成年男性血清生殖激素水平与代谢综合征关系的调查研究

Levels of serum reproductive hormones and metabolic syndrome in adult males

目的:调查我国社区成年男性代谢综合征(MS)的患病率以及生殖激素与代谢综合征之间的关系。方法:采用整群及年龄分层抽样相结合的方法,调查河北、陕西和江苏3省20~89岁以上成年社区男性人群共3 600例,进行生殖激素、生化指标检测以及身体基本参数测量。结果:共获得有效血清样本3 332例。社区人群中成年男性MS的患病率为38. 5%,MS组游离睾酮指数(FTI)显著高于对照组(0. 45±0. 19 vs 0. 39±0. 15,P <0. 01),而总睾酮(TT)、性激素结合蛋白(SHBG)及睾酮分泌指数(TSI)均显著低于对照组[TT:(13. 37±4. 23) nmol/L vs (16. 35±4. 78) nmol/L,SHBG:(33. 32±14. 91) nmol/L vs (47. 13±20. 50) nmol/L,TSI:3. 14±1. 80 vs 3. 64±1. 92,P <0. 01],计算的游离睾酮(cFT)和黄体生成素(LH)两组之间没有统计学意义(P> 0. 05)。Spearman等级相关分析表明,除收缩压(SBP)外,TT、SHBG与MS各个组分均密切相关(P <0. 01),而cFT只与高密度脂蛋白胆固醇(HDL)、空腹血糖(FBG)、SBP有相关性(P <0. 01)。多重线性回归分析中,在调整年龄、吸烟及饮酒因素、体质量指数(BMI)影响后,MS各组分均与SHBG水平显著相关(P <0. 01),MS各组分中血压的升高与血清TT水平无相关性(P> 0. 05)。Logistic回归分析中调整年龄、吸烟、饮酒、BMI和TT的影响因素后,SHBG仍然是MS发病的主要独立危险因素(OR:0. 965,95%CI:0. 958~0. 973,P <0. 01)。结论:cFT水平与MS无关,SHBG是MS发病的主要独立的危险因素。

Objective： To investigate the prevalence of metabolic syndrome （MS） and its relationship with reproductive hor-mones in adult males in China. Methods： Using the cluster and stratified sampling methods, we conducted an investigation among 3 600 adult males aged over 20 years in Hebei, Shaanxi and Jiangsu provinces. We obtained their reproductive hormone levels, bio-chemical indicators and basic body indexes and compared them between the two groups of subjects. Results ： A total of 3 332 valid serum samples were collected, which revealed a prevalence rate of MS of 38.5% in the adult males. Compared with the non-MS sub-jects, the MS males showed a significantly higher free testosterone index （ FTI, 0.39 ± 0.15 vs O. 45 ± 0.19, P 〈 0.01 ） but lower levels of total testosterone （TT, [ 16.35 ± 4.78 ] vs [ 13.37 ±4.23 ] nmo/L, P 〈 0.01 ） and sex hormone-binding globulin （ SH-BG, [47.13 ± 20.50] vs [33.32 ± 14.91] nmoL/L, P 〈 0.01） and testosterone secretion index （TSI, 3.64 ± 1.92 vs 3.14 ± 1.80, P 〈 0.01 ）. There were no statistically significant differences between the two groups in the levels of calculated free testosterone （cFT） and LH （P 〉 0.05 ）. Spearman rank correlation analysis showed that the levels of serum TT and SHBG were correlated with all the indicators of MS （ P 〈 0.01 ） except systolic blood pressure （ SBP）, while that of cFT only with the levels of high-density lipo-protein （HDL）, fasting blood glucose （FBG） and SBP （P 〈 0.01 ）. After adjusted for age, smoking, drinking, and body mass in-dex （BMI）, all the MS indicators were significantly associated with the SHBC level （P 〈 0.01 ）, but not high blood pressure with the serum TT level （P 〉 0.05 ）. After adjusted for the age, smoking, drinking, BMI and TT, the serum SHBC level was the main inde-pendent risk factor for MS （OR： 0.965, 95% CI： 0.958-0.973, P 〈 0.01）. Conclusion： The level of serum cFT is not correla-ted with while that of SHBG is the main independent risk factor for metabolic syndrome in adult males in China.