Department of Pediatrics, Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, United States of America.
Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2021 Jun 2;16(6):e0251449. doi: 10.1371/journal.pone.0251449. eCollection 2021.
Hypogonadism is reported to occur in non-alcoholic fatty liver disease (NAFLD), but earlier studies used low-sensitivity diagnostic techniques (CT, ultrasound), for NAFLD diagnosis. We hypothesized that if hypogonadism was due to NAFLD, and not solely attributable to underlying obesity/diabetes, it would be more severe in the presence of steatohepatitis (NASH). To examine the influence of liver disease on testosterone in males with type 2 diabetes mellitus (T2DM), we used gold-standard liver imaging with MR-spectroscopy (1H-MRS), and performed liver biopsies to grade/stage the NAFLD.
In this cross-sectional study, we measured in 175 males with T2DM total and free testosterone, markers of insulin resistance, and intrahepatic triglyceride content (IHTG) by 1H-MRS. Those with NAFLD on imaging underwent a liver biopsy.
Total testosterone was higher in the group without NAFLD ("No-NAFLD"; n = 48) compared to isolated steatosis (IS; n = 62) or NASH (n = 65) (385 ± 116 vs. 339 ± 143 vs. 335 ± 127 ng/ml, ptrend 0.03). Testosterone was also lower in obese vs. non-obese subjects in both the No-NAFLD and IS groups (p = 0.06 and p = 0.11, respectively), but not in obese vs. non-obese patients with NASH (p = 0.81). IHTG was independently associated with total testosterone (ß = -4.8, p = 0.004). None of the liver histology characteristics were associated with lower testosterone.
NAFLD is linked to lower total testosterone in patients with T2DM, but likely given a common soil of insulin resistance/obesity and not from the severity of liver necroinflammation or fibrosis. Nevertheless, clinicians should consider screening patients with T2DM and NAFLD for hypogonadism.
据报道，非酒精性脂肪性肝病（NAFLD）会导致性腺功能减退症，但早期研究使用低灵敏度的诊断技术（CT、超声）诊断 NAFLD。我们假设，如果性腺功能减退症是由于 NAFLD 引起的，而不仅仅是由于潜在的肥胖/糖尿病引起的，那么在存在脂肪性肝炎（NASH）的情况下，它会更严重。为了研究肝脏疾病对 2 型糖尿病（T2DM）男性睾酮的影响，我们使用了磁共振波谱（1H-MRS）的金标准肝脏成像，并进行了肝活检以对 NAFLD 进行分级/分期。
在这项横断面研究中，我们对 175 名 T2DM 男性进行了总睾酮和游离睾酮、胰岛素抵抗标志物以及通过 1H-MRS 测量的肝内甘油三酯含量（IHTG）的测量。那些有影像学表现为 NAFLD 的患者进行了肝活检。
与单纯性脂肪变性（IS；n = 62）或 NASH（n = 65）相比，无 NAFLD 组（n = 48）的总睾酮水平更高（385 ± 116 比 339 ± 143 比 335 ± 127ng/ml，ptrend = 0.03）。在无 NAFLD 和 IS 组中，肥胖患者的睾酮水平均低于非肥胖患者（分别为 p = 0.06 和 p = 0.11），但在肥胖患者与非肥胖患者的 NASH 患者中则无差异（p = 0.81）。IHTG 与总睾酮独立相关（ß = -4.8，p = 0.004）。肝脏组织学特征均与较低的睾酮水平无关。
在 T2DM 患者中，NAFLD 与总睾酮降低有关，但可能是由于胰岛素抵抗/肥胖的共同基础，而不是由于肝坏死性炎症或纤维化的严重程度所致。尽管如此，临床医生仍应考虑对患有 T2DM 和 NAFLD 的患者进行性腺功能减退症筛查。
