多毛女性5α-还原酶活性的评估：血清雄烷二醇葡糖苷酸与尿中雄酮及本胆烷醇酮排泄量的比较

Gilad S, Chayen R, Tordjman K, Kisch E, Stern N

Institute of Endocrinology, Tel-Aviv Sourasky Medical Centre, Ichilov Hospital, Israel.

Clin Endocrinol (Oxf). 1994 Apr;40(4):459-64. doi: 10.1111/j.1365-2265.1994.tb02484.x.

OBJECTIVE

Recent evidence suggests that androstanediol glucuronide (AG), a metabolite of dihydrotestosterone (DHT) formed in skin, is frequently elevated in hirsute women, presumably reflecting enhanced 5 alpha-reductase activity. An alternative method of demonstrating 5 alpha-reductase activity is the androsterone (A)/aetiocholanolone (E) ratio in urine. A and E are the 5 alpha- and 5 beta-reduced metabolites, respectively, of androstenedione, which is the principal metabolite of dehydroepiandrosterone (D). Although serum AG and the urinary A/E ratio have both been considered valid methods for assessing 5 alpha-reductase activity, the two have not been previously compared in hirsute women. The present study was undertaken to assess 5 alpha-reductase activity in hirsute patients as determined by these two different methods.

PATIENTS AND MEASUREMENTS

We surveyed 47 untreated women (ages 17-33) with various degrees of hirsutism. Serum testosterone, bioavailable testosterone, dehydroepiandrosterone sulphate, and AG were determined. Additionally, A, E and D were measured in 24-hour collections of urine.

RESULTS

For the 47 women, 37 had elevated blood levels of AG (17.4 +/- 2.2, mean +/- SEM; normal < 8 nmol/l), but only 18 of these had an increased urinary A/E ratio (> 1.5). All but one of the remainder had elevated urinary and/or serum androgen levels. Overall, no significant correlation between AG and A/E was observed. There was a highly significant correlation between AG in serum and A in urine (r = 0.82, P < 0.001). AG was also positively related to dehydroepiandrosterone sulphate (r = 0.64; P < 0.005), bioavailable testosterone (r = 0.6; P < 0.001), aetiocholanolone (r = 0.58; P < 0.001) and total testosterone (r = 0.52; P < 0.01). In contrast, A/E was not significantly related to androgen production.

CONCLUSIONS

There is a poor correlation between AG and the A/E ratio in hirsute women. Although AG may be raised by increased 5 alpha-reductase activity, it is probably also affected by the presence of elevated androgens regardless of 5 alpha-reductase activity.

目的

最近有证据表明，雄烷二醇葡糖苷酸（AG）是皮肤中形成的二氢睾酮（DHT）的一种代谢产物，在多毛女性中其水平常常升高，这可能反映了5α-还原酶活性增强。另一种证明5α-还原酶活性的方法是尿液中的雄酮（A）/本胆烷醇酮（E）比值。A和E分别是雄烯二酮的5α-和5β-还原代谢产物，而雄烯二酮是脱氢表雄酮（D）的主要代谢产物。尽管血清AG和尿A/E比值都被认为是评估5α-还原酶活性的有效方法，但此前尚未在多毛女性中对两者进行比较。本研究旨在通过这两种不同方法评估多毛患者的5α-还原酶活性。

患者与测量

我们调查了47名未经治疗的女性（年龄17 - 33岁），她们有不同程度的多毛症。测定了血清睾酮、生物可利用睾酮、硫酸脱氢表雄酮和AG。此外，在24小时尿液收集样本中测量了A、E和D。

结果

对于这47名女性，37名的AG血水平升高（17.4±2.2，均值±标准误；正常<8 nmol/l），但其中只有18名的尿A/E比值升高（>1.5）。其余患者中除一人外，尿和/或血清雄激素水平均升高。总体而言，未观察到AG与A/E之间有显著相关性。血清AG与尿A之间存在高度显著相关性（r = 0.82，P < 0.001）。AG还与硫酸脱氢表雄酮（r = 0.64；P < 0.005）、生物可利用睾酮（r = 0.6；P < 0.001）、本胆烷醇酮（r = 0.58；P < 0.001）和总睾酮（r = 0.52；P < 0.01）呈正相关。相比之下，A/E与雄激素生成无显著相关性。