Samavat J, Facchiano E, Cantini G, Di Franco A, Alpigiano G, Poli G, Seghieri G, Lucchese M, Forti G, Luconi M
Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy.
Bariatric and Metabolic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Int J Obes (Lond). 2014 Mar;38(3):357-63. doi: 10.1038/ijo.2013.228. Epub 2013 Dec 5.
Bone modulates testis function through osteocalcin (OCN) production. This paper assesses the association between serum OCN and androgen production recovery in morbidly obese males at 9 months after bariatric surgery.
A cohort of n=103 obese males with mean±s.d. body mass index (BMI) 47.7±8.2 kg m(-2), age 42±11 years, consisting of n=76 patients undergoing gastric bypass and n=27 in the waiting list for surgery.
At 9 months from surgery, a significant increase was observed in mean±s.d. total OCN (tOCN=10.4±10.3 ng ml(-1), P<0.001) and undercarboxylated OCN (ucOCN=5.4±3.7 ng ml(-1), P<0.001), total testosterone (TT, 5.6±6.5 nM, P<0.001) and calculated free testosterone (cFT, 0.035±0.133 nM, P<0.006), sex hormone binding globulin (SHBG, 21.2±16.7 nM, P<0.001) and decrease in estradiol (E2, -30.1±51.9 pM, P<0.001) levels only in operated patients, with a significant reduction in BMI (24%) and waist (20%). A positive correlation existed between tOCN and ucOCN (age-adjustment (age-adj.): β=0.692, P<0.001) and their variations (age-adj.: β=0.629, P<0.001) after surgery. Multivariate analysis in operated patients showed a significant positive association between variations in tOCN and TT (age-adj.: β=0.289, P=0.012), SHBG (age-adj.: β=0.326, P=0.005) but not with cFT variation. tOCN, but not luteinizing hormone (LH) variation was the only significant predictive factor of cFT recovery in the hypogonadal (TT<12 nM) operated subjects even after age- and BMI-adjustment (adj.: β=0.582, P<0.05). cFT improvement was significantly higher when considering operated patients with tOCN increase (0.045±0.123 vs -0.02±0.118 nM, P=0.015), hypogonadism (0.059±0.111 vs -0.059±0.138 nM, P=0.002) and younger than 35 years (0.102±0.108 vs -0.019±0.123 nM, P=0.009).
OCN recovery observed after bariatric surgery is significantly associated with cFT improvement independently of BMI variation and age in hypogonadal morbidly obese males.
骨骼通过产生骨钙素（OCN）调节睾丸功能。本文评估了病态肥胖男性在减肥手术后9个月时血清OCN与雄激素生成恢复之间的关联。
一组n = 103名肥胖男性，平均体重指数（BMI）为47.7±8.2 kg·m⁻²，年龄42±11岁，其中n = 76例接受胃旁路手术患者，n = 27例在手术等待名单中。
术后9个月时，仅手术患者的平均±标准差总OCN（tOCN = 10.4±10.3 ng·ml⁻¹，P < 0.001）、未羧化OCN（ucOCN = 5.4±3.7 ng·ml⁻¹，P < 0.001）、总睾酮（TT，5.6±6.5 nM，P < 0.001）、计算游离睾酮（cFT，0.035±0.133 nM，P < 0.006）、性激素结合球蛋白（SHBG，21.2±16.7 nM，P < 0.001）显著升高，雌二醇（E2，-30.1±51.9 pM，P < 0.001）水平降低，BMI显著降低（24%），腰围显著降低（20%）。术后tOCN与ucOCN之间及其变化之间存在正相关（年龄校正（age - adj.）：β = 0.692，P < 0.001）（年龄校正：β = 0.629，P < 0.001）。手术患者的多变量分析显示tOCN变化与TT（年龄校正：β = 0.289，P = 0.012）、SHBG（年龄校正：β = 0.326，P = 0.005）之间存在显著正相关，但与cFT变化无关。即使在年龄和BMI校正后，tOCN而非促黄体生成素（LH）变化是性腺功能减退（TT < 12 nM）手术患者中cFT恢复的唯一显著预测因素（校正：β = 0.582，P < 0.05）。当考虑tOCN升高的手术患者（0.045±0.123对 - 0.02±0.118 nM，P = 0.015）、性腺功能减退患者（0.059±0.111对 - 0.059±0.138 nM，P = 0.002）和年龄小于35岁患者（0.102±0.108对 - 0.019±0.123 nM，P = 0.009）时，cFT改善显著更高。
减肥手术后观察到的OCN恢复与性腺功能减退的病态肥胖男性的cFT改善显著相关，与BMI变化和年龄无关。
