Blijdorp Karin, van Dorp Wendy, Laven Joop S E, Pieters Rob, de Jong Frank H, Pluijm Saskia M F, van der Lely Aart Jan, van den Heuvel-Eibrink Marry M, Neggers Sebastian J C M M
Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Medicine - Section Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Obesity (Silver Spring). 2014 Aug;22(8):1896-903. doi: 10.1002/oby.20766. Epub 2014 Apr 22.
Although obesity is associated with gonadal dysfunction in the general population, gonadotoxic treatment might diminish the impact of obesity in childhood cancer survivors (CCS). The aim was to evaluate whether altered body composition is associated with gonadal dysfunction in male CCS, independent of gonadotoxic cancer treatment.
Three hundred fifty-one male CCS were included. Median age at diagnosis was 5.9 years (0-17.8) and median age at follow-up 25.6 years (18.0-45.8). Total and non-SHBG-bound testosterone, sex hormone-binding globulin, inhibin B, and follicle-stimulating hormone (FSH) were studied. Potential determinants were BMI, waist circumference, waist-hip ratio, and body composition measures (dual energy X-ray absorptiometry).
Non-SHBG-bound testosterone was significantly decreased in survivors with BMI ≥ 30 kg/m(2) (adjusted mean 9.1 nmol/L vs. 10.2 nmol/L, P = 0.015), high fat percentage (10.0 vs. 11.2, P = 0.004), and high waist circumference (>102 cm) (9.0 vs. 11.0, P = 0.020). Survivors with high fat percentage (≥25%) had significantly lower inhibin B/FSH ratios (inhibin B/FSH ratio: β -34%, P = 0.041).
Obesity is associated with gonadal dysfunction in male CCS, independent of the irreversible effect of previous cancer treatment. Randomized controlled trials are required to evaluate whether weight normalization could improve gonadal function, especially in obese survivors with potential other mechanisms than lifestyle causing their obesity.
虽然在普通人群中肥胖与性腺功能障碍有关，但性腺毒性治疗可能会减弱肥胖对儿童癌症幸存者（CCS）的影响。本研究旨在评估身体成分改变是否与男性CCS的性腺功能障碍有关，而不受性腺毒性癌症治疗的影响。
纳入351例男性CCS。诊断时的中位年龄为5.9岁（0 - 17.8岁），随访时的中位年龄为25.6岁（18.0 - 45.8岁）。研究了总睾酮、非性激素结合球蛋白（SHBG）结合睾酮、性激素结合球蛋白、抑制素B和促卵泡生成素（FSH）。潜在的决定因素包括体重指数（BMI）、腰围、腰臀比和身体成分测量指标（双能X线吸收法）。
BMI≥30 kg/m²的幸存者中非SHBG结合睾酮显著降低（校正后均值为9.1 nmol/L，而对照组为10.2 nmol/L，P = （0.015），脂肪百分比高者（10.0对11.2，P = 0.004）以及腰围高者（>102 cm）（9.0对11.0，P = 0.020）。脂肪百分比高（≥25%）的幸存者抑制素B/FSH比值显著降低（抑制素B/FSH比值：β - 34%，P = 0.041）。
肥胖与男性CCS的性腺功能障碍有关，与既往癌症治疗的不可逆影响无关。需要进行随机对照试验来评估体重正常化是否能改善性腺功能，特别是对于那些肥胖原因可能不是生活方式而是其他潜在机制的肥胖幸存者。
