睾酮替代治疗改善性腺功能减退症青少年男性的胰岛素敏感性

Testosterone replacement in hypogonadotropic hypogonadal young male improves insulin sensitivity

目的评价短期睾酮替代治疗对性腺功能减退症青少年男性胰岛素敏感性的影响。方法（1）比较胰岛素抵抗指数（HOMA-IR）在性腺功能减退症青少年男性（n=21）与健康男性（n=18）之间的差异。（2）对患病组行9个月的睾酮替代治疗，比较治疗前后体重、腹围、握力、体脂含量、血总睾酮水平（TT）、空腹血糖和胰岛素、血脂谱和超敏C反应蛋白（hsCRP）的变化。结果（1）睾酮替代治疗前：患病组平均TT（0．9±0．6）nmol／L，明显低于健康组（18．8±3．2）nmol／L；患病组中有3例诊断为糖耐量受损，健康组中无糖耐量受损或糖尿病；患病组空腹胰岛素水平显著高于健康组，[（16．0±9．8）mdU／L vs（8．4±3．3）mIU／L，P=0．018）]；患病组HOMA—IR显著高于对照组，（3．7±2．4 vs 1．8±0．7，P=0．021）；（2）患病组经睾酮替代治疗后，空腹胰岛素水平下降[（16．0±9．8）mIU／L vs 12．1±7．4）mIU／L，P=0．03）]；HOMA-IR从3．7±2．4下降到2．7±1．7（P=0．045）；总胆固醇和甘油三酯都有下降，但差异无统计学意义（P均〉0．05）。hsCRP从（1．49±1．18）mg／L下降到（0．70±0．56）mg／L（P=0．025）。结论（1）性腺功能减退症患者胰岛素敏感性下降，发生糖代谢异常的风险增加。（2）睾酮替代治疗可改善患者的胰岛素敏感性，降低hsCRP水平。

Objective To evaluate the effect of testosterone replacement therapy in patients with hypogonatrophic hypogonadism （HH） on insulin sensitivity and high sensitivity C reactive protein （hsCRP）. Methods 21 males with HH, aged 15 -30, and 18 age, and BMI-matched healthy males underwent detection of homeostasis model assessment insulin resistance index （HOMA-IR）. Second, the values of weight, abdominal circumstance, grips strength, body composition, total testosterone （TT）, fast blood glucose and insulin, serum lipid profile, and hsCRP were compared before and after 9-month testosterone replacement therapy in the HH patient group. Results （ 1 ） Before treatment the TT level of the HH patients WAS （0. 9 ±0. 6） nmol/L, significantly lower than that of the healthy control group （ 18.8 ±3.2） nmol/L. The fast insulin level of the HH patients was （ 16. 0 ± 9. 8 ） mlU/L, significantly higher than that of the control group [ （8.4 ± 3.3 ） mIU/L, P = 0. 018 ]. The HOMA-IR of the HH patient was 3.7 ± 2. 4, not significantly different from that of the control group （ 1.8 ± 0. 7, P = 0. 021 ）. （2） After testosterone therapy, the fast insulin level of the HH patients decreased from （ 16.0 ± 9. 8） mIU/L to （ 12. 1 ± 7.4） mlU/L （ P = 0. 03 ） ; the HOMA-IR decreased from （ 3.7 ± 2. 4） to （ 2.7 ± 1.7 ） （ P = 0. 045 ） ; and the total cholesterol, LDL-c, HDL-c, and Triglyceride all decreased, but not significantly （ all P 〉 0. 05）. The hsCRP decreased from （ 1.49 ± 1.18） mg/L to （0. 70 ± 0. 56） mg/L （ P = 0. 025 ）. Conclusion Short period of testosterone replacement therapy in young HH male patients significantly improves the insulin sensitivity and decreases the risk of cardiovascular disease.