Kopp Hans-Peter, Krzyzanowska Katharina, Schernthaner Gerit-Holger, Kriwanek Stefan, Schernthaner Guntram
Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria.
Obes Surg. 2006 Sep;16(9):1214-20. doi: 10.1381/096089206778392130.
Morbid obesity is associated with insulin resistance (IR), type 2 diabetes, lipid abnormalities, and hypertension. The association of obesity with increased androgen production and low concentrations of sex hormone-binding globulin (SHBG) in women has been demonstrated as well as a strong association of androgens with markers of inflammation such as high-sensitive C-reactive protein (hsCRP). Because weight loss results in a significant decrease in cardiovascular risk factors, IR and inflammation, we questioned a possible interrelationship between androgens, IR and inflammation in a prospective study with 43 morbidly obese female patients undergoing bariatric surgery.
SHBG, dehydroepiandrosterone-sulfate (DHEA-S), and insulin were measured by ELISA, cortisol by fluorescence polarization immunoassay, androstendione by RIA, and testosterone by electrochemiluminescence immunoassay. The free androgen index (FAI) was calculated as the total testosterone/SHBG ratio. High sensitivity assays were used to obtain concentrations of fasting hsCRP, Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha).
Weight loss resulted in a significant increase in SHBG (17+/-12 vs 70+/-30 nmol/l, P<0.0001). Serum concentrations of androstendione, total testosterone, DHEA-S and the FAI decreased significantly (2.05+/-0.78 vs 1.40+/-0.54 ng/ml, P<0.0001; 1.88+/-0.84 vs 1.16+/-0.57 nmol/L, P<0.0001; 1.72+/-0.86 vs 1.49+/-0.78 microg/ml, P<0.01; 0.15+/-0.10 vs 0.02+/-0.01, P<0.0001; respectively). Preoperatively and postoperatively, no association between androgens and IR, chronic subclinical inflammation and lipid parameters could be observed.
Massive weight loss induced by bariatric surgery is associated with a significant reduction of androgen concentrations but not related to the concomitant decline of chronic inflammation, IR, glucose and lipid abnormalities in premenopausal morbidly obese women.
病态肥胖与胰岛素抵抗（IR）、2型糖尿病、脂质异常和高血压相关。肥胖与女性雄激素生成增加及性激素结合球蛋白（SHBG）浓度降低之间的关联已得到证实，并且雄激素与炎症标志物如高敏C反应蛋白（hsCRP）之间也存在密切关联。由于体重减轻会导致心血管危险因素、IR和炎症显著降低，因此我们在一项对43例接受减肥手术的病态肥胖女性患者进行的前瞻性研究中，探讨了雄激素、IR和炎症之间可能存在的相互关系。
采用酶联免疫吸附测定法（ELISA）检测SHBG、硫酸脱氢表雄酮（DHEA-S）和胰岛素，采用荧光偏振免疫测定法检测皮质醇，采用放射免疫分析法检测雄烯二酮，采用电化学发光免疫测定法检测睾酮。游离雄激素指数（FAI）计算为总睾酮/SHBG比值。采用高灵敏度测定法获得空腹hsCRP、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的浓度。
体重减轻导致SHBG显著升高（17±12 vs 70±30 nmol/l，P<0.0001）。血清雄烯二酮、总睾酮、DHEA-S和FAI显著降低（分别为2.05±0.78 vs 1.40±0.54 ng/ml，P<0.0001；1.88±0.84 vs 1.16±0.57 nmol/L，P<0.0001；1.72±0.86 vs 1.49±0.78 μg/ml，P<0.01；0.15±0.10 vs 0.02±0.01，P<0.0001）。术前和术后，未观察到雄激素与IR、慢性亚临床炎症和脂质参数之间存在关联。
减肥手术导致的大量体重减轻与雄激素浓度显著降低相关，但与绝经前病态肥胖女性慢性炎症、IR、血糖和脂质异常的同时下降无关。
