the development of incident T2Dm. Androgen deficiency is consequent upon, rather than a cause of, poor metabolic status.
尽管男性雄激素缺乏与肥胖及代谢综合征有关，但它是2型糖尿病（T2DM）的诱因还是结果仍不清楚。
确定70岁及以上男性血浆雄激素水平、肥胖、代谢状态与T2DM之间的关系。
从澳大利亚老龄化纵向研究中选取195名平均年龄为76.2±0.3岁的男性，随访8年。在基线时评估总睾酮（TT）、空腹血糖（FPG）、尿酸、血清肌酐、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）、血压（BP）、体重指数（BMI）、腰围（WC）和糖尿病状态。8年后获得自我报告的糖尿病状态。根据第三次全国胆固醇教育计划成人治疗小组临床标准诊断代谢综合征。
糖尿病男性的TT水平低于非糖尿病男性（12.1±0.7 vs. 14.2±0.4 nmol/l，p = 0.026）。80岁以上健康非糖尿病男性的TT水平低于70 - 79岁男性（11.9±0.8 vs. 15.0±0.5 nmol/l，p = 0.002），与BMI（r = -0.26，p = 0.001）、WC（r = -0.30，p < 0.001）和TG（r = -0.22，p = 0.005）呈负相关，与LDL-C（r = 0.25，p = 0.002）呈正相关。与无代谢综合征的男性相比，患有代谢综合征的男性TT和HDL-C水平显著降低，BP、FPG、TG、BMI和WC值更高。然而，新发T2Dm男性与健康男性的血浆TT水平无显著差异。逐步线性回归分析显示，仅LDL-C和WC与TT的方差显著相关。多元逻辑回归显示FPG是新发糖尿病的唯一独立预测因子（比值比 = 60.2，p = 0.003）。
即使是80岁以上的健康男性，睾酮水平仍持续下降。尽管TT水平与内脏肥胖及代谢综合征的几个组分呈负相关，但我们的数据不支持TT水平降低在新发T2Dm发生中起预测或因果作用。雄激素缺乏是代谢状态不佳的结果而非原因。
