男性和绝经后女性性激素与糖尿病血管并发症的新关联：一项横断面研究。
Novel associations between sex hormones and diabetic vascular complications in men and postmenopausal women: a cross-sectional study.
机构信息
Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
出版信息
Cardiovasc Diabetol. 2019 Jul 31;18(1):97. doi: 10.1186/s12933-019-0901-6.
BACKGROUND
Associations between sex hormones and vascular remodeling have been extensively studied, but the results vary widely among different races and sex. We aimed to investigate whether total testosterone (TT), estrogen (E2), and dehydroepiandrosterone (DHEA) associate with macrovascular complications and diabetic kidney disease (DKD) among community-dwelling patients with diabetes.
METHODS
A total of 4720 participants with type 2 diabetes were recruited from Shanghai, China. Common carotid artery (CCA) plaques and diameter were assessed by ultrasound. Cardiovascular disease (CVD) was defined by prior diagnosis of coronary heart disease, myocardial infarction or stroke. DKD was defined according to the ADA Guidelines.
RESULTS
(1) In men, TT was negatively associated with CCA diameter (regression coefficient (β) - 0.044, 95% CI - 0.087, 0). E2 levels were positively associated with CVD and CCA plaque prevalence (OR 1.151, 95% CI 1.038, 1.277 and OR 1.13, 95% CI 1.017, 1.255, respectively). DHEA was negatively associated with CVD (OR 0.809, 95% CI 0.734, 0.893). In postmenopausal women, TT levels were negatively associated with CCA diameter (β - 0.046, 95% CI - 0.083, - 0.010) and positively associated with CVD (OR 1.154, 95% CI 1.038, 1.284). (2) In both men and postmenopausal women, TT levels were negatively associated with the albumin/creatinine ratio and DKD (β - 0.098, 95% CI - 0.154, - 0.043 and OR 0.887, 95% CI 0.790, 0.997 vs. β - 0.084, 95% CI - 0.137, - 0.031 and OR 0.822, 95% CI 0.731, 0.924, respectively) and DHEA levels were positively associated with DKD (OR 1.167, 95% CI 1.038, 1.313 vs. OR 1.251, 95% CI 1.104, 1.418, respectively).
CONCLUSIONS
Our study indicates that macrovascular complications were associated with low TT, DHEA and high E2 in men and with high TT in postmenopausal women. DKD was associated with low TT and high DHEA levels in both genders. Sex hormone replacement therapy requires careful and comprehensive consideration. Trial registration ChiCTR1800017573, http://www.chictr.org.cn . Registered 04 August 2018.
背景
性激素与血管重塑之间的关系已得到广泛研究，但不同种族和性别的结果差异很大。我们旨在研究总睾酮（TT）、雌激素（E2）和脱氢表雄酮（DHEA）是否与社区居住的糖尿病患者的大血管并发症和糖尿病肾病（DKD）有关。
方法
共招募了 4720 名来自中国上海的 2 型糖尿病患者。通过超声评估颈总动脉（CCA）斑块和直径。心血管疾病（CVD）定义为既往诊断为冠心病、心肌梗死或中风。根据 ADA 指南定义 DKD。
结果
（1）在男性中，TT 与 CCA 直径呈负相关（回归系数（β）-0.044，95%CI-0.087，0）。E2 水平与 CVD 和 CCA 斑块患病率呈正相关（OR 1.151，95%CI 1.038，1.277 和 OR 1.13，95%CI 1.017，1.255）。DHEA 与 CVD 呈负相关（OR 0.809，95%CI 0.734，0.893）。在绝经后妇女中，TT 水平与 CCA 直径呈负相关（β-0.046，95%CI-0.083，-0.010），与 CVD 呈正相关（OR 1.154，95%CI 1.038，1.284）。（2）在男性和绝经后妇女中，TT 水平与白蛋白/肌酐比值和 DKD 呈负相关（β-0.098，95%CI-0.154，-0.043 和 OR 0.887，95%CI 0.790，0.997 与β-0.084，95%CI-0.137，-0.031 和 OR 0.822，95%CI 0.731，0.924），DHEA 水平与 DKD 呈正相关（OR 1.167，95%CI 1.038，1.313 与 OR 1.251，95%CI 1.104，1.418）。
结论
我们的研究表明，男性的大血管并发症与 TT、DHEA 降低和 E2 升高有关，绝经后女性与 TT 升高有关。DKD 与两性的 TT 水平降低和 DHEA 水平升高有关。性激素替代治疗需要仔细和全面的考虑。试验注册 ChiCTR1800017573，http://www.chictr.org.cn。注册于 2018 年 8 月 4 日。
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