Jankowska Ewa A, Tkaczyszyn Michał, Węgrzynowska-Teodorczyk Kinga, Majda Jacek, von Haehling Stephan, Doehner Wolfram, Banasiak Waldemar, Anker Stefan D, Ponikowski Piotr
Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland.
Cardiology Department, Centre for Heart Diseases, Military Hospital, Wrocław, Poland.
ESC Heart Fail. 2014 Sep;1(1):41-51. doi: 10.1002/ehf2.12002.
Male ageing is characterized by diminished circulating androgens with several adverse psychosomatic consequences and can be aggravated by concomitant chronic diseases. According to the European Male Aging Study (EMAS) Group, late-onset hypogonadism (LOH) refers to testosterone deficiency accompanied by sexual complaints.
We investigated the prevalence of LOH in men with systolic heart failure (HF), and its clinical determinants and prognostic consequences.
Among 201 men with systolic HF (age: 60 ± 11 years), serum total testosterone (TT) was assessed using an immunoassay, and estimated free testosterone (eFT) was calculated using Vermeulen's formula. LOH was diagnosed when TT < 3.2 ng/mL and eFT < 64 pg/mL were accompanied by three sexual symptoms (decrease in the number of morning erections, reduced potency, and low libido) of at least moderate severity assessed using the Aging Males' Symptoms Scale.
Decreased frequency of morning erections, reduced potency, and low libido were experienced by 56%, 62%, and 55% of men with HF, respectively; whereas 67%, 61%, and 44% of subjects complained of at least one, two, and three symptoms, respectively. Hypogonadal TT and eFT were observed in 34% and 47% of patients, respectively; and in 33% subjects, both TT and eFT were reduced. Finally, 30 men with HF (15%) were diagnosed with LOH as compared with 2% in a European male population (EMAS). In a multivariable model, older age and higher serum uric acid were independently associated with greater LOH prevalence (both P < 0.05). Among men aged ≤60 years (but not in those aged >60 years), LOH increased 5-year all-cause mortality in the univariable model; however, when adjusted for HF severity, the association lost its statistical significance.
Men with systolic HF commonly report sexual complaints. LOH-the combination of sexual dysfunction and testosterone deficiency-occurs more frequently than in a general male population. LOH does not affect long-term mortality, when adjusted for HF severity.
男性衰老的特征是循环雄激素水平降低，伴有多种不良身心后果，且可能因合并慢性疾病而加重。根据欧洲男性衰老研究（EMAS）小组的定义，迟发性性腺功能减退（LOH）是指伴有性相关主诉的睾酮缺乏。
我们调查了收缩性心力衰竭（HF）男性中LOH的患病率、其临床决定因素及预后后果。
在201名收缩性HF男性（年龄：60±11岁）中，采用免疫分析法评估血清总睾酮（TT），并使用Vermeulen公式计算游离睾酮（eFT）。当TT<3.2 ng/mL且eFT<64 pg/mL，并伴有使用老年男性症状量表评估的至少中度严重程度的三种性症状（晨勃次数减少、性功能减退和性欲低下）时，诊断为LOH。
HF男性中分别有56%、62%和55%的人经历了晨勃频率降低、性功能减退和性欲低下；而分别有67%、61%和44%的受试者抱怨至少一种、两种和三种症状。分别在34%和47%的患者中观察到性腺功能减退的TT和eFT；在33%的受试者中，TT和eFT均降低。最后，30名HF男性（15%）被诊断为LOH，而欧洲男性人群（EMAS）中的这一比例为2%。在多变量模型中，年龄较大和血清尿酸水平较高与LOH患病率较高独立相关（均P<0.05）。在年龄≤60岁的男性中（但在年龄>60岁的男性中并非如此），在单变量模型中LOH增加了5年全因死亡率；然而，在调整HF严重程度后，这种关联失去了统计学意义。
收缩性HF男性普遍存在性相关主诉。LOH（性功能障碍和睾酮缺乏的组合）的发生频率高于普通男性人群。在调整HF严重程度后，LOH不影响长期死亡率。
