减肥手术后骨钙素增加预示性腺功能减退肥胖男性雄激素恢复。
Osteocalcin increase after bariatric surgery predicts androgen recovery in hypogonadal obese males.
作者信息
Samavat J, Facchiano E, Cantini G, Di Franco A, Alpigiano G, Poli G, Seghieri G, Lucchese M, Forti G, Luconi M
机构信息
Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy.
Bariatric and Metabolic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
出版信息
Int J Obes (Lond). 2014 Mar;38(3):357-63. doi: 10.1038/ijo.2013.228. Epub 2013 Dec 5.
OBJECTIVE
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.
SUBJECTS
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.
RESULTS
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).
CONCLUSION
OCN recovery observed after bariatric surgery is significantly associated with cFT improvement independently of BMI variation and age in hypogonadal morbidly obese males.
目的
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。
对象
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。
结果
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。
结论
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。
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