Raza Muhammad T, Sharif Sabira, Khan Zohaib Ahmad, Naz Sadaf, Mushtaq Samsam, Umer Amina
Medicine, Allama Iqbal Medical College/Jinnah Hospital, Lahore, PAK.
Internal Medicine, Shaikh Zayed Hospital, Lahore, PAK.
Cureus. 2019 Dec 29;11(12):e6500. doi: 10.7759/cureus.6500.
Introduction Hypogonadism is characterized by clinical and biochemical evidence of testosterone deficiency. Low testosterone levels have been reported in patients with type 2 diabetes mellitus (T2DM), which can predispose to coronary artery disease (CAD). It has been proposed that diabetic men with proven CAD have lower androgen levels than patients with normal coronary arteriograms. We conducted this study with the objective to determine the frequency of hypogonadism in patients with diabetes mellitus and its relationship with CAD. Materials and Methods It was a comparative cross-sectional study conducted at a tertiary care hospital. We recruited a total of 108 patients, divided into two groups, 54 patients in each arm of the study. Group A comprised patients with CAD, whereas group B consisted of diabetic patients without CAD. Hypogonadism was defined on the basis of erectile dysfunction clinically and total testosterone levels biochemically. CAD was diagnosed on the basis of findings of coronary angiography. Fasting blood samples were drawn and evaluated for fasting plasma glucose, HbA1c, fasting lipid profile, thyroid-stimulating hormone (TSH), serum prolactin, blood urea, serum creatinine, liver function tests (LFT), total testosterone, luteinizing hormone (LH), and follicle‑stimulating hormone (FSH) levels. Hypogonadism among two study groups was compared using chi-square and serum testosterone level was compared using independent -test with < 0.05 considered as statistically significant. Results There were 108 subjects in the study with the mean age of 54.4 ± 4.29 (range: 22 to 68) years. The mean duration of T2DM was 12.6 ± 8.2 years. The mean BMI of patients with and without CAD was 25.7 ± 2.37 and 26.9 ± 4.21 kg/m, respectively. There was no significant difference in waist circumference and obesity between both the groups (-value > 0.05). Fasting plasma glucose and HbA1c in both groups were not significantly different. Testosterone levels and erectile dysfunction score were found lower in T2DM with CAD compared to T2DM patients without CAD, although this difference was not statistically significant (-value: 0.051). The majority of the subjects with hypogonadism in both groups had a hypogonadotrophic hypogonadism (39/42, 92.9% versus 16/20, 80.0%). No statistically significant difference was seen in serum levels of LH and FSH between the study groups. The frequency of hypogonadism was found higher in the group with CAD (72.2%, 39/54) as compared with T2DM patients without CAD (37.03%, 20/54; -value = 0.000). Conclusion Testosterone deficiency is a significant problem of males with T2DM. Patients with CAD have markedly low levels of testosterone as compared with patients without any CAD.
引言
性腺功能减退的特征是有睾酮缺乏的临床和生化证据。2型糖尿病（T2DM）患者中已报道有低睾酮水平，这可能易患冠状动脉疾病（CAD）。有人提出，经证实患有CAD的糖尿病男性雄激素水平低于冠状动脉造影正常的患者。我们进行这项研究的目的是确定糖尿病患者中性腺功能减退的发生率及其与CAD的关系。
材料与方法
这是一项在三级护理医院进行的比较性横断面研究。我们共招募了108名患者，分为两组，每组54名患者。A组为患有CAD的患者，而B组由无CAD的糖尿病患者组成。性腺功能减退根据临床上的勃起功能障碍和生化指标总睾酮水平来定义。CAD根据冠状动脉造影结果进行诊断。采集空腹血样并评估空腹血糖、糖化血红蛋白（HbA1c）、空腹血脂谱、促甲状腺激素（TSH）、血清泌乳素、血尿素、血清肌酐、肝功能检查（LFT）、总睾酮、黄体生成素（LH）和卵泡刺激素（FSH）水平。使用卡方检验比较两个研究组之间的性腺功能减退情况，使用独立样本t检验比较血清睾酮水平，P<0.05被认为具有统计学意义。
结果
本研究中有108名受试者，平均年龄为54.4±4.29（范围：22至68）岁。T2DM的平均病程为12.6±8.2年。有CAD和无CAD患者的平均体重指数分别为25.7±2.37和26.9±4.21kg/m²。两组之间的腰围和肥胖情况无显著差异（P值>0.05）。两组的空腹血糖和HbA1c无显著差异。与无CAD的T2DM患者相比，患有CAD的T2DM患者的睾酮水平和勃起功能障碍评分较低，尽管这种差异无统计学意义（P值：0.051）。两组中大多数性腺功能减退的受试者为低促性腺激素性性腺功能减退（39/42，92.9%对16/20，80.0%）。研究组之间LH和FSH的血清水平无统计学显著差异。与无CAD的T2DM患者（37.03%，20/54）相比，CAD组中性腺功能减退的发生率更高（72.2%，39/54；P值=0.000）。
结论
睾酮缺乏是T2DM男性的一个重要问题。与无任何CAD的患者相比，患有CAD的患者睾酮水平明显较低。
