血清睾酮与骨钙素水平在广西地区男性勃起功能障碍中的流行病学研究

发布时间：2018-05-20 02:26

本文选题：骨钙素 + 睾酮　；参考：《广西医科大学》2015年博士论文

【摘要】：目的：睾酮在阴茎勃起的生理过程中起到非常重要的作用,但是睾酮与勃起功能障碍(erectile dysfunction, ED)的关系并不十分清楚,所以我们利用基于普通人群的大样本流行病调查数据,探索血清总睾酮(total testosterone, TT),游离睾酮(free testosterone, FT),以及生物活性睾酮(bio-available testosterone)和ED的关系。方法：我们纳入1776名2009年9月至2009年12月来广西防城港市第一人民医院参加体检的男性,年龄范围在20岁至77岁之间。通过国际勃起功能评估量表(five-item International Index of Erectile Function, IIEF-5)对ED进行评估。TT,性激素结合球蛋白(sex hormone binding globulin, SHBG)和其他生化指标在检验科检测,FT和BT通过Vermeulen公式来计算。其他收集的数据还包括吸烟,饮酒,体力活动以及代谢综合征。结果：ED (IIEF-522)的患病率为47.6%。患有ED的男性比健康男性有较高的年龄,并且有较多的入每天吸烟超过20支,以及更多的人每周饮酒超过3次,并且有更多的人同时有血压升高(P=0.036),或者血糖升高(P0.001)的表现。SHBG随年龄增加而升高的趋势,与SHBG随ED严重程度增加而升高的趋势基本一致(P0.001)。TT随ED不同程度的变化趋势经分析没有统计学意义(P=0.418),但是在年龄校正之后,TT与ED患病率有正相关关系[odds ratio (OR)=1.02, 95% CI (confidence internal):1.00-1.04]。在未校正任何协变量之前,FT、BT与ED患病率是负相关关系(OR=0.14,95%CI: 0.06-0.33; OR=0.92 (95% CI:0.89-0.96, respectively),并且负相关关系独立于吸烟,饮酒,体力运动,高血脂,以及高血糖等风险因素。结论：FT和BT与ED患病率是负相关,而TT与ED之间的正相关关系可能是受到SHBG的影响。目的：睾酮水平的下降和勃起功能障碍(erectile dysfunction, ED)的患病率有关,但是睾酮是否对ED发病率有预测作用还没有确定。为了研究睾酮与ED发病率之间的关系,我们基于前期横断面研究的结果,也是利用普通人群的数据,开展这项前瞻性队列研究。方法：该队列研究纳入733名2009年9月至2009年12月来广西防城港市第一人民医院参加体检的男性,年龄范围在20岁至77岁之间,并在4年后进行随访。ED的评估还是通过国际勃起功能评估量表(five-item International Index of Erectile Function, IIEF-5)对ED进行评估。TT,性激素结合球蛋白(sex hormone binding globulin, SHBG)和其他生化指标在检验科检测,FT和BT通过Vermeulen公式来计算。其他收集的数据还包括吸烟,饮酒和体力活动。分析方法采用Cox比例风险模型。结果：在最高三分位水平FT(RR=0.21,95%CI:0.09-0.46),以及最低三分位水平的SHBG (RR=0.38,95%CI:0.19-0.73),均与ED的低发病率有关。在年龄范围21岁至40岁之间的年轻男性中,随着FT或BT水平的增加,ED的发病风险会显著降低[adjusted RR and 95%CI: 0.78 (0.67-0.92) and 0.75 (0.62-0.95), respectively]. TT在校正SHBG之后与ED是负相关(RR=0.89,95%CI:0.81-0.98),而SHBG在校正TT之后是正相关(RR=1.04,95%CI:1.02-1.06)。当FT低水平合并SHBG高水平的情况下,ED的发病风险相对其他情况是最高(adjusted RR=4.61,95%CI:1.33-16.0)。结论：年轻人的高水平FT和BT均能对立预测ED的发病风险是下降的。建议更深入的研究来探索睾酮和ED之间的分子生物学机制。目的：骨钙素可以调节能量代谢,也能增加睾酮生成。尽管有研究发现骨钙素与睾酮是正相关关系,但是代谢因素在两者之间的关系中起到什么作用还不清楚。方法：我们纳入2400名2009年9月至2009年12月来广西防城港市第一人民医院参加体检的男性,年龄范围在20岁至69岁之间。根据检测的生化指标进行代谢因素的评估,其中代谢综合征(Metabolic syndrome, MetS)的定义是根据国际胆固醇教育计划成人治疗协作组(National Cholesterol Education Program Adult Treatment Panel)针对亚洲人制定的标准。血清骨钙素,总睾酮(total testosterone, TT),以及性激素球蛋白(sex hormone binding globulin, SHBG)在检验科检测,游离睾酮(free testosterone, FT)和生物活性睾酮(bioavailable testosterone, BT)通过Vermeulen公式来计算。采用的分析方法是多因素线性回归。结果：骨钙素与TT, FT以及BT在未校正任何协变量的模型中是正相关关系(all P0.001)。在校正年龄之后,骨钙素与TT之间正相关关系依然有统计学意义(p=0.17,95%CI=0.14-0.20),并且这种关系在MetS亚组也没有减弱,包括高血脂,高血糖,高血压以及血脂异常者四个亚组,而自腹型肥胖这个亚组,两者的关系反而增强(p=0.21,95%CI=0.12-0.30)。在深入分析中校正SHBG之后,骨钙素依然在腹型肥胖亚组里,与TT, FT, BT保持稳定的正相关关系(P0.05)。结论：血清总骨钙素水平与睾酮水平是正相关关系,两者之间的关系可能是由于SHBG或者腹型肥胖介导的。目的：骨钙素低水平是代谢综合征的危险因子,而代谢综合征作为勃起功能障碍(erectile dysfunction, ED)的危险因子,骨钙素与ED之间的关系还没有人研究,所以我们开展这个前瞻性队列研究,探索骨钙素水平与ED发病率之间的关系。方法：我们纳入757名2009年9月至2009年12月来广西防城港市第一人民医院参加体检的男性,年龄范围在20岁至69岁之间,并在2年后进行随访。ED的评估还是通过国际勃起功能评估量表(five-item International Index of Erectile Function, IIEF-5)对ED进行评估。骨钙素水平在检验科进行检测。采用的分析方法是Cox比例风险模型。结果：新发ED的男性比两年内没有ED发生的男性,其血清骨钙素水平偏低(P0.05).最高三分位水平的血糖,与ED升高的发病率有关(RR=1.94,95%CI:1.44-2.61).在患有高血糖(空腹血糖=5.6mmol/L)的男性中,高水平的骨钙素会增加ED的发病率(adjusted RR=2.65,95%CI：1.74-4.02)。相比血糖水平低且骨钙素水平高的男性,血糖水平高且骨钙素水平高的男性有最高的ED发病风险(adjusted RR=2.31,95%CI:1.57-3.42),即使把轻度ED的人群去掉,敏感性分析的结果依然提示,血糖水平高且骨钙素水平高相对其他情况有最高的ED发病风险(adjusted RR=2.73,95%CI:1.16-6.43)。结论：高骨钙素水平,以及高血糖水平,可能是在普通人群中能有效预测ED发病风险的因子,建议更多研究深入探索骨钙素与ED的关系。
