Li Shu-Ying, Zhao Ya-Ling, Yang Yu-Fan, Wang Xi, Nie Min, Wu Xue-Yan, Mao Jiang-Feng
Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China.
Int J Endocrinol. 2020 Sep 30;2020:4732021. doi: 10.1155/2020/4732021. eCollection 2020.
Testosterone replacement therapy (TRT) is commonly used for the treatment of hypogonadism in men, which is often associated with type 2 diabetes mellitus (T2DM) and metabolic syndrome (Mets). Recent compiling evidence shows that TRT has beneficial metabolic effects on these patients.
A meta-analysis has been conducted to evaluate the effects of TRT on cardiovascular metabolic factors.
We conducted a systemic search on PubMed, Embase, Cochrane Library, Wanfang, and CNKI and selected randomized controlled trials (RCTs) to include. The efficacy of TRT on glycemia, insulin sensitivity, lipid profile, and body weight was meta-analyzed by Review Manager.
A total of 18 RCTs, containing 1415 patients (767 in TRT and 648 in control), were enrolled for the meta-analysis. The results showed that TRT could reduce HbA1c (MD = -0.67, 95% CI -1.35, -0.19, and =0.006) and improve HOMA-IR (homeostatic model assessment of insulin resistance) (SMD = -1.94, 95% CI -2.65, -1.23, and < 0.0001). TRT could also decrease low-density lipoprotein (SMD = -0.50, 95% CI -0.82, -0.90, and =0.002) and triglycerides (MD = -0.64, 95% CI -0.91, -0.36, and < 0.0001). In addition, TRT could reduce body weight by 3.91 kg (MD = -3.91, 95% CI -4.14, -3.69, and < 0.00001) and waist circumference by 2.8 cm (MD -2.80, 95% CI -4.38, -1.21 and =0.0005). Erectile dysfunction (measured by IIEF-5) did not improve, while aging-related symptoms (measured by AMS scores) significantly improved.
TRT improves glycemic control, insulin sensitivity, and lipid parameters in hypogonadism patients with T2DM and MetS, partially through reducing central obesity.
睾酮替代疗法（TRT）常用于治疗男性性腺功能减退，而性腺功能减退常与2型糖尿病（T2DM）和代谢综合征（Mets）相关。最近汇总的证据表明，TRT对这些患者具有有益的代谢作用。
进行一项荟萃分析以评估TRT对心血管代谢因素的影响。
我们在PubMed、Embase、Cochrane图书馆、万方和知网进行了系统检索，并选择纳入随机对照试验（RCT）。通过Review Manager对TRT对血糖、胰岛素敏感性、血脂谱和体重的疗效进行荟萃分析。
总共18项RCT（共1415例患者，TRT组767例，对照组648例）被纳入荟萃分析。结果显示，TRT可降低糖化血红蛋白（MD = -0.67，95%CI -1.35，-0.19，P = 0.006）并改善胰岛素抵抗的稳态模型评估（HOMA-IR）（标准化均数差[SMD] = -1.94，95%CI -2.65，-1.23，P < 0.0001）。TRT还可降低低密度脂蛋白（SMD = -0.50，95%CI -0.82，-0.90，P = 0.002）和甘油三酯（MD = -0.64，95%CI -0.91，-0.36，P < 0.0001）。此外，TRT可使体重减轻3.91 kg（MD = -3.91，95%CI -4.14，-3.69，P < 0.00001），腰围减少2.8 cm（MD -2.80，95%CI -4.38，-1.21，P = 0.0005）。勃起功能障碍（通过国际勃起功能指数-5[IIEF-5]测量）未改善，而与衰老相关的症状（通过衰老男性症状量表[AMS]评分测量）显著改善。
TRT可改善合并T2DM和Mets的性腺功能减退患者的血糖控制、胰岛素敏感性和血脂参数，部分是通过减轻中心性肥胖实现的。
