Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, Institute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, University of Manchester, Manchester, UK.
Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, UK.
Clin Endocrinol (Oxf). 2018 Mar;88(3):479-490. doi: 10.1111/cen.13524. Epub 2017 Dec 25.
Elevated luteinizing hormone (LH) with normal testosterone (T) suggests compensated dysregulation of the gonadal axis. We describe the natural history, risk factors and clinical parameters associated with the development of high LH (HLH, LH >9.4 U/L) in ageing men with normal T (T ≥ 10.5 nmol/L).
DESIGN, PATIENTS AND MEASUREMENTS: We conducted a 4.3-year prospective observational study of 3369 community-dwelling European men aged 40-79 years. Participants were classified as follows: incident (i) HLH (n = 101, 5.2%); persistent (p) HLH (n = 128, 6.6%); reverted (r) HLH (n = 46, 2.4%); or persistent normal LH (pNLH, n = 1667, 85.8%). Potential predictors and changes in clinical features associated with iHLH and rHLH were analysed using regression models.
Age >70 years (OR = 4.12 [2.07-8.20]), diabetes (OR = 2.86 [1.42-5.77]), chronic pain (OR = 2.53 [1.34-4.77]), predegree education (OR = 1.79 [1.01-3.20]) and low physical activity (PASE ≤ 78, OR = 2.37 [1.24-4.50]) predicted development of HLH. Younger age (40-49 years, OR = 8.14 [1.35-49.13]) and nonsmoking (OR = 5.39 [1.48-19.65]) predicted recovery from HLH. Men with iHLH developed erectile dysfunction, poor health, cardiovascular disease (CVD) and cancer more frequently than pNLH men. In pHLH men, comorbidities, including CVD, developed more frequently, and cognitive and physical function deteriorated more, than in pNLH men. Men with HLH developed primary hypogonadism more frequently (OR = 15.97 [5.85-43.60]) than NLH men. Men with rHLH experienced a small rise in BMI.
Elevation of LH with normal T is predicted by multiple factors, reverts frequently and is not associated with unequivocal evidence of androgen deficiency. High LH is a biomarker for deteriorating health in aged men who tend to develop primary hypogonadism.
黄体生成素（LH）升高伴正常睾酮（T）提示性腺轴失调代偿。我们描述了在正常 T（T≥10.5nmol/L）的老年男性中，与高 LH（HLH，LH>9.4U/L）发展相关的自然史、危险因素和临床参数。
设计、患者和测量：我们对 3369 名年龄在 40-79 岁的社区居住的欧洲男性进行了为期 4.3 年的前瞻性观察研究。参与者分为以下几类：新发（i）HLH（n=101，5.2%）；持续（p）HLH（n=128，6.6%）；恢复（r）HLH（n=46，2.4%）；或持续正常 LH（pNLH，n=1667，85.8%）。使用回归模型分析与 iHLH 和 rHLH 相关的潜在预测因素和临床特征变化。
年龄>70 岁（OR=4.12[2.07-8.20]）、糖尿病（OR=2.86[1.42-5.77]）、慢性疼痛（OR=2.53[1.34-4.77]）、低学历（OR=1.79[1.01-3.20]）和低体力活动（PASE≤78，OR=2.37[1.24-4.50]）预测 HLH 的发生。年龄较小（40-49 岁，OR=8.14[1.35-49.13]）和不吸烟（OR=5.39[1.48-19.65]）预测 HLH 恢复。与 pNLH 男性相比，iHLH 男性更常出现勃起功能障碍、健康状况不佳、心血管疾病（CVD）和癌症。在 pHLH 男性中，与 pNLH 男性相比，合并症（包括 CVD）更常见，认知和身体功能恶化更严重。HLH 男性发生原发性性腺功能减退症的频率更高（OR=15.97[5.85-43.60]）。rHLH 男性的 BMI 略有上升。
LH 升高伴正常 T 受多种因素预测，常可恢复，与明确的雄激素缺乏无关。在年龄较大的男性中，LH 升高是健康恶化的生物标志物，这些男性往往会发生原发性性腺功能减退症。