[Abstract]:Objective: testosterone plays a very important role in the physiological process of penile erection, but the relationship between testosterone and erectile dysfunction (ED) is not very clear, so we explored the total testosterone (total testosterone, TT), free testosterone (free TE) based on the large sample epidemiological data based on the general population. Stosterone, FT), and the relationship between bioactive testosterone (bio-available testosterone) and ED. Methods: We included 1776 men who participated in physical examination in the first people's Hospital of Fangchenggang, Guangxi, from September 2009 to December 2009. The age range was between the ages of 20 and 77. Through the five-item International Index (five-item International Index) Of Erectile Function, IIEF-5) evaluated the ED by.TT, the sex hormone binding globulin (sex hormone binding globulin, SHBG) and other biochemical indicators were tested in the laboratory. FT and other data included smoking, drinking, physical activity and metabolic syndrome. Men with 47.6%. with ED had higher age than healthy men, and more than 20 cigarettes per day, and more people drinking more than 3 times a week, and more people with elevated blood pressure (P=0.036), or elevated blood sugar (P0.001), the trend of.SHBG to increase with age, and SHBG with ED severity. The trend of increase and increase was basically consistent (P0.001).TT with different degrees of ED, and there was no statistical significance (P=0.418), but after age correction, the incidence of TT and ED was positively related to [odds ratio (OR) =1.02, and 95% CI (confidence): It is a negative correlation (OR=0.14,95%CI: 0.06-0.33; OR=0.92 (95% CI:0.89-0.96, respectively), and the negative correlation is independent of smoking, drinking, physical exercise, hyperlipidemia, and high blood sugar risk factors. Conclusion: FT and BT are negatively correlated with the prevalence of ED, and the positive correlation between TT and ED may be influenced by SHBG. The decline in testosterone levels is associated with the prevalence of erectile dysfunction (ED), but whether testosterone has a predictive effect on the incidence of ED is not yet determined. In order to study the relationship between testosterone and the incidence of ED, we are based on the results of previous cross-sectional studies and are using data from the general population to carry out this prospective team. Methods: the cohort study was included in 733 men who participated in physical examination in the first people's Hospital of Fangchenggang, Guangxi, from September 2009 to December 2009. The age range was between the ages of 20 and 77, and the follow-up.ED assessment after 4 years or the five-item International Index of Erectile Function, IIEF-5) evaluation of ED.TT, sex hormone binding globulin (sex hormone binding globulin, SHBG) and other biochemical indicators in the laboratory. FT and BT are calculated by Vermeulen formula. Other data collected include smoking, drinking and physical activity. The analytical method uses a Cox proportional risk model. Results: at the highest level of three FT (RR=0.21,95%CI:0.09-0.46), and SHBG (RR=0.38,95%CI:0.19-0.73) at the lowest level of three, were all related to the low incidence of ED. Among young men aged 21 to 40, the risk of ED was significantly reduced with the increase of FT or BT levels [adjusted RR and 95%CI: 