Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
Hepatology. 2012 Mar;55(3):759-68. doi: 10.1002/hep.24618. Epub 2011 Dec 14.
Males have strikingly increased risk of advanced liver disease. However, the association between testosterone and risk of hepatitis C virus (HCV)-related advanced liver disease is unknown. We performed a cross-sectional study in male veterans with chronic HCV. Blood samples were obtained to measure total serum testosterone and perform the FibroSURE-ActiTest. Other risk-factor data were obtained through systematic questionnaires (e.g., alcohol), physical measurements (e.g., body mass index), and serological tests (e.g., viral load). The association between total testosterone and risk of advanced hepatic fibrosis (F3 and F3/F4) and inflammatory activity (A3 and A2/3) measured by the FibroSURE-ActiTest was evaluated with logistic regression. A total of 308 eligible study participants were prospectively recruited (mean age: 57; 52% African-American). There were 105 cases with advanced fibrosis and 203 mild fibrosis controls as well as 88 cases with advanced inflammatory activity and 220 mild activity controls. Mean total serum testosterone was significantly higher in advanced fibrosis cases as well as advanced inflammatory activity cases, compared to mild disease controls (6.0 versus 5.3 ng/mL and 5.9 versus 5.4 ng/mL, respectively). We observed a significant 25% increase in advanced fibrosis risk and 15% increase in advanced inflammatory activity risk for each 1-ng/mL increase in total serum testosterone. Total testosterone in the upper tertile was associated with an even greater excess risk of advanced fibrosis than advanced inflammatory activity (odds ratio [OR](adjusted advanced fibrosis) = 3.74; 95% CI: 1.86-6.54 versus OR(adjusted advanced inflammatory activity) = 2.23; 95% CI: 1.07-4.93, respectively).
Total serum testosterone is associated with an increased risk of both advanced hepatic fibrosis and advanced hepatic inflammatory activity in HCV-infected men. Testosterone may be important in the pathogenesis of HCV-related advanced liver disease in males.
男性患晚期肝病的风险显著增加。然而，睾酮与丙型肝炎病毒（HCV）相关的晚期肝病的风险之间的关联尚不清楚。我们对患有慢性 HCV 的男性退伍军人进行了一项横断面研究。采集血样以测量总血清睾酮并进行 FibroSURE-ActiTest。通过系统问卷（例如，酒精）、身体测量（例如，体重指数）和血清学测试（例如，病毒载量）获得其他危险因素数据。使用逻辑回归评估 FibroSURE-ActiTest 测量的总睾酮与晚期肝纤维化（F3 和 F3/F4）和炎症活动（A3 和 A2/3）的风险之间的关联。共前瞻性招募了 308 名符合条件的研究参与者（平均年龄：57 岁；52%为非裔美国人）。有 105 例晚期纤维化病例和 203 例轻度纤维化对照病例，以及 88 例晚期炎症活动病例和 220 例轻度炎症活动对照病例。与轻度疾病对照组相比，晚期纤维化病例和晚期炎症活动病例的总血清睾酮明显更高（分别为 6.0 与 5.3ng/mL 和 5.9 与 5.4ng/mL）。我们观察到总血清睾酮每增加 1ng/mL，晚期纤维化风险增加 25%，晚期炎症活动风险增加 15%。总睾酮在上三分位时与晚期纤维化的额外风险甚至大于晚期炎症活动的风险（调整后的晚期纤维化比值比[OR]（调整后的晚期纤维化）=3.74；95%CI：1.86-6.54 与 OR（调整后的晚期炎症活动）=2.23；95%CI：1.07-4.93）。
总血清睾酮与 HCV 感染男性的晚期肝纤维化和晚期肝炎症活动风险增加相关。睾酮可能在男性 HCV 相关晚期肝病的发病机制中起重要作用。
