Nikolaou Evdokia, Tziastoudi Maria, Gougoura Sofia G, Filippidis Georgios, Dousdampanis Periklis, Bargiota Alexandra, Mertens Peter Rene, Eleftheriadis Theodoros, Hadjigeorgiou Georgios M, Koukoulis Georgios N, Stefanidis Ioannis
Department of Nephrology, University of Thessaly School of Medicine, Mezourlo Hill, Larissa, 41110, Greece.
Department of Endocrinology, University of Thessaly School of Medicine, Larissa, Greece.
Diabetol Metab Syndr. 2024 Jul 16;16(1):166. doi: 10.1186/s13098-024-01406-9.
In males with end stage renal disease biochemical hypogonadism is a frequent finding. Testosterone and sex hormone binding globulin (SHBG) have been associated with insulin resistance, a well-known condition in uremia. The aim of the present study was to investigate in males on chronic hemodialysis the relationship of testosterone and SHBG serum levels with insulin resistance.
In a cross-sectional study we enrolled men treated with chronic hemodialysis who did not suffer from an acute illness or other endocrinopathy, as well as primary hypogonadism, and were not hospitalised. Diabetes mellitus, diabetic nephropathy or previous transplantation were not exclusion criteria. As controls we used a community-based group of healthy males matched for age and Body Mass Index (BMI). We assessed the BMI (kg/m) from body weight and height, the body fat content (%) by bioelectrical impedance and serum testosterone (ng/ml), SHBG (nmol/L) and estradiol (pg/ml) by standard methods. Testosterone < 3.25 ng/ml defined biochemical hypogonadism. In non-diabetic males, we calculated the homeostasis model assessment index (HOMA-R), an estimate of insulin resistance, from serum fasting insulin and glucose.
27 men (age 54.4 ± 19 years) on chronic hemodialysis (treatment duration 29.1 ± 14.4 months) and 51 healthy men (age 47.1 ± 9.6 years) were included. In men on hemodialysis vs. healthy men there were increased serum levels of SHBG (40.9 ± 26.9 vs. 27.6 ± 11.9 nmol/L; p = 0.031) and a significantly enhanced frequency of biochemical hypogonadism (22.2 vs. 3.9%; p = 0.011). In cases without diabetes (n = 22) a significant correlation was observed between the HOMA-R (r = -0.586, p = 0.004) and the fasting insulin levels (r = -0.650, p = 0.001) on the one hand and the serum SHBG levels on the other.
Our findings confirm enhanced prevalence of biochemical hypogonadism in males on chronic hemodialysis. In non-diabetic cases the serum levels of SHBG correlated with serum insulin and insulin resistance.
在终末期肾病男性患者中，生化性性腺功能减退是常见表现。睾酮和性激素结合球蛋白（SHBG）与胰岛素抵抗有关，胰岛素抵抗是尿毒症中一种众所周知的病症。本研究的目的是调查慢性血液透析男性患者中睾酮和SHBG血清水平与胰岛素抵抗的关系。
在一项横断面研究中，我们纳入了接受慢性血液透析治疗的男性，这些男性没有患急性疾病或其他内分泌病，也没有原发性性腺功能减退，并且未住院。糖尿病、糖尿病肾病或既往移植不是排除标准。作为对照，我们使用了一组以社区为基础的年龄和体重指数（BMI）匹配的健康男性。我们通过体重和身高评估BMI（kg/m），通过生物电阻抗评估体脂含量（%），并通过标准方法评估血清睾酮（ng/ml）、SHBG（nmol/L）和雌二醇（pg/ml）。睾酮<3.25 ng/ml定义为生化性性腺功能减退。在非糖尿病男性中，我们根据空腹血清胰岛素和葡萄糖计算稳态模型评估指数（HOMA-R），以评估胰岛素抵抗。
纳入了27名接受慢性血液透析的男性（年龄54.4±19岁，治疗时间29.1±14.4个月）和51名健康男性（年龄47.1±9.6岁）。与健康男性相比，接受血液透析的男性血清SHBG水平升高（40.9±26.9 vs. 27.6±11.9 nmol/L；p = 0.031），生化性性腺功能减退的发生率显著增加（22.2% vs. 3.9%；p = 0.011）。在无糖尿病的病例（n = 22）中，一方面HOMA-R（r = -0.586，p = 0.004）和空腹胰岛素水平（r = -0.650，p = 0.001）与另一方面血清SHBG水平之间存在显著相关性。
我们的研究结果证实慢性血液透析男性患者中生化性性腺功能减退的患病率增加。在非糖尿病病例中，SHBG血清水平与血清胰岛素和胰岛素抵抗相关。
