男性2型糖尿病患者合并低促性腺激素性性腺功能减退的临床观察

Study on type 2 diabetic patients with hypogonadotropic hypogonadism

目的探讨男性T2DM患者性腺功能减退的原因。方法选择男性T2DM患者156例,分为低睾酮(TT)组(n=59)和正常TT组(n=97),测定血压、血糖、血脂、胰岛β细胞功能,以及性激素[包括血清TT、性激素结合球蛋白(SHBG)、孕激素(P)、催乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)、脱氢表雄酮(DHEA)],比较两组性激素、糖脂代谢指标及胰岛素等的差异,并分别按BMI及LH进行分组,比较各组间TT水平。结果与正常TT组比较,低TT组BMI、FIns、2 hIns及胰岛素抵抗指数(HOMA-IR)升高(￡=3.76,2.03,2.68,2.13,P<0.05),低TT组LH、FSH、SHBG、E2降低(t=-2.94,-2.16,-3.08,-3.50,P<0.05);与高体重组比较,低体重组TT增加(P<0.05);与低LH组相比,高LH组TT增加(P<0.05)。相关分析显示,TT与BMI、FIns及HOMA-IR呈负相关(r=-0.33,-0.18,-0.17,P<0.05),与LH、FSH、E2呈正相关(r=0.14,0.16,0.28,P<0.05)。结论男性T2DM患者往往会合并低促性激素性性腺功能减退症。

Objective To investigate the incidence of hypogonadlsm in male type 2 diabetic patients. Methods A total of 156 patients were enrolled and divided into low TT group （n=59） and normal TT group （n=97）. Blood pressure, blood glucose, blood lipids, serum insulin and sex hormones including total testosterone （TT）, sex hormone binding globulin （SHBG）, pregnendione （P）, prolactin （PRL）, estradioI （E2）, luteinizing hormone （LH）, follicle-stimulating hormone （FSH） and dehydroepiandrosterone （DHEA） were measured in all patients. The correlations between the metabolic indexes and sex hormone levels were analyzed. Patients were divided into three subgroups according to BMI and LH level. The levels of TT among different groups were compared. Results Compared with normal TT group, INS and HOMA-IR levels were significantly increased in low TT group（t= 3.76, 2.03, 2.68 and 2.13, respectively, all P〈0. 05） ;LH, FSH, SHBG and E2 levels were significantly decreased in low TT group （t=- 2.94,-2.16,-3.08 and -3.50, respectively, all P〈0.05）. Compared with low BMI group, TT decreased significantly in high BMI group （P〈 0. 05）; Compared with low LH group, TT increased significantly in high LH group（P〈0. 05）. Pearson correlation analysis found that ＂IT was negatively correlated with FINS, PINS and HOMA-IR（r=-0. 33, -0. 18 and -0. 17, respectively, all P〈0. 05）. TT were positively correlated with LH, FSH and E2（r=0.14, 0. 16 and 0.28, respectively, all P〈0.05）.Conclusion Hypogonadotropic hypogonadism often occurs in male type 2 diabetic patients.