Barbonetti Arcangelo, Caterina Vassallo Maria Rosaria, Cotugno Michele, Felzani Giorgio, Francavilla Sandro, Francavilla Felice
a Andrology Unit, Department of Life, Health and Environment Sciences , University of L'Aquila , L'Aquila , Italy.
b Spinal Unit , San Raffaele Sulmona Institute , Sulmona , Italy.
J Spinal Cord Med. 2016 Jul;39(4):443-9. doi: 10.1179/2045772314Y.0000000288. Epub 2016 Feb 25.
Non-alcoholic fatty liver disease (NAFLD) has been claimed as a liver phenotype of metabolic syndrome, which in turn is associated with male hypogonadism. We assessed whether an independent association between NAFLD and androgen deficiency could be revealed in men with chronic spinal cord injury (SCI), who exhibit a high prevalence of biochemical androgen deficiency and a combination of risk factors for metabolic syndrome.
Fifty-five consecutive men with chronic SCI admitted to a rehabilitation program underwent clinical/biochemical evaluations and liver ultrasonography.
NAFLD was diagnosed in 27 patients (49.1%). Men with NAFLD were older and exhibited significantly higher body mass index, Homeostatic model assessment of insulin resistance, triglycerides and gamma-glutamyl transpeptidase values, lower total and free testosterone levels and they were engaged in a significantly poorer weekly leisure time physical activity (LTPA). At the multiple logistic regression analysis, only total and free testosterone levels exhibited a significant independent association with NAFLD. The risk of having NAFLD increased indeed of 1% for each decrement of 1 ng/dL of total testosterone and of 3% for each decrement of 1 pg/mL of free testosterone, after adjustment for confounders. In men with total testosterone < 300 ng/dL (36.4%) the prevalence of NAFLD reached 85%: they had a risk of having NAFLD significantly higher (∼12-fold) than those with total testosterone ≥ 300 ng/dL, after adjustment for confounders.
The evidence of an independent association between NAFLD and low testosterone is strongly reinforced by its demonstration in men with chronic SCI, in spite of the many confounders peculiar to this population.
非酒精性脂肪性肝病（NAFLD）被认为是代谢综合征的一种肝脏表型，而代谢综合征又与男性性腺功能减退有关。我们评估了在慢性脊髓损伤（SCI）男性中，能否揭示NAFLD与雄激素缺乏之间的独立关联，这些男性存在生化性雄激素缺乏的高患病率以及代谢综合征的多种危险因素。
55名连续入住康复项目的慢性SCI男性接受了临床/生化评估和肝脏超声检查。
27名患者（49.1%）被诊断为NAFLD。患有NAFLD的男性年龄更大，体重指数、胰岛素抵抗稳态模型评估、甘油三酯和γ-谷氨酰转肽酶值显著更高，总睾酮和游离睾酮水平更低，且他们每周的休闲时间体力活动（LTPA）明显较差。在多因素逻辑回归分析中，只有总睾酮和游离睾酮水平与NAFLD存在显著的独立关联。在对混杂因素进行调整后，总睾酮每降低1 ng/dL，患NAFLD的风险确实增加1%，游离睾酮每降低1 pg/mL，患NAFLD的风险增加3%。在总睾酮<300 ng/dL的男性（36.4%）中，NAFLD的患病率达到85%：在对混杂因素进行调整后，他们患NAFLD的风险比总睾酮≥300 ng/dL的男性显著更高（约12倍）。
尽管该人群存在许多特殊的混杂因素，但在慢性SCI男性中证实了NAFLD与低睾酮之间的独立关联，这有力地强化了这一证据。
