Barbonetti A, Vassallo M R C, Pacca F, Cavallo F, Costanzo M, Felzani G, Francavilla S, Francavilla F
Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy; San Raffaele Sulmona Institute, Sulmona, Italy.
Andrology. 2014 Sep;2(5):721-8. doi: 10.1111/j.2047-2927.2014.00235.x. Epub 2014 Jun 13.
Although high rates of serum testosterone deficiency have been reported in men with spinal cord injury (SCI), its determinants and attributes are not yet established. The aim of this study was to recognize, among putative determinants and attributes of androgen deficiency, those significantly associated to low testosterone after adjustment for confounders recognizable in men with chronic SCI. A biochemical androgen deficiency (total testosterone <300 ng/dL) was exhibited by 18 of 51 patients (35.3%). Significant correlates of testosterone levels were as follows: weekly leisure time physical activity (LTPA) explored by the LTPA Questionnaire for people with SCI, body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides and sexual symptoms, explored by the aging males' symptom (AMS) questionnaire. At the multiple linear regression analysis, among putative determinants of low testosterone, only weekly LTPA and BMI exhibited a significant association with testosterone levels, explaining 54.2 and 9.0% of testosterone variability respectively. At the linear regression models, among various putative attributes of androgen deficiency, only lower sexual desire and, at a lesser extent, higher HOMA-IR, exhibited significant associations with lower testosterone levels, after adjustment for BMI, age, comorbidities and weekly LTPA. In conclusion, poor LTPA, high BMI and low sexual desire are independent predictors of low testosterone in men with chronic SCI. This is relevant to clinical practice, as all these features are routinely assessed in rehabilitation settings for SCI. As poor LTPA and high BMI are modifiable life-style related risk factors, prospective studies could clarify whether life-style modification could increase the level of testosterone and improve the low sexual desire, relevant clinical attribute of low testosterone in men with SCI.
尽管已有报道称脊髓损伤（SCI）男性血清睾酮缺乏率较高，但其决定因素和特征尚未明确。本研究的目的是在雄激素缺乏的假定决定因素和特征中，识别出在对慢性SCI男性中可识别的混杂因素进行调整后，与低睾酮显著相关的因素。51例患者中有18例（35.3%）表现出生化性雄激素缺乏（总睾酮<300 ng/dL）。睾酮水平的显著相关因素如下：通过脊髓损伤患者LTPA问卷探索的每周休闲时间体力活动（LTPA）、体重指数（BMI）、胰岛素抵抗稳态模型评估（HOMA-IR）、甘油三酯以及通过老年男性症状（AMS）问卷探索的性症状。在多元线性回归分析中，在低睾酮的假定决定因素中，只有每周LTPA和BMI与睾酮水平表现出显著关联，分别解释了睾酮变异性的54.2%和9.0%。在线性回归模型中，在雄激素缺乏的各种假定特征中，在对BMI、年龄、合并症和每周LTPA进行调整后，只有较低的性欲以及在较小程度上较高的HOMA-IR与较低的睾酮水平表现出显著关联。总之，LTPA差、BMI高和性欲低是慢性SCI男性低睾酮的独立预测因素。这与临床实践相关，因为在SCI康复环境中通常会对所有这些特征进行评估。由于LTPA差和BMI高是与生活方式相关的可改变风险因素，前瞻性研究可以阐明生活方式的改变是否可以提高睾酮水平并改善性欲低这一SCI男性低睾酮的相关临床特征。
