School of Medicine and Pharmacology, Level 2, T Block, Fremantle Hospital, Alma Street, P.O. Box 480, Fremantle, Western Australia 6959, Australia.
J Clin Endocrinol Metab. 2010 Mar;95(3):1123-30. doi: 10.1210/jc.2009-1696. Epub 2010 Jan 8.
Abdominal aortic aneurysm (AAA) is associated with mortality in older adults, and increasing aortic diameter predicts incident cardiovascular events. Although AAA occurs predominantly in men, its association with male sex hormones is unclear.
The objective of the study was to examine whether male sex hormones are independently associated with AAA or increased abdominal aortic diameter.
This was a cross-sectional analysis.
Participants included 3620 community-dwelling men aged 70-88 yr.
Abdominal aortic diameter was measured with ultrasound. Early morning sera were assayed for total testosterone, SHBG, and LH. Free testosterone was calculated using mass action equations.
AAA (aortic diameter > or =30 mm) was present in 262 men (7.2%). Men with AAA had lower serum total and free testosterone (mean +/- sd 14.5 +/- 6.0 vs. 15.5 +/- 5.6 nmol/liter, P = 0.005 and 256 +/- 87 vs. 280 +/- 97 pmol/liter, P < 0.001, respectively) compared with men without. LH was higher in men with AAA (median, interquartile range: 4.9, 3.1-7.9 vs. 4.3, 3.0-6.4 IU/liter, P = 0.013). In multivariate analysis adjusting for potential confounders, free testosterone was negatively associated with AAA (odds ratio per 1 sd increase: 0.84, 95% confidence interval 0.72-0.98, P = 0.026). LH was positively associated (odds ratio 1.14, 95% confidence interval 1.03-1.25, P = 0.008). Comparable results were seen with aortic diameter analyzed as a continuous variable.
Lower free testosterone and higher LH levels are independently associated with AAA in older men. Impaired gonadal function may be involved in arterial dilatation as well as occlusive vascular disease in older men. Additional studies are needed to clarify direction of causality and determine possible scope for preventive intervention.
腹主动脉瘤（AAA）与老年人的死亡率相关，且主动脉直径的增加可预测心血管事件的发生。尽管 AAA 主要发生于男性，但男性性激素与 AAA 的关系尚不清楚。
本研究旨在探讨男性性激素是否与 AAA 或腹主动脉直径增加独立相关。
这是一项横断面分析。
研究对象包括 3620 名年龄在 70-88 岁的社区居住男性。
使用超声测量腹主动脉直径。清晨采集血清，检测总睾酮、性激素结合球蛋白（SHBG）和黄体生成素（LH）。采用质量作用方程计算游离睾酮。
262 名男性（7.2%）存在 AAA（主动脉直径≥30 mm）。与无 AAA 的男性相比，AAA 患者的血清总睾酮和游离睾酮水平较低[（均值±标准差）分别为 14.5±6.0 nmol/L 比 15.5±5.6 nmol/L，P=0.005 和 256±87 pmol/L 比 280±97 pmol/L，P<0.001]。AAA 患者的 LH 较高[中位数（四分位间距）：4.9（3.1-7.9）IU/L 比 4.3（3.0-6.4）IU/L，P=0.013]。在校正了潜在混杂因素后，多元分析显示游离睾酮与 AAA 呈负相关（每增加 1 个标准差的比值比：0.84，95%置信区间：0.72-0.98，P=0.026）。LH 与 AAA 呈正相关（比值比 1.14，95%置信区间：1.03-1.25，P=0.008）。以主动脉直径为连续变量进行分析，也得到了类似的结果。
在老年男性中，较低的游离睾酮和较高的 LH 水平与 AAA 独立相关。睾丸功能障碍可能与老年男性的动脉扩张和闭塞性血管疾病均有关。需要进一步研究来阐明因果关系的方向，并确定可能的预防干预范围。
