Tibblin G, Adlerberth A, Lindstedt G, Björntorp P
Department of Family Medicine, University of Uppsala, Sweden.
Diabetes. 1996 Nov;45(11):1605-9. doi: 10.2337/diab.45.11.1605.
The results of recent studies suggest that a relative hypogonadism in men is associated with several established risk factors for prevalent diseases. Therefore, we determined total and free testosterone, luteinizing hormone (LH), and sex-hormone binding globulin (SHBG) in a cohort of randomly selected men (n = 659) at 67 years of age. These data were analyzed cross-sectionally in relation to blood glucose and serum insulin, which were measured while fasting and after an oral glucose tolerance test, in addition to plasma lipids and blood pressure. The data were also analyzed in relation to impaired glucose tolerance (IGT) and diabetes, which were discovered at examination or earlier diagnosis. Risk factors for the development of diabetes up to 80 years of age were analyzed with univariate and multivariate statistics. Total and free testosterone and SHBG concentrations correlated negatively with glucose and insulin values; total testosterone and SHBG, with triglycerides; and SHBG, with blood pressure (from P < 0.05 to P < 0.01). Men with IGT or newly diagnosed diabetes had higher BMI values (26.2 +/- 0.31 and 27.0 +/- 0.59 [mean +/- SE], respectively) and waist circumference (99.0 +/- 1.03 and 100.5 +/- 1.57) than nondiabetic men (BMI, 25.1 +/- 0.14; waist circumference, 95.4 +/- 0.47; P < 0.05), indicating abdominal obesity. Such men and men with previously diagnosed diabetes had, in general, lower total and free testosterone and SHBG levels, while those for LH were not different. In multivariate analyses that included BMI, waist-to-hip ratio, total and free testosterone, and SHBG, the remaining independent predictors for the development of diabetes were low total testosterone (P = 0.015) and, on the borderline, low SHBG (P = 0.053). In relation to nondiabetic men, the risk ratio for mortality, myocardial infarction, and stroke increased gradually and significantly from 1.18 to 1.68, from 1.51 to 1.78, and from 1.72 to 2.46 in men with IGT, newly diagnosed diabetes, and previously known diabetes, respectively. It was concluded that low testosterone and SHBG concentrations in elderly men are associated with established risk factors for diabetes and in established diabetes. Moreover, low testosterone levels independently predict the risk of developing diabetes. In different degrees of expression, the diabetic state predicts strongly (and gradually mortality from) myocardial infarction and stroke. It has been suggested that a relative hypogonadism might be a primary event, because other studies have shown that testosterone deficiency is followed by insulin resistance, which is ameliorated by testosterone substitution. The data suggest that the relative hypogonadism involved might be of both central and peripheral origin.
近期研究结果表明，男性相对性腺功能减退与几种常见疾病的既定风险因素相关。因此，我们测定了一组随机选取的67岁男性（n = 659）的总睾酮、游离睾酮、促黄体生成素（LH）和性激素结合球蛋白（SHBG）。除了血脂和血压外，还对这些数据进行了横断面分析，以研究空腹及口服葡萄糖耐量试验后测量的血糖和血清胰岛素。还针对检查时发现或更早诊断出的糖耐量受损（IGT）和糖尿病进行了数据分析。采用单变量和多变量统计分析了80岁前患糖尿病的风险因素。总睾酮、游离睾酮和SHBG浓度与血糖和胰岛素值呈负相关；总睾酮和SHBG与甘油三酯呈负相关；SHBG与血压呈负相关（P < 0.05至P < 0.01）。IGT或新诊断糖尿病的男性的BMI值（分别为26.2 +/- 0.31和27.0 +/- 0.59 [平均值 +/- 标准误]）和腰围（99.0 +/- 1.03和100.5 +/- 1.57）高于非糖尿病男性（BMI，25.1 +/- 0.14；腰围，95.4 +/- 0.47；P < 0.05），表明存在腹型肥胖。此类男性以及先前诊断为糖尿病的男性总体上总睾酮、游离睾酮和SHBG水平较低，而LH水平无差异。在包括BMI、腰臀比、总睾酮、游离睾酮和SHBG的多变量分析中，糖尿病发生的其余独立预测因素为总睾酮水平低（P = 0.015）以及处于临界值的SHBG水平低（P = 0.053）。与非糖尿病男性相比，IGT男性、新诊断糖尿病男性和先前已知糖尿病男性的死亡、心肌梗死和中风风险比分别从1.18逐渐显著增加至1.68、从1.51增加至1.
