Onat Altan, Hergenç Gülay, Karabulut Ahmet, Albayrak Sinan, Can Günay, Kaya Zekeriya
Turkish Society of Cardiology, Istanbul University, 34384 Istanbul, Turkey.
Metabolism. 2007 Oct;56(10):1356-62. doi: 10.1016/j.metabol.2007.05.020.
Serum sex hormone-binding globulin (SHBG) is related to cardiometabolic disorders; but whether or not this relationship is purely secondary to hyperinsulinemia and/or obesity, which down-regulates SHBG, is unknown. The aim of the study was to investigate the association of SHBG and total testosterone with atherogenic dyslipidemias, metabolic syndrome (MS), and diabetes among predominantly elderly Turkish adults. After appropriate exclusions, 777 randomly selected male and female subjects with available measurements of both variables were eligible and were analyzed cross-sectionally, with diabetic subjects analyzed separately. Free testosterone was calculated. Metabolic syndrome was identified by the modified criteria of the Adult Treatment Panel III. Metabolic syndrome was identified in half the sample, which had a median age of 58 years. The odds of low SHBG concentrations (<45 nmol/L in men, <55 nmol/L in women) for the likelihood of 2 types of dyslipidemias, MS, and diabetes were examined by regression analyses in standard models including age, smoking status, presence of abdominal obesity, and insulin resistance (homeostasis model assessment of insulin resistance). In both sexes, low SHBG was associated independently with high triglyceride/low high-density lipoprotein dyslipidemia and with MS, at significant 2.2- to 4.5-fold odds ratios, independent of waist circumference or homeostasis model assessment of insulin resistance index. Low SHBG among women was additionally associated with the likelihood of hypertriglyceridemia with elevated apolipoprotein B and-at borderline significance-with that of diabetes, again when adjusted for the same confounders. In an elderly population with prevalent MS, low SHBG levels significantly associate with high triglyceride/low high-density lipoprotein dyslipidemia, MS, and, in women alone, diabetes and a dyslipidemia marking small dense low-density lipoprotein particles, all independent of abdominal obesity and insulin resistance. Low SHBG may be an important independent factor for cardiometabolic risk, particularly in women.
血清性激素结合球蛋白（SHBG）与心脏代谢紊乱有关；但这种关系是否仅仅是由于高胰岛素血症和/或肥胖导致SHBG下调所致尚不清楚。本研究的目的是调查在以老年土耳其成年人为主的人群中，SHBG和总睾酮与致动脉粥样硬化性血脂异常、代谢综合征（MS）和糖尿病之间的关联。经过适当排除后，777名随机选择的、两项变量测量值均可用的男性和女性受试者符合条件，并进行了横断面分析，糖尿病受试者单独分析。计算游离睾酮。采用成人治疗小组III的修订标准确定代谢综合征。在年龄中位数为58岁的一半样本中发现了代谢综合征。通过标准模型中的回归分析，在包括年龄、吸烟状况、腹部肥胖情况和胰岛素抵抗（胰岛素抵抗稳态模型评估）的模型中，检验了低SHBG浓度（男性<45 nmol/L，女性<55 nmol/L）与两种血脂异常、MS和糖尿病发生可能性之间的比值比。在男女两性中，低SHBG均独立与高甘油三酯/低高密度脂蛋白血脂异常和MS相关，比值比显著为2.2至4.5倍，独立于腰围或胰岛素抵抗指数的稳态模型评估。在女性中，低SHBG还与载脂蛋白B升高的高甘油三酯血症发生可能性相关，并且在调整相同混杂因素后，与糖尿病发生可能性呈临界显著性相关。在患有MS的老年人群中，低SHBG水平与高甘油三酯/低高密度脂蛋白血脂异常、MS显著相关，并且仅在女性中与糖尿病以及一种标志着小而密低密度脂蛋白颗粒的血脂异常相关，所有这些均独立于腹部肥胖和胰岛素抵抗。低SHBG可能是心脏代谢风险的一个重要独立因素，尤其是在女性中。
