男性 HIV 感染者或高危人群中的性激素、胰岛素抵抗与糖尿病。
Sex hormones, insulin resistance, and diabetes mellitus among men with or at risk for HIV infection.
机构信息
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
J Acquir Immune Defic Syndr. 2011 Oct 1;58(2):173-80. doi: 10.1097/QAI.0b013e3182278c09.
OBJECTIVE
To examine the relationship of free testosterone (FT) and sex hormone-binding globulin (SHBG) with insulin resistance and diabetes mellitus (DM) in HIV disease.
DESIGN
Cross-sectional analysis from 322 HIV-uninfected and 534 HIV-infected men in the Multicenter AIDS Cohort Study.
METHODS
: The main outcomes were DM and homeostasis model assessment-insulin resistance (HOMA-IR). DM was defined as fasting serum glucose ≥126 or self-reported DM and use of DM medications. HOMA-IR was calculated from fasting serum glucose and fasting insulin.
RESULTS
Compared with HIV-uninfected men in our sample, HIV-infected men were younger, with lower body mass index, and more often black. HIV-infected men had lower FT (P < 0.001) and higher SHBG (P < 0.0001). The adjusted odds ratio for DM was 1.98 (95% confidence interval: 1.04 to 3.78); mean adjusted log HOMA-IR was 0.21 units higher in HIV-infected men (P < 0.0001). Log SHBG, but not log FT, was associated with DM (odds ratio = 0.44, 95% confidence interval: 0.25 to 0.80) in both groups. Log FT and log SHBG were inversely related to insulin resistance (P < 0.05 for both) independent of HIV.
CONCLUSIONS
Compared with HIV-uninfected men, HIV-infected men had lower FT, higher SHBG, and more insulin resistance and DM. Lower FT and lower SHBG were associated with insulin resistance regardless of HIV serostatus. This suggests that sex hormones play a role in the pathogenesis of glucose abnormalities among HIV-infected men.
目的
探讨游离睾酮（FT）和性激素结合球蛋白（SHBG）与 HIV 疾病中胰岛素抵抗和糖尿病（DM）的关系。
设计
来自多中心艾滋病队列研究的 322 名未感染 HIV 的男性和 534 名感染 HIV 的男性的横断面分析。
方法
主要结局是 DM 和稳态模型评估-胰岛素抵抗（HOMA-IR）。DM 定义为空腹血清葡萄糖≥126 或自我报告的 DM 和使用 DM 药物。HOMA-IR 由空腹血清葡萄糖和空腹胰岛素计算得出。
结果
与我们样本中的未感染 HIV 的男性相比，感染 HIV 的男性年龄较小，体重指数较低，且黑人居多。感染 HIV 的男性 FT 较低（P <0.001），SHBG 较高（P <0.0001）。DM 的调整后比值比为 1.98（95%置信区间：1.04 至 3.78）；感染 HIV 的男性平均调整后 log HOMA-IR 高 0.21 单位（P <0.0001）。在两组中，log SHBG 与 DM 相关（比值比=0.44，95%置信区间：0.25 至 0.80），但 log FT 与 DM 无关。log FT 和 log SHBG 与胰岛素抵抗呈负相关（均 P <0.05），与 HIV 无关。
结论
与未感染 HIV 的男性相比，感染 HIV 的男性 FT 较低，SHBG 较高，胰岛素抵抗和 DM 较多。无论 HIV 血清状态如何，较低的 FT 和较低的 SHBG 与胰岛素抵抗相关。这表明性激素在 HIV 感染男性中葡萄糖异常的发病机制中发挥作用。
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