性激素对左心室收缩功能的复杂影响：对性别二态性的深入了解。
Complex Association of Sex Hormones on Left Ventricular Systolic Function: Insight into Sexual Dimorphism.
机构信息
AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421; INSERM, CIC-1421 and UMR ICAN 1166; Sorbonne Universités, Paris, France; UPMC Univ Paris 06, Faculty of Medicine; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France.
AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421; INSERM, CIC-1421 and UMR ICAN 1166; Sorbonne Universités, Paris, France; UPMC Univ Paris 06, Faculty of Medicine; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France.
出版信息
J Am Soc Echocardiogr. 2018 Feb;31(2):231-240.e1. doi: 10.1016/j.echo.2017.10.017. Epub 2017 Dec 13.
BACKGROUND
Normal values of left ventricular ejection fraction (LVEF) and absolute values of global longitudinal strain (GLS) are lower in men than in women. Data concerning the association of sex hormone levels on these left ventricular systolic function surrogates are scarce. The aim of this study was to determine the association of sex hormones with systolic left ventricular function in healthy subjects and patients with congenital adrenal hyperplasia (CAH) as a model of testosterone dysregulation.
METHODS
Eighty-four adult patients with CAH (58 women; median age, 27 years; interquartile range, 23-36 years) and 84 healthy subjects matched for sex and age were prospectively included. Circulating concentrations of sex hormones were measured within 48 hours of echocardiography with assessment of LVEF and left ventricular longitudinal, radial, and circumferential strain.
RESULTS
LVEF and GLS were higher in healthy women than in healthy men (63.9 ± 4.2% vs 60.9 ± 5.1% [P < .05] and 20.0 ± 1.9% vs 17.9 ± 2.4% [P < .001], respectively), while there was no difference in LVEF or GLS between women and men with CAH (63.9 ± 4.5% vs 63.0 ± 4.6% [P = NS] and 19.4 ± 2.2% vs 18.3 ± 1.8% [P = NS], respectively). Bioavailable testosterone levels were higher in women with CAH than in female control subjects (0.08 ng/mL [interquartile range, 0.04-0.14 ng/mL] vs 0.16 ng/mL [interquartile range, 0.04-0.3 ng/mL], P < .001) and lower in men with CAH than in male control subjects (2.3 ng/mL [interquartile range, 1.3-3 ng/mL] vs 2.9 ng/mL [interquartile range, 2.5-3.4 ng/mL], P < .05). In men, LVEF and GLS were negatively correlated with bioavailable testosterone levels (r = -0.3, P ≤ .05, and r = -0.45, P < .01, respectively), while midventricular radial strain was positively correlated with bioavailable testosterone level (r = 0.38, P < .05). The absolute value of circumferential strain was positively correlated with follicle-stimulating hormone (r = 0.65, P < .0001).
CONCLUSIONS
These data support that the existence of sex dimorphism concerning left ventricular systolic cardiac function is significantly associated with testosterone levels.
背景
左心室射血分数（LVEF）的正常值和整体纵向应变（GLS）的绝对值在男性中低于女性。关于性激素水平与这些左心室收缩功能替代物之间关联的数据很少。本研究的目的是确定在健康受试者和先天性肾上腺增生（CAH）患者中，性激素与左心室收缩功能之间的关联，CAH 是一种睾酮失调的模型。
方法
前瞻性纳入 84 名患有 CAH 的成年患者（58 名女性；中位年龄 27 岁；四分位间距 23-36 岁）和 84 名年龄和性别匹配的健康受试者。在超声心动图检查的 48 小时内测量了性激素的循环浓度，并评估了 LVEF 和左心室长轴、径向和环向应变。
结果
健康女性的 LVEF 和 GLS 高于健康男性（分别为 63.9%±4.2%比 60.9%±5.1%[P<.05]和 20.0%±1.9%比 17.9%±2.4%[P<.001]），而 CAH 患者中女性和男性之间的 LVEF 或 GLS 无差异（分别为 63.9%±4.5%比 63.0%±4.6%[P=NS]和 19.4%±2.2%比 18.3%±1.8%[P=NS]）。CAH 女性的生物可利用睾酮水平高于女性对照组（0.08ng/mL[四分位间距，0.04-0.14ng/mL]比 0.16ng/mL[四分位间距，0.04-0.3ng/mL]，P<.001），而 CAH 男性的生物可利用睾酮水平低于男性对照组（2.3ng/mL[四分位间距，1.3-3ng/mL]比 2.9ng/mL[四分位间距，2.5-3.4ng/mL]，P<.05）。在男性中，LVEF 和 GLS 与生物可利用睾酮水平呈负相关（r=-0.3，P≤.05，r=-0.45，P<.01），而中室径向应变与生物可利用睾酮水平呈正相关（r=0.38，P<.05）。环向应变的绝对值与卵泡刺激素呈正相关（r=0.65，P<.0001）。
结论
这些数据支持这样一种观点，即左心室收缩心功能的性别二态性与睾酮水平显著相关。
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