1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.
2 Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
Chron Respir Dis. 2019 Jan-Dec;16:1479972318793004. doi: 10.1177/1479972318793004. Epub 2018 Sep 11.
Testosterone deficiency is common in men with chronic obstructive pulmonary disease (COPD) and may exacerbate their condition. Research suggests that testosterone replacement therapy (TRT) may have a beneficial effect on respiratory outcomes in men with COPD. To date, however, no large-scale nationally representative studies have examined this association. The objective of the study was to assess whether TRT reduced the risk of respiratory hospitalizations in middle-aged and older men with COPD. We conducted two retrospective cohort studies. First, using the Clinformatics Data Mart-a database of one of the largest commercially insured populations in the United States-we examined 450 men, aged 40-63 years, with COPD who initiated TRT between 2005 and 2014. Second, using the national 5% Medicare database, we examined 253 men, aged ≥66 years, with COPD who initiated TRT between 2008 and 2013. We used difference-in-differences (DID) statistical modeling to compare pre- versus post-respiratory hospitalization rates in TRT users versus matched TRT nonusers over a parallel time period. DID analyses showed that TRT users had a greater relative decrease in respiratory hospitalizations compared with nonusers. Specifically, middle-aged TRT users had a 4.2% greater decrease in respiratory hospitalizations compared with nonusers (-2.4 decrease vs. 1.8 increase; p = 0.03); and older TRT users had a 9.1% greater decrease in respiratory hospitalizations compared with nonusers (-0.8 decrease vs. 8.3 increase; p = 0.04). These findings suggest that TRT may slow disease progression in patients with COPD. Future studies should examine this association in larger cohorts of patients, with particular attention to specific biological pathways.
男性慢性阻塞性肺疾病（COPD）患者常出现睾酮缺乏，且其病情可能恶化。研究表明，睾酮替代疗法（TRT）可能对 COPD 患者的呼吸结局有有益影响。然而，迄今为止，尚无大规模的全国代表性研究检验这种关联。本研究旨在评估 TRT 是否降低中年和老年 COPD 男性的呼吸住院风险。我们进行了两项回顾性队列研究。首先，我们使用 Clinformatics Data Mart（美国最大的商业保险人群之一的数据库），研究了 2005 年至 2014 年期间开始接受 TRT 的 450 名年龄在 40-63 岁之间的 COPD 男性。其次，我们使用全国 5%的医疗保险数据库，研究了 2008 年至 2013 年期间开始接受 TRT 的 253 名年龄≥66 岁的 COPD 男性。我们使用差异（DID）统计建模比较了 TRT 使用者与匹配的 TRT 非使用者在平行时间段内的呼吸住院前与后比率。DID 分析显示，与非使用者相比，TRT 使用者的呼吸住院率相对下降更大。具体而言，中年 TRT 使用者的呼吸住院率下降了 4.2%，而非使用者下降了 1.8%（p=0.03）；老年 TRT 使用者的呼吸住院率下降了 9.1%，而非使用者上升了 8.3%（p=0.04）。这些发现表明，TRT 可能减缓 COPD 患者的疾病进展。未来的研究应在更大的患者队列中检验这种关联，并特别关注特定的生物学途径。
