鞘内阿片类药物治疗患者的性腺功能减退症评估中诊断标准的流行率和影响。

Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients.

机构信息

Birmingham City University, Birmingham, UK.

出版信息

Pain Physician. 2013 Jan;16(1):9-14.

Abstract

BACKGROUND

Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI).

OBJECTIVES

The aim of this study was to investigate the prevalence of hypogonadism in male chronic non-cancer pain patients undertaking long-term intrathecal opioid therapy and the existence of diagnostic discrepancies according to the criteria used.

STUDY DESIGN

Prospective observational study.

SETTING

Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom.

METHODS

Twenty consecutive male patients undertaking long-term intrathecal opioid therapy had the gonadal axis evaluated by assays of luteinising hormone (LH), follicle stimulating hormone (FSH), TT, SHBG and by calculating the FT, BT and FAI.

RESULTS

Hypogonadism was present in 17 (85%) of the patients based on TT; 17 (85%) according to FT and BT calculations; and 14 (70%) when calculating FAI. Based on either TT or FT being low or borderline/low, 19 (95%) of the investigated patients were biochemically hypogonadal. Significant differences were observed between diagnosis based on FT and FAI (P < 0.05). No significant differences were observed between diagnosis based on TT and FT (P = 0.40) or TT and FAI (P = 0.20).

CONCLUSION

Hypogonadism is common in patients undertaking intrathecal opioid therapy for the management of chronic non-malignant pain; however, diagnostic criteria can influence the diagnosis of this side effect. The assessment of the hypothalamic-pituitary-gonadal axis should include evaluation of total serum testosterone, free testosterone, or bioavailable testosterone.

摘要

背景

性腺功能减退症通常仅根据总睾酮（TT）水平来诊断。然而，99%的睾酮与性激素结合球蛋白（SHBG）结合，只有 1%的游离睾酮。替代评估方法包括通过平衡透析测定游离睾酮（FT）或生物可利用睾酮（BT），通过 Vermeulen 方程计算 FT 和 BT，以及计算游离雄激素指数（FAI）。

目的

本研究旨在调查接受长期鞘内阿片类药物治疗的男性慢性非癌性疼痛患者中性腺功能减退症的患病率，并根据使用的标准探讨诊断差异。

研究设计

前瞻性观察性研究。

地点

英国达德利拉塞尔大厅医院疼痛管理科。

方法

连续 20 例接受长期鞘内阿片类药物治疗的男性患者通过黄体生成素（LH）、卵泡刺激素（FSH）、TT、SHBG 的测定以及 FT、BT 和 FAI 的计算来评估性腺轴。

结果

根据 TT，17 例（85%）患者存在性腺功能减退症；根据 FT 和 BT 计算，17 例（85%）患者存在性腺功能减退症；计算 FAI 时，14 例（70%）患者存在性腺功能减退症。根据 TT 或 FT 降低或处于低边缘/低水平，19 例（95%）接受调查的患者存在生化性腺功能减退症。基于 FT 和 FAI 的诊断存在显著差异（P<0.05）。基于 TT 和 FT（P=0.40）或 TT 和 FAI（P=0.20）的诊断没有显著差异。