Caminiti Giuseppe, Volterrani Maurizio, Iellamo Ferdinando, Marazzi Giuseppe, Massaro Rosalba, Miceli Marco, Mammi Caterina, Piepoli Massimo, Fini Massimo, Rosano Giuseppe M C
Centre for Clinical and Basic Research, Cardiovascular Research Unit, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.
J Am Coll Cardiol. 2009 Sep 1;54(10):919-27. doi: 10.1016/j.jacc.2009.04.078.
This study investigated the effect of a 12-week long-acting testosterone administration on maximal exercise capacity, ventilatory efficiency, muscle strength, insulin resistance, and baroreflex sensitivity (BRS) in elderly patients with chronic heart failure (CHF).
CHF is characterized by a metabolic shift favoring catabolism and impairment in skeletal muscle bulk and function that could be involved in the pathophysiology of heart failure.
Seventy elderly patients with stable CHF-median age 70 years, ejection fraction 31.8 +/- 7%-were randomly assigned to receive testosterone (n = 35, intramuscular injection every 6 weeks) or placebo (n = 35), both on top of optimal medical therapy. At baseline and at the end of the study, all patients underwent echocardiogram, cardiopulmonary exercise test, 6-min walk test (6MWT), quadriceps maximal voluntary contraction (MVC), and isokinetic strength (peak torque) and BRS assessment (sequences technique).
Baseline peak oxygen consumption (VO(2)) and quadriceps isometric strength showed a direct relation with serum testosterone concentration. Peak VO(2) significantly improved in testosterone but was unchanged in placebo. Insulin sensitivity was significantly improved in testosterone. The MVC and peak torque significantly increased in testosterone but not in placebo. The BRS significantly improved in testosterone but not in placebo. Increase in testosterone levels was significantly related to improvement in peak VO(2) and MVC. There were no significant changes in left ventricular function either in testosterone or placebo.
These results suggest that long-acting testosterone therapy improves exercise capacity, muscle strength, glucose metabolism, and BRS in men with moderately severe CHF. Testosterone benefits seem to be mediated by metabolic and peripheral effects.
本研究调查了为期12周的长效睾酮给药对老年慢性心力衰竭（CHF）患者最大运动能力、通气效率、肌肉力量、胰岛素抵抗和压力反射敏感性（BRS）的影响。
CHF的特征是代谢向分解代谢转变，以及骨骼肌体积和功能受损，这可能参与心力衰竭的病理生理过程。
70例年龄中位数为70岁、射血分数为31.8±7%的老年稳定CHF患者被随机分配接受睾酮（n = 35，每6周肌肉注射一次）或安慰剂（n = 35），两者均在最佳药物治疗基础上使用。在基线和研究结束时，所有患者均接受了超声心动图、心肺运动试验、6分钟步行试验（6MWT）、股四头肌最大自主收缩（MVC）、等速肌力（峰值扭矩）和BRS评估（序列技术）。
基线峰值耗氧量（VO₂）和股四头肌等长力量与血清睾酮浓度呈直接关系。睾酮组的峰值VO₂显著改善，而安慰剂组无变化。睾酮组的胰岛素敏感性显著改善。睾酮组的MVC和峰值扭矩显著增加，而安慰剂组未增加。睾酮组的BRS显著改善，而安慰剂组未改善。睾酮水平的升高与峰值VO₂和MVC的改善显著相关。睾酮组和安慰剂组的左心室功能均无显著变化。
这些结果表明，长效睾酮治疗可改善中度严重CHF男性的运动能力、肌肉力量、葡萄糖代谢和BRS。睾酮的益处似乎是由代谢和外周效应介导的。
