Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Steroids. 2010 Nov;75(11):772-8. doi: 10.1016/j.steroids.2010.01.011. Epub 2010 Jan 25.
Male sex is a risk factor for development and progression of diabetic nephropathy; however, the relationship between sex hormone levels and diabetic nephropathy in type 1 diabetic men is unknown. This was a prospective follow-up study as part of the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study; 297 patients were followed for 5.9+/-1.5 years. Serum total testosterone (Tt) and estradiol (Te), calculated free testosterone (cFt) and estradiol (cFe) and sex hormone binding globulin were measured at baseline and correlated with urinary albumin excretion rate, estimated glomerular filtration rate and markers of metabolic syndrome. Diabetes without renal disease was associated with decreased Tt (p<0.001), Te (p<0.001) and cFt (p=0.001) levels compared with healthy non-diabetic men. With progression of renal disease from micro- to macroalbuminuria, this decrease in serum Tt was even more pronounced. Cox regression showed that cFt and cFe were independent predictors of the progression from macroalbuminuria to end-stage renal disease. Our study shows that men with type 1 diabetes exhibit dysregulated sex hormone levels, which is most pronounced in men with progressive renal disease, suggesting that sex hormones may play a role in the pathogenesis of diabetic nephropathy associated with type 1 diabetes.
男性性别是糖尿病肾病发生和进展的一个危险因素；然而，1 型糖尿病男性的性激素水平与糖尿病肾病之间的关系尚不清楚。这是一项作为全国性芬兰糖尿病肾病（FinnDiane）研究的一部分的前瞻性随访研究；297 名患者随访了 5.9+/-1.5 年。在基线时测量了血清总睾酮（Tt）和雌二醇（Te）、计算的游离睾酮（cFt）和雌二醇（cFe）以及性激素结合球蛋白，并与尿白蛋白排泄率、估计肾小球滤过率和代谢综合征标志物相关联。与健康非糖尿病男性相比，无肾脏疾病的糖尿病与 Tt（p<0.001）、Te（p<0.001）和 cFt（p=0.001）水平降低有关。随着肾脏疾病从微量白蛋白尿进展到大量白蛋白尿，血清 Tt 的下降更为明显。Cox 回归显示 cFt 和 cFe 是从大量白蛋白尿进展到终末期肾病的独立预测因子。我们的研究表明，1 型糖尿病男性存在性激素水平失调，在进展性肾病男性中更为明显，这表明性激素可能在与 1 型糖尿病相关的糖尿病肾病发病机制中发挥作用。
