TT、TSI、FTI评估男性雄激素水平价值的初步研究

Preliminary study on TT,TSI and FTI in the assessment of male androgen level

目的:游离睾酮(FT)是有活性的睾酮,可以准确反应男性雄激素水平,是判定男性雄激素缺乏最可靠的检验指标,但是检测方法复杂,所以目前常用计算游离睾酮(cFT)替代。血清总睾酮(TT)、睾酮分泌指数(TSI)、游离睾酮指数(FTI)是3种常用的判定男性雄激素缺乏的指标。通过研究上述指标与cFT的相关性,探讨TT、TSI、FTI评估男性雄激素水平的价值。方法:选取大连医科大学附属第一医院男科门诊2012年1月至2012年12月就诊的男科患者161例,测定患者血清总睾酮(TT)、黄体生成素(LH)、性激素结合蛋白(SHBG)和白蛋白(ALB),通过Vermeulen公式计算cFT、睾酮分泌指数(TSI=TT/LH)、游离睾酮指数(FTI=TT/SHBG)。以TT≤11.5nmol/L、TSI≤2.8nmol/IU、FTI≤0.42nmol/nmol为参考截点值,cFT≤0.3nmol/L为标准,探讨TT、TSI、FTI评估男性雄激素水平的价值。结果:以cFT为评估标准,评估男性雄激素水平的符合率分别为:TT 84.9%、TSI 74.0%、FTI 71.1%。诊断男性雄激素缺乏的漏诊率分别为TT 33.3%、TSI 24.6%、FTI 62.3%,诊断男性雄激素缺乏的误诊率分别为TT 2.1%、TSI 26.9%、FTI 5.2%。Kappa值分别为:TT 0.676、TSI 0.472、FTI 0.411。P值均小于0.01,具有统计学意义。结论:(1)TT、TSI、FTI无法替代cFT,准确评估男性雄激素水平仍需检测cFT。(2)TT、TSI在初步评估男性雄激素水平方面有参考价值:①TT评估男性雄激素缺乏的准确性好;②TSI可作为筛查男性雄激素缺乏的指标。(3)相对于TT、TSI,FTI在评估男性雄激素水平方面价值较小。

Objectives： Free testosterone is active, accurately reflecting the male androgen levels. FT is the most reliable test indicator to determine male androgen deficiency. Considering the detection method is complex and costly, free testosterone （cFT） calculating is commonly used as an alternative. Male serum total testosterone （TT）, the testosterone secretion index （TSI）, free testosterone index （FTI） are three commonly used indicators to determine male androgen deficiency. The research focuses on the value of the three indicators and cFT of assessing the male androgen level. Method： 161 cases of male patients presenting in the First Affiliated Hospital of Dalian Medical Male University from January 2012 to December 2012 were selected, some indicators such as serum testosterone （TT）, luteinizing hormone （LH）, sex hormone binding globulin （SHBG） and albu- min （ALB） were tested and then cFT, the testosterone secretion Index （TSI = TF/LH） and the free testosterone index （FTI = tit / SHBG） were calculated by Vermeulen formula. TT≤11.5nmol / L, TSI≤ 2. 8nmol/IU, FTI≤ 0. 42nmol/nmol are re- garded as the critical value, cFT ≤0. 3nmol / L as the gold standard to study the value of TT, TSI, FTI assessing the male an-drogen level. Results： Regarding TT, TSI and FTI as evaluation criteria and cFT as the evaluation gold standard, the conform rate （accuracy） were 84.9%, 74. 0% and 71.1% respectively; the rate of missed diagnosis of male hypogonadism were 33.3% , 24. 6% and 62.3% ; the male androgen deficiency misdiagnosis rate were 2. 1%, 26.9%, 5.2%. Kappa values were qT 0. 676, TSI 0. 472 and FTI 0. 411. P values were less than 0.01, with statistical significance. Conclusion ： 1. eFT is the most accurate indicator assessing male androgen level, which cannot be substituted by TT, TSI, FFI. 2. TY and TSI are referable in preliminary assessing male androgen level, including （ 1 ） TT is accurate in assessing male androgen level ; （ 2 ） TSI can be used as a screening indicator of male androgen deficiency. 3. FTI is less referable in preliminary assessing male androgen level comparing with TT and TSI.