内源性雄激素与男性冠心病及血脂关系的研究

The association between endogenous androgens and coronary artery disease as well as serum lipid in males

目的:探讨内源性雄激素与男性冠心病及血脂之间的关系。方法:用断面调查的方法收集200例行择期冠状动脉造影的男性患者作为研究对象,根据冠状动脉造影结果分为冠心病组104例,对照组96例,用放免法检测血清游离睾酮、总睾酮、去氢表雄酮、去氢表雄酮硫酸酯、雌二醇和性激素结合球蛋白。结果:校正体重指数、血压及血脂因素的影响后,冠心病组血清游离睾酮、总睾酮、总睾酮/雌二醇及性激素结合球蛋白水平显著低于对照组(P<0.01或P<0.05);冠心病组与对照组血清去氢表雄酮、去氢表雄酮硫酸酯及雌二醇水平无显著性差异(均P>0.05)。冠心病患者血清游离睾酮、总睾酮及总睾酮/雌二醇与总胆固醇、甘油三酯及低密度脂蛋白胆固醇显著负相关(P<0.01或P<0.05);与高密度脂蛋白胆固醇显著正相关(P<0.01或P<0.05);性激素结合球蛋白与总胆固醇及甘油三酯显著负相关(P<0.01或P<0.05)。多元Logistic回归分析结果显示血清游离睾酮与冠心病的发生独立负相关。结论:男性冠心病患者血清睾酮水平降低,对血脂代谢具有不利影响,血清游离睾酮水平减低可能是冠心病的独立预测因子。

Objective： To investigate association between endogenous androgens and coronary artery disease as well as serum lipid in males. Methods： One hundred and four male subjects with coronary heart disease （CHD） and 96 male subjects without CHD proved by angiography were recruited. Serum free testosterone （FT）, total testosterone （TT）, dehydroepiandrosterone （DHEA）, dehydroepiandrosterone sulfate （DHEAS）, estradiol （E2） and sex hormone binding globulin （SHBG） were determined by radioimmunossays （RIA）. Results： Men with CHD had significantly lower levels of FT,TT,TT/E2 ratio and SHBG compared with controls after controlling for differences in blood pressure, body mass index and lipid profile（P〈0.05 or 0.01）.No obvious difference in DHEA,DHEAS and E2 level was found between two groups （all P〉0.05）.FT, TT and TT/E2 ratio were negatively correlated with total cholesterol, triglyceride and low density lipoprotein cholesterol, and positively correlated with high density lipoprotein cholesterol（P〈0.05 or 0.01）.Multivariate logistic regression analysis result demonstrated that FT was independently and inversely related to presence of CHD. Conclusion： The decrease of serum testosterone level in men with CHD may adversely affect on lipid metabolism. Low serum FT concentration is an independent predictor of CHD.