Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden; Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
J Vasc Surg. 2021 Dec;74(6):2023-2029. doi: 10.1016/j.jvs.2021.06.020. Epub 2021 Jun 26.
Abdominal aortic aneurysms (AAAs) primarily affect elderly men. The effect of sex on aneurysm development has been associated with the effects of sex hormones through mechanisms that are not fully understood. The present study examined the association between the levels of sex hormones and the occurrence of AAAs in elderly men.
A prospective case-control study was conducted of 452 men aged 65 years participating in screening for AAAs from 2013 to 2019. Of the 452 men, 230 had an AAA and 222 an aortic diameter of <30 mm (control group). Questionnaires and blood samples were collected and stored consecutively. The serum levels of total testosterone, estradiol, progesterone, luteinizing hormone, and sex hormone-binding globulin were analyzed using electrochemiluminescent immunoassays. Multivariable logistic regression analysis was used to assess the association between sex hormones and AAA.
The median aneurysm diameter was 33 mm. Men with AAA had greater estradiol (93 pmol/L vs 84 pmol/L; P =.003) and progesterone (0.41 nmol/L vs 0.17 nmol/L; P < .001) levels compared with the controls. The testosterone levels were lower in the AAA group than in the control group (13 nmol/L vs 14 nmol/L; P = .026). AAA was associated with detectable levels of progesterone (odds ratio [OR], 6.69; 95% confidence interval [CI], 3.86-11.47), smoking (OR, 5.26; 95% CI, 3.12-8.85), coronary heart disease (OR, 4.06; 95% CI, 1.92-8.58), and a body mass index >25 kg/m (OR, 2.26; 95% CI, 1.34-3.82).
The observed higher estradiol and progesterone levels in men with an AAA suggest an effect of sex hormones on aneurysm development. The association between progesterone levels and the aortic diameter stresses the importance of focusing on the potential effect of this unconsidered female sex hormone on aneurysm formation.
腹主动脉瘤（AAA）主要影响老年男性。通过尚未完全阐明的机制，性激素对动脉瘤发展的影响与性激素的影响有关。本研究探讨了老年男性性激素水平与 AAA 发生之间的关系。
对 2013 年至 2019 年参加 AAA 筛查的 452 名 65 岁男性进行了一项前瞻性病例对照研究。在 452 名男性中，230 名患有 AAA，222 名主动脉直径<30mm（对照组）。连续收集问卷和血样。使用电化学发光免疫分析测定总睾酮、雌二醇、孕酮、黄体生成素和性激素结合球蛋白的血清水平。多变量逻辑回归分析用于评估性激素与 AAA 之间的关系。
AAA 的中位瘤径为 33mm。与对照组相比，AAA 组的雌二醇（93pmol/L 比 84pmol/L；P<.001）和孕酮（0.41nmol/L 比 0.17nmol/L；P<.001）水平更高。与对照组相比，AAA 组的睾酮水平较低（13nmol/L 比 14nmol/L；P=.026）。AAA 与孕酮可检测水平相关（比值比 [OR]，6.69；95%置信区间 [CI]，3.86-11.47）、吸烟（OR，5.26；95%CI，3.12-8.85）、冠心病（OR，4.06；95%CI，1.92-8.58）和体重指数>25kg/m（OR，2.26；95%CI，1.34-3.82）。
在患有 AAA 的男性中观察到的雌二醇和孕酮水平升高表明性激素对动脉瘤发展有影响。孕酮水平与主动脉直径之间的关系强调了关注这种被忽视的女性性激素对动脉瘤形成的潜在影响的重要性。
