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睾酮:健康与疾病中的代谢激素。

Testosterone: a metabolic hormone in health and disease.

机构信息

Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield S10 2RX, UK.

出版信息

J Endocrinol. 2013 Apr 29;217(3):R25-45. doi: 10.1530/JOE-12-0455. Print 2013 Jun.

Abstract

Testosterone is a hormone that plays a key role in carbohydrate, fat and protein metabolism. It has been known for some time that testosterone has a major influence on body fat composition and muscle mass in the male. Testosterone deficiency is associated with an increased fat mass (in particular central adiposity), reduced insulin sensitivity, impaired glucose tolerance, elevated triglycerides and cholesterol and low HDL-cholesterol. All these factors are found in the metabolic syndrome (MetS) and type 2 diabetes, contributing to cardiovascular risk. Clinical trials demonstrate that testosterone replacement therapy improves the insulin resistance found in these conditions as well as glycaemic control and also reduces body fat mass, in particular truncal adiposity, cholesterol and triglycerides. The mechanisms by which testosterone acts on pathways to control metabolism are not fully clear. There is, however, an increasing body of evidence from animal, cell and clinical studies that testosterone at the molecular level controls the expression of important regulatory proteins involved in glycolysis, glycogen synthesis and lipid and cholesterol metabolism. The effects of testosterone differ in the major tissues involved in insulin action, which include liver, muscle and fat, suggesting a complex regulatory influence on metabolism. The cumulative effects of testosterone on these biochemical pathways would account for the overall benefit on insulin sensitivity observed in clinical trials. This review discusses the current knowledge of the metabolic actions of testosterone and how testosterone deficiency contributes to the clinical disease states of obesity, MetS and type 2 diabetes and the role of testosterone replacement.

摘要

睾酮是一种在碳水化合物、脂肪和蛋白质代谢中起关键作用的激素。有一段时间以来,人们已经知道,睾酮对男性的体脂成分和肌肉量有重大影响。睾酮缺乏与脂肪量增加(特别是中央肥胖)、胰岛素敏感性降低、葡萄糖耐量受损、甘油三酯和胆固醇升高以及高密度脂蛋白胆固醇降低有关。所有这些因素都存在于代谢综合征(MetS)和 2 型糖尿病中,导致心血管风险增加。临床试验表明,睾酮替代疗法可改善这些情况下的胰岛素抵抗以及血糖控制,并减少体脂肪量,特别是躯干脂肪,还可降低胆固醇和甘油三酯。睾酮作用于控制代谢途径的机制尚不完全清楚。然而,越来越多的动物、细胞和临床研究证据表明,睾酮在分子水平上控制着参与糖酵解、糖原合成以及脂质和胆固醇代谢的重要调节蛋白的表达。睾酮在涉及胰岛素作用的主要组织中的作用不同,包括肝脏、肌肉和脂肪,这表明它对代谢有复杂的调节影响。睾酮对这些生化途径的累积影响可以解释临床试验中观察到的胰岛素敏感性整体获益。本文综述了睾酮的代谢作用的现有知识,以及睾酮缺乏如何导致肥胖、MetS 和 2 型糖尿病的临床疾病状态,并讨论了睾酮替代的作用。

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