Pugeat M, Moulin P, Cousin P, Fimbel S, Nicolas M H, Crave J C, Lejeune H
Laboratoire de la Clinique Endocrinologique, Hôpital de l'Antiquaille, Lyon, France.
J Steroid Biochem Mol Biol. 1995 Jun;53(1-6):567-72. doi: 10.1016/0960-0760(95)00102-6.
The incidence of coronary artery disease is significantly higher in men than in women, at least until menopause. This gender difference could be explained by the action of sex steroids on the lipoprotein profile. In prepubertal children, high-density lipoprotein (HDL) cholesterol and triglyceride levels are similar between sexes, while adult men have generally lower HDL cholesterol and higher triglyceride levels than premenopausal adult women. Most cross-sectional studies have reported that sex hormone binding globulin (SHBG) and testosterone levels correlate positively with HDL cholesterol levels between sexes. Thus SHBG by modulating the balance in the biodisposal of testosterone and estradiol, might have a profound effect on the risk of cardiovascular disease. However, adjustment for body weight and body fat distribution weakens the association between SHBG, testosterone and HDL cholesterol. The negative correlation of fasting insulin with SHBG and HDL cholesterol levels in both sexes, and some evidence that insulin is an inhibitor of SHBG production in vitro, has suggested that hyperinsulinism might negatively regulate SHBG and HDL levels. It remains to be determined whether the inverse relationship between SHBG and insulin levels is coincidental or has a causal effect on the increase of atherosclerosis. Decreased SHBG has been shown to be predictive of the incidence of non-insulin-dependent diabetes mellitus in women but not in men, and of subsequent development of cardiovascular disease and overall mortality in postmenopausal women. SHBG is an index of androgenism in women and of insulin-resistance in both sexes, and might be useful in epidemiological studies of cardiovascular risk. However, in men, SHBG is not predictive of the occurrence of cardiovascular disease. Whether SHBG might have an intrinsic protective effect on the arterial wall through SHBG-receptors is still highly speculative.
冠状动脉疾病的发病率在男性中显著高于女性，至少在绝经前是这样。这种性别差异可以通过性类固醇对脂蛋白谱的作用来解释。在青春期前儿童中，男女之间的高密度脂蛋白（HDL）胆固醇和甘油三酯水平相似，而成年男性的HDL胆固醇水平通常低于绝经前成年女性，甘油三酯水平则高于她们。大多数横断面研究报告称，性激素结合球蛋白（SHBG）和睾酮水平在男女之间与HDL胆固醇水平呈正相关。因此，SHBG通过调节睾酮和雌二醇的生物处置平衡，可能对心血管疾病风险产生深远影响。然而，调整体重和体脂分布会削弱SHBG、睾酮与HDL胆固醇之间的关联。空腹胰岛素与男女SHBG和HDL胆固醇水平均呈负相关，并且有一些证据表明胰岛素在体外是SHBG产生的抑制剂，这表明高胰岛素血症可能对SHBG和HDL水平产生负调节作用。SHBG与胰岛素水平之间的负相关关系是巧合还是对动脉粥样硬化增加有因果影响，仍有待确定。已证明SHBG降低可预测女性而非男性非胰岛素依赖型糖尿病的发病率，以及绝经后女性心血管疾病的后续发展和总体死亡率。SHBG是女性雄激素作用和男女胰岛素抵抗的一个指标，可能在心血管风险的流行病学研究中有用。然而，在男性中，SHBG不能预测心血管疾病的发生。SHBG是否可能通过SHBG受体对动脉壁具有内在保护作用，仍然极具推测性。
