胰岛素抵抗替代预测指标对性腺功能减退症的诊断价值

Predictive value of insulin resistance surrogates in hypogonadism

目的探讨胰岛素抵抗替代预测指标对性腺功能减退症的诊断价值,以获得筛查性腺功能减退症的简易指标。方法选取中国宁阳县居住时间5年以上且年龄为40~65岁的男性居民4249例,根据总睾酮水平分为性腺功能减退组(总睾酮水平<12 nmol/L)588例和性腺功能正常组(总睾酮水平≥12 nmol/L)3661例。收集两组人群腰围、臀围、舒张压等基线资料,检测空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及血清总睾酮。比较两组稳态模型评估胰岛素抵抗指数(HOMA-IR)以及胰岛素抵抗替代预测指标甘油三酯高密度脂蛋白胆固醇比值(TG/HDL-C)、甘油三酯葡萄糖指数(TyG)、胰岛素抵抗代谢评分(METS-IR)、甘油三酯葡萄糖体质量指数(TyG-BMI)的差异;采用Pearson相关分析血清总睾酮水平与胰岛素抵抗替代预测指标的相关性,多因素Logistic回归模型分析性腺功能减退症的危险因素,受试者工作特征(ROC)曲线评估胰岛素抵抗替代预测指标对性腺功能减退症的诊断价值。结果性腺功能减退组腰围、臀围、舒张压、TG、TC、LDL-C、FPG、糖化血红蛋白、胰岛素水平高于性腺功能正常组,HDL-C、总睾酮水平低于性腺功能正常组(P均<0.05)。性腺功能减退组HOMA-IR、TyG、TyG-BMI、TG/HDL-C和METS-IR高于性腺功能正常组(P均<0.05)。血清总睾酮水平与HOMA-IR、TG/HDL-C、TyG、METS-IR、TyG-BMI呈负相关(r分别为-0.164、-0.206、-0.388、-0.416、-0.437,P均<0.05)。HOMA-IR和TyG-BMI是性腺功能减退症的危险因素(P均<0.05);TG/HDL-C、TyG、TyGBMI、METS-IR、HOMA-IR诊断性腺功能减退症的ROC曲线下面积、敏感度、特异度比较差异均无统计学意义(P均>0.05)。结论TyG-BMI是性腺功能减退的独立危险因素;胰岛素抵抗预测替代指标TyG、TyG-BMI和METS-IR与常用指标HOMA-IR具有相同的性腺功能减退诊断能力。

Objective To explore the predictive value of insulin resistance surrogates on hypogonadism and to determine simple screening indicators for hypogonadism.Methods Totally 4249 patients who lived in Ningyang County of China for at least 5 years and aged 40 years and older were selected,and according to total testosterone,they were divided into two groups:the normal testosterone group(total testosterone<12 mmol/L,n=588)and hypogonadism group(total testosterone≥12 mmol/L,n=3661).The demographic and anthropometric indices including waist circumference,hip circumference and diastolic blood pressure,and biochemical indices including fasting blood glucose(FPG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and total testosterone levels were obtained.Homeostasis model assessment for insulin resistance(HOMA-IR),triglycerideto-high density lipoprotein cholesterol ratio(TG/HDL-C),triglyceride-glucose(TYG)index,metabolic score for IR(METS-IR)and TYG-BMI index were compared between two groups.Pearson correlation was performed to analyze the correlation between total testosterone and insulin resistance surrogates.Multivariate Logistic regression analysis was performed to analyze the risk factors of hypogonadism.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of insulin resistance surrogates in hypogonadism.Results Compared with the normal testosterone group,the levels of waist circumference,hip circumference,diastolic blood pressure,TG,TC,LDL-C,FPG,HbA1c,and insulin significantly increased,and the level of HDL-C and total testosterone levels decreased in the hypogonadism group(all P<0.05).HOMA-IR,TyG,TyG-BMI,TG/HDL-C and METS-IR were significantly higher in the hypogonadism group than in the normal testosterone group(all P<0.05).Pearson correlation showed that HOMA-IR,TG/HDL-C,TyG,METS-IR,and TyG-BMI were negatively correlated with total testosterone(r=-0.164,-0.206,-0.388,-0.416,-0.437,respectively;all P<0.05).HOMA-IR and TyG-BMI were independent risk factors for hypogonadism.TG/HDLC,TyG,Tyg-BMI,METS-IR and HOMA-IR in the diagnosis of hypogonadism showed no statistically significant differences in area under ROC curve,sensitivity,or specificity(all P>0.05).Conclusions TyG-BMI is an independent risk factor for hypogonadism.TyG,Tyg-BMI and METS-IR have the similar diagnostic ability of hypogonadism as HOMA-IR.