Herman S M, Robinson J T, McCredie R J, Adams M R, Boyer M J, Celermajer D S
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
Arterioscler Thromb Vasc Biol. 1997 Oct;17(10):2004-9. doi: 10.1161/01.atv.17.10.2004.
Male gender is an independent risk factor for coronary artery disease, and androgen administration has been associated with increased atherosclerosis in experimental animals. Since endothelial dysfunction is an important event in the atherogenic process, we hypothesized that androgen deprivation in adult men might be associated with enhanced arterial endothelial function. Using external vascular ultrasound, brachial artery diameter was measured at rest, after flow increase (causing endothelium-dependent dilatation) and after nitroglycerin (an endothelium-independent dilator). We studied 30 adult males aged 40 to 70 years: 10 had had bilateral orchidectomy and/or maximal androgen blockade for > or = 6 months for treatment of prostate cancer, and all were in complete remission (group 1). Ten healthy controls (group 2) and 10 controls who had remission from nonprostate cancers (group 3) were matched for age and smoking history. Testosterone levels were lower in men in group 1 versus groups 2 or 3 (0.8 +/- 0.1 versus 19.2 +/- 8.4 or 16.1 +/- 4.9 nmol/L, P < .001). By contrast, endothelium-dependent dilatation was markedly higher in group 1 than in groups 2 or 3 (6.2 +/- 3 versus 2.7 +/- 2 or 2.0 +/- 1.9%, P < .001). The nitroglycerin response was similar in all three groups (P = .92). On multivariate analysis, increased endothelium-dependent dilatation was significantly associated with low serum testosterone levels (P = .001) but not with cholesterol levels or with a past history of malignancy (P > .25). The withdrawal of male sex hormones may be associated with enhanced endothelial function in adult men. This is consistent with a deleterious effect of physiologic levels of male sex steroids on the arterial wall.
男性是冠状动脉疾病的独立危险因素，在实验动物中，给予雄激素与动脉粥样硬化增加有关。由于内皮功能障碍是动脉粥样硬化形成过程中的一个重要事件，我们推测成年男性雄激素缺乏可能与动脉内皮功能增强有关。使用体外血管超声，在静息状态下、血流增加后（引起内皮依赖性舒张）以及给予硝酸甘油后（一种非内皮依赖性舒张剂）测量肱动脉直径。我们研究了30名年龄在40至70岁之间的成年男性：10名因前列腺癌接受双侧睾丸切除术和/或最大雄激素阻断治疗≥6个月，且均处于完全缓解状态（第1组）。10名健康对照者（第2组）和10名非前列腺癌缓解期对照者（第3组）在年龄和吸烟史方面进行了匹配。第1组男性的睾酮水平低于第2组或第3组（0.8±0.1对19.2±8.4或16.1±4.9 nmol/L，P<.001）。相比之下，第1组的内皮依赖性舒张明显高于第2组或第3组（6.2±3对2.7±2或2.0±1.9%，P<.001）。三组的硝酸甘油反应相似（P=.92）。多因素分析显示，内皮依赖性舒张增加与低血清睾酮水平显著相关（P=.001），但与胆固醇水平或恶性肿瘤病史无关（P>.25）。成年男性体内雄激素的撤除可能与内皮功能增强有关。这与生理水平的男性性激素对动脉壁的有害作用是一致的。
