Bhatia Vishal, Chaudhuri Ajay, Tomar Rashmi, Dhindsa Sandeep, Ghanim Husam, Dandona Paresh
Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, New York, USA.
Diabetes Care. 2006 Oct;29(10):2289-94. doi: 10.2337/dc06-0637.
After the demonstration that one-third of male patients with type 2 diabetes have hypogonadotrophic hypogonadism, we have shown that patients with hypogonadotrophic hypogonadism also have markedly elevated C-reactive protein (CRP) concentrations. We have now hypothesized that type 2 diabetic subjects with hypogonadotrophic hypogonadism may have a lower hematocrit because testosterone stimulates, whereas chronic inflammation suppresses, erythropoiesis.
Seventy patients with type 2 diabetes at a tertiary referral center were included in this study.
The mean hematocrit in patients with hypogonadotrophic hypogonadism (n = 37), defined as calculated free testosterone (cFT) of <6.5 ng/dl, was 40.6 +/- 1.1%, whereas that in eugonadal patients (n = 33) was 43.3 +/- 0.7% (P = 0.011). The hematocrit was related to cFT concentration (r = 0.46; P < 0.0001); it was inversely related to plasma CRP concentration (r = 0.41; P < 0.0004). Patients with CRP <3 mg/l had a higher hematocrit (42.7 +/- 0.7%) than those with CRP >3 mg/l (39.9 +/- 1.1%; P < 0.05). The prevalence of normocytic normochromic anemia (hemoglobin <13 g/dl) was 23% in the entire group, whereas it was 37.8% in the men with hypogonadotrophic hypogonadism and 3% in the eugonadal men (P < 0.01). Erythropoietin concentration was elevated or high normal in all 11 patients with anemia in whom it was tested.
We conclude that hypogonadotrophic hypogonadism in male type 2 diabetic subjects is associated with a lower hematocrit and a frequent occurrence of mild normocytic normochromic anemia with normal or high erythropoietin concentrations. In these patients, hematocrit is also inversely related to CRP concentration. Thus, low testosterone and chronic inflammatory mechanisms may contribute to mild anemia. Such patients may also have a high risk of atherosclerotic cardiovascular events in view of their markedly elevated CRP concentrations.
在证实三分之一的2型糖尿病男性患者存在低促性腺激素性性腺功能减退后，我们发现低促性腺激素性性腺功能减退患者的C反应蛋白（CRP）浓度也显著升高。我们现在推测，患有低促性腺激素性性腺功能减退的2型糖尿病患者可能血细胞比容较低，因为睾酮刺激红细胞生成，而慢性炎症则抑制红细胞生成。
本研究纳入了一家三级转诊中心的70例2型糖尿病患者。
低促性腺激素性性腺功能减退患者（n = 37，定义为计算游离睾酮（cFT）<6.5 ng/dl）的平均血细胞比容为40.6±1.1%，而性腺功能正常患者（n = 33）的平均血细胞比容为43.3±0.7%（P = 0.011）。血细胞比容与cFT浓度相关（r = 0.46；P < 0.0001）；与血浆CRP浓度呈负相关（r = 0.41；P < 0.0004）。CRP<3 mg/l的患者血细胞比容（42.7±0.7%）高于CRP>3 mg/l的患者（39.9±1.1%；P < 0.05）。整个研究组中正常细胞性正色素性贫血（血红蛋白<13 g/dl）的患病率为23%，而低促性腺激素性性腺功能减退男性中的患病率为37.8%，性腺功能正常男性中的患病率为3%（P < 0.01）。在所有11例接受检测的贫血患者中，促红细胞生成素浓度升高或处于正常高值。
我们得出结论，男性2型糖尿病患者的低促性腺激素性性腺功能减退与较低的血细胞比容以及轻度正常细胞性正色素性贫血的频繁发生相关，且促红细胞生成素浓度正常或升高。在这些患者中，血细胞比容也与CRP浓度呈负相关。因此，低睾酮和慢性炎症机制可能导致轻度贫血。鉴于其CRP浓度显著升高，这类患者发生动脉粥样硬化性心血管事件的风险可能也很高。
