2型糖尿病男性患者合并性腺功能减退的危险因素分析

Analysis of risk factors on hypogonadism in male patients with type 2 diabetes

目的 探讨2型糖尿病男性患者合并性腺功能减退的危险因素.方法 选择男性2型糖尿病患者213例,根据睾酮水平分为低睾酮组75例和正常睾酮组138例.所有患者测定血压、血糖、血脂、胰岛素以及性激素,包括睾酮、性激素结合球蛋白（SHBG）、孕酮、催乳素、黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇、脱氢表雄酮（DHEA）,分析性激素与各指标的相关性.结果 与正常睾酮组相比,低睾酮组体重指数（BMI）、空腹胰岛素（FINS）及稳态模型评估的胰岛素抵抗指数（HOMA-IR）明显升高（均P〈0.05）,而LH、FSH、SHBG显著降低（均P〈0.05）;并且睾酮与FINS、HOMA-IR呈负相关（r=-0.142,-0.154, 均P〈0.05）,与LH、FSH呈正相关（r=0.157,0.138, 均P〈0.05）.代谢综合征（MS）患者总睾酮水平显著降低（P〈0.05）.Logistic回归分析显示BMI、MS、HOMA-IR、LH是2型糖尿病男性患者性腺功能减退的独立危险因素.结论 2型糖尿病男性患者常存在性腺功能减退,特别是MS患者尤为显著,其中BMI、HOMA-IR、LH、MS是性腺功能减退的危险因素.

Objective To investigate the risk factors of hypogonadism in male type 2 diabetic patients.Methods A total of 213 male patients with type 2 diabetes were enrolled and divided into low testosterone group （n=75） and normal testosterone group （n=138）. Blood pressure, blood glucose, blood lipids, serum insulin and sex hormones including total testosterone （TT）, sex hormone binding globulin （SHBG）, progesterone, prolactin, estradiol, luteinizing hormone （LH）, follicle-stimulating hormone （FSH）, dehydroepiandrosterone （DHEA） were measured in all patients.The correlations between the metabolic index and sex hormone levels were analyzed.Results Compared with normal testosterone group, body mass index （BMI）, fasting insulin （FINS）, and homeostasis model assessment insulin resistance （HOMA-IR） levels were significantly increased in low testosterone group（all P〈0.05）while LH, FSH, and SHBG levels were significantly decreased（all P〈0.05）.Pearson correlation analysis showed that TT was negatively correlated with FINS and HOMA-IR（r=-0.142,-0.154, both P〈0.05）while positively correlated with LH and FSH （r=0.157, 0.138, both P〈0.05）.TT level in patients with metabolic syndrome（MS） was significantly decreased （P〈0.05）.A multiple logistic regression analysis revealed that BMI, MS, HOMA-IR, and LH were significant independent risk factors for hypogonadism.Conclusions Hypogonadism often occurs in male patients with type 2 diabetes,especially in patients with MS.BMI, HOMA-IR, LH, and MS are risk factors for hypogonadism in male type 2 diabetic patients.