Abbasi A A, Drinka P J, Mattson D E, Rudman D
Department of Medicine, Medical College of Wisconsin, Milwaukee.
J Am Geriatr Soc. 1993 Sep;41(9):975-82. doi: 10.1111/j.1532-5415.1993.tb06764.x.
To determine the prevalences of and the associations between hyposomatomedinemia and hypogonadism in healthy young men, healthy old men, and chronically institutionalized old men.
Survey with serial blood tests.
Veterans Affairs nursing home and young and old men living in the community.
Three groups were studied: healthy young men (20-29 years old, n = 32), healthy old men (59-98 years old, n = 30), and chronically institutionalized old men (59-95 years old, n = 112).
Plasma insulin-like growth factor-I (IGF-I), total testosterone (TT), free testosterone (FT), and plasma insulin-like growth factor-II (IGF-II) were measured. In subjects with low testosterone level, serum luteinizing hormone (LH) was also determined. In a subset of chronically institutionalized old men with low IGF-I, the serum growth hormone (GH) level was analyzed during the first 4 hours of sleep.
A low IGF-I level (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 85% of the healthy old men when compared with healthy young men (P < 0.001), in 90% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 26% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). In chronically institutionalized old men with low IGF-I compared with healthy young men, nocturnal peaks of serum GH were < 2 ng/mL in most cases. Low TT (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 86% of the healthy old men when compared with healthy young men (P < 0.001), in 88% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 28% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). The results of FT were similar. In 80% of the institutionalized old men with low TT and FT, the serum LH level was low (< 20 mU/mL). In 53% of the institutionalized old men, the IGF-II level was below the lower 2.5 percentile of the healthy old men (P < 0.001). In both healthy and institutionalized old men, IGF-I and IGF-II levels were significantly correlated to each other (r = 0.6), but neither was significantly correlated to TT or FT. In the institutionalized old men, IGF-I was inversely correlated with age and with a diagnosis of dementia; TT and FT were inversely correlated with age and with the degree of dependency in ADL's.
Compared with healthy young men, most healthy old men have low serum IGF-I, TT, and FT levels. The geriatric hyposomatomedinemia and hypogonadism are more severe in institutionalized old men. In the latter group, both endocrine deficiencies are usually of central origin, but their occurrences are not significantly associated. Healthy old men usually have a low level of IGF-I compared with healthy young men, but a similar level of IGF-II; institutionalized old men are usually low in both values.
确定健康年轻男性、健康老年男性以及长期住院的老年男性中生长激素介质水平降低和性腺功能减退的患病率及其相关性。
进行系列血液检测的调查。
退伍军人事务疗养院以及社区中的年轻和老年男性。
研究了三组人群：健康年轻男性（20 - 29岁，n = 32）、健康老年男性（59 - 98岁，n = 30）以及长期住院的老年男性（59 - 95岁，n = 112）。
检测血浆胰岛素样生长因子 - I（IGF - I）、总睾酮（TT）、游离睾酮（FT）以及血浆胰岛素样生长因子 - II（IGF - II）。对于睾酮水平低的受试者，还测定血清促黄体生成素（LH）。在一部分IGF - I水平低的长期住院老年男性亚组中，分析睡眠最初4小时的血清生长激素（GH）水平。
与健康年轻男性相比，85%的健康老年男性出现IGF - I水平低（定义为低于对照组下限2.5百分位数的值）（P < 0.001）；与健康年轻男性相比，90%的长期住院老年男性出现IGF - I水平低（P < 0.001）；与健康老年男性相比，26%的长期住院老年男性出现IGF - I水平低（P < 0.001）。与健康年轻男性相比，大多数IGF - I水平低的长期住院老年男性血清GH夜间峰值在多数情况下< 2 ng/mL。与健康年轻男性相比，86%的健康老年男性出现TT水平低（定义为低于对照组下限2.5百分位数的值）（P < 0.001）；与健康年轻男性相比，88%的长期住院老年男性出现TT水平低（P < 0.001）；与健康老年男性相比，28%的长期住院老年男性出现TT水平低（P < 0.001）。FT的结果相似。在80%的TT和FT水平低的住院老年男性中，血清LH水平低（< 20 mU/mL）。在53%的住院老年男性中，IGF - II水平低于健康老年男性下限2.5百分位数（P < 0.001）。在健康和住院老年男性中，IGF - I和IGF - II水平彼此显著相关（r = 0.6），但两者与TT或FT均无显著相关性。在住院老年男性中，IGF - I与年龄以及痴呆诊断呈负相关；TT和FT与年龄以及日常生活活动依赖程度呈负相关。
与健康年轻男性相比，大多数健康老年男性血清IGF - I、TT和FT水平低。在住院老年男性中，老年人生长激素介质水平降低和性腺功能减退更为严重。在后者中，两种内分泌缺乏通常源于中枢，但它们的发生无显著相关性。与健康年轻男性相比，健康老年男性通常IGF - I水平低，但IGF - II水平相似；住院老年男性通常两者水平均低。
