接受抗逆转录病毒治疗的HIV感染男性中睾酮缺乏的患病率。
Prevalence of testosterone deficiency in HIV-infected men under antiretroviral therapy.
作者信息
Gomes Ana Rita, Souteiro Pedro, Silva Carolina Germana, Sousa-Pinto Bernardo, Almeida Francisco, Sarmento António, Carvalho Davide, Freitas Paula
机构信息
Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal.
出版信息
BMC Infect Dis. 2016 Nov 3;16(1):628. doi: 10.1186/s12879-016-1892-5.
BACKGROUND
The prevalence of hypogonadism in HIV-infected patients is still a matter of debate as there is no standardized consensual diagnostic method. In addition, the etiology and endocrine/metabolic implications of hypogonadism in this population remain controversial. This study aims to determine the prevalence of testosterone deficiency in a single-site hospital and to evaluate its association with potential risk factors, lipodystrophy, metabolic syndrome, and cardiovascular risk.
METHODS
This study analyzed 245 HIV-infected men on combined antiretroviral therapy. Patients with low total testosterone (TT) levels (<2.8 ng/mL) and/or low calculated free testosterone (FT) levels (<6.5 ng/dL) were considered testosterone deficient. According to their LH and FSH levels, patients were classified as having hypogonadotropic or hypergonadotropic dysfunction. Other clinical, anthropometric, and analytic parameters were also collected and analyzed.
RESULTS
The prevalence of testosterone deficiency in our population was 29.4 %. Among them, 56.9 % had hypogonadotropic dysfunction and 43.1 % presented with hypergonadotropic dysfunction. Patients with testosterone deficiency were older (p < 0.001), had higher HbA1c levels (p = 0.016) and higher systolic blood pressure (p = 0.007). Patients with lower testosterone levels had higher prevalence of isolated central fat accumulation (p = 0.015) and had higher median cardiovascular risk at 10 years as measured by the Framingham Risk Score (p = 0.004) and 10-Year ASCVD risk (p = 0.002).
CONCLUSIONS
The prevalence of testosterone deficiency in this HIV population is high, with hypogonadotropic dysfunction being responsible for the majority of cases. Testosterone deficiency might predispose to, or be involved, in the pathogenesis of HIV-associated lipodystrophy. Patients with low testosterone levels have higher cardiovascular risk, highlighting the importance of early diagnosis of this condition.
背景
由于缺乏标准化的共识诊断方法，性腺功能减退在HIV感染患者中的患病率仍存在争议。此外，该人群中性腺功能减退的病因及其对内分泌/代谢的影响仍存在争议。本研究旨在确定单中心医院中睾酮缺乏的患病率，并评估其与潜在危险因素、脂肪代谢障碍、代谢综合征和心血管风险的关联。
方法
本研究分析了245例接受联合抗逆转录病毒治疗的HIV感染男性。总睾酮（TT）水平低（<2.8 ng/mL）和/或计算的游离睾酮（FT）水平低（<6.5 ng/dL）的患者被认为存在睾酮缺乏。根据促黄体生成素（LH）和促卵泡生成素（FSH）水平，将患者分为低促性腺激素性功能减退或高促性腺激素性功能减退。还收集并分析了其他临床、人体测量和分析参数。
结果
我们研究人群中睾酮缺乏的患病率为29.4%。其中，56.9%为低促性腺激素性功能减退，43.1%为高促性腺激素性功能减退。睾酮缺乏的患者年龄较大（p<0.001），糖化血红蛋白（HbA1c）水平较高（p=0.016），收缩压较高（p=0.007）。睾酮水平较低的患者孤立性中心脂肪堆积的患病率较高（p=0.015），根据弗雷明汉风险评分（p=0.004）和10年动脉粥样硬化性心血管疾病（ASCVD）风险（p=0.002）测量，其10年心血管风险中位数较高。
结论
该HIV人群中睾酮缺乏的患病率较高，大多数病例为低促性腺激素性功能减退。睾酮缺乏可能易患HIV相关脂肪代谢障碍或参与其发病机制。睾酮水平低的患者心血管风险较高，突出了早期诊断该病的重要性。
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