在 2 型糖尿病男性中，性激素结合球蛋白与死亡率的关联是通过年龄和睾酮介导的。
The association of sex hormone-binding globulin with mortality is mediated by age and testosterone in men with type 2 diabetes.
机构信息
Department of Clinical Biochemistry, University Hospitals of North Midlands/Faculty of Health Sciences, Staffordshire University, Staffordshire, UK.
College of Engineering, Design & Physical Sciences, Brunel University, London, UK.
出版信息
Andrology. 2018 Nov;6(6):846-853. doi: 10.1111/andr.12520. Epub 2018 Jul 13.
BACKGROUND
Serum sex hormone-binding globulin levels have been associated with mortality in adult men with type 2 diabetes (T2DM).
OBJECTIVES
To confirm the association of serum sex hormone-binding globulin with mortality and then determine whether this association is mediated by age and total testosterone concentration.
MATERIALS AND METHODS
We studied 364 men (median age: 66 years) with T2DM over a median follow-up of 4.3 years using the Cox regression to study associations between sex hormone-binding globulin, age, total testosterone, and mortality.
RESULTS
Mortality was significantly and independently associated with sex hormone-binding globulin, age, and total testosterone. In pairwise combinations of age and sex hormone-binding globulin dichotomized by median values, the association of sex hormone-binding globulin with mortality was age-dependent. Relative to the combination of age >66 years/SHBG >35 nmol/L (mortality 22.5%), the other combinations were associated with significantly less mortality (mortality in men ≤66 years/SHBG ≤ 35 nmol/L was 3.23%). In men >66 years, SHBG ≤ 35 nmol/L was associated with decreased mortality (HR: 0.41, p = 0.037) compared with SHBG > 35 nmol/L. In men ≤66 years, there was no significant difference between those with sex hormone-binding globulin above or below the median (HR: 1.73, p = 0.56, reference: SHBG ≤ 35 nmol/L). TT < 12 nmol/L was associated with increased mortality in both age categories. Men >66 years with the reference combination of SHBG > 35 nmol/L and TT < 12 nmol/L (36.84%) nmol/L had significantly higher mortality than those with SHBG > 35 nmol/L and TT ≥ 12 (18.06%) and those with SHBG ≤ 35 nmol/L and TT < 12 nmol/L (13.79%).
DISCUSSION
Our data suggest sex hormone-binding globulin and total testosterone have particular impact on mortality in men aged over 66 years. Further, in older men, the combination of high sex hormone-binding globulin levels and low total testosterone is associated with greater risk than either high sex hormone-binding globulin or low total testosterone individually.
CONCLUSIONS
Our findings are compatible with data suggesting the importance of sex hormone-binding globulin lies in mediating free testosterone levels.
背景
血清性激素结合球蛋白水平与 2 型糖尿病（T2DM）成年男性的死亡率有关。
目的
确认血清性激素结合球蛋白与死亡率之间的关联，然后确定这种关联是否由年龄和总睾酮浓度介导。
材料和方法
我们使用 Cox 回归研究了 364 名中位年龄为 66 岁的 T2DM 男性中位随访 4.3 年后的性激素结合球蛋白、年龄、总睾酮与死亡率之间的关系。
结果
死亡率与性激素结合球蛋白、年龄和总睾酮显著且独立相关。在按中位数将年龄和性激素结合球蛋白分为两组的成对组合中，性激素结合球蛋白与死亡率的关联随年龄而变化。与年龄>66 岁/性激素结合球蛋白>35nmol/L 的组合相比，其他组合与死亡率显著降低相关（年龄≤66 岁/性激素结合球蛋白≤35nmol/L 的男性死亡率为 3.23%）。在年龄>66 岁的男性中，性激素结合球蛋白≤35nmol/L 与死亡率降低相关（HR：0.41，p=0.037），而性激素结合球蛋白>35nmol/L 则没有。在年龄≤66 岁的男性中，性激素结合球蛋白高于或低于中位数的患者之间没有显著差异（HR：1.73，p=0.56，参考：性激素结合球蛋白≤35nmol/L）。TT<12nmol/L 在两个年龄组中均与死亡率升高相关。年龄>66 岁且参考组合为性激素结合球蛋白>35nmol/L 和 TT<12nmol/L（36.84%）的男性死亡率明显高于性激素结合球蛋白>35nmol/L 和 TT≥12（18.06%）和性激素结合球蛋白≤35nmol/L 和 TT<12nmol/L（13.79%）的男性。
讨论
我们的数据表明，性激素结合球蛋白和总睾酮对 66 岁以上男性的死亡率有特殊影响。此外，在老年男性中，高性激素结合球蛋白水平和低总睾酮的组合与高性激素结合球蛋白或低总睾酮单独存在时相比，与更高的风险相关。
结论
我们的发现与表明性激素结合球蛋白重要性在于调节游离睾酮水平的数据相吻合。
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