0.78]. Pectively]. TT is negatively correlated with ED after correcting SHBG (RR=0.89,95%CI:0.81-0.98), and SHBG is positive correlation (RR=1.04,95%CI:1.02-1.06) after correcting TT. When FT low level combines SHBG high level, ED incidence is the highest (adjusted). T can predict that the risk of ED is down. A further study is suggested to explore the molecular biological mechanism between testosterone and ED. Methods: We included 2400 men who participated in physical examination in the first people's Hospital of Fangchenggang, Guangxi, from September 2009 to December 2009. The age range was between 20 and 69 years. The metabolic factors were evaluated according to the biochemical parameters tested. The definition of Metabolic syndrome (MetS) was based on the definition of metabolic syndrome. The international Cholesterol Education Program (National Cholesterol Education Program Adult Treatment Panel) is a standard for Asians. Serum osteocalcin, total testosterone (total testosterone, TT), and sex hormone globulin (sex hormone) are tested in the laboratory. E, FT) and bioactive testosterone (bioavailable testosterone, BT) are calculated by the Vermeulen formula. The analytical method used is multifactor linear regression. Results: osteocalcin and TT, FT, and BT are positive correlation (all P0.001) in the models that have not corrected any covariates. After the correction of age, the positive correlation between osteocalcin and TT is in relation to TT. There was still statistical significance (p=0.17,95%CI=0.14-0.20), and the relationship was not weakened in the MetS subgroup, including four subgroups of hyperlipidemia, hyperglycemia, hypertension, and dyslipidemia, while the relationship between the two groups was enhanced (p=0.21,95%CI= 0.12-0.30). After an in-depth analysis of SHBG, osteocalcin still remained. There was a positive correlation between the abdominal obesity subgroup and the TT, FT and BT (P0.05). Conclusion: the serum total osteocalcin level is positively correlated with the testosterone level, and the relationship between them may be mediated by SHBG or abdominal obesity. Objective: low osteocalcin is a risk factor for metabolic syndrome, and metabolic syndrome is the Bob The risk factors for erectile dysfunction (ED) and the relationship between osteocalcin and ED have not been studied. So we conducted this prospective cohort study to explore the relationship between the level of osteocalcin and the incidence of ED. Methods: We included 757 people's Hospital in Fangchenggang, Guangxi, from September 2009 to December 2009. Men with a physical examination were between 20 and 69 years of age and were followed up for.ED assessment after 2 years or assessed by the five-item International Index of Erectile Function, IIEF-5. The level of osteocalcin was tested in the laboratory. The analytical method used was a Cox proportional hazard model. Results: the level of serum osteocalcin in men with new ED was lower than that of men without ED within two years (P0.05). The highest level of blood sugar at the highest level of three was associated with the incidence of elevated ED (RR=1.94,95%CI:1.44-2.61). High levels of osteocalcin in men with hyperglycemia (fasting glucose =5.6mmol/L) increased the incidence of ED (adjusted RR=2). .65,95%CI:1.74-4.02). Men with high blood glucose levels and high osteocalcin levels have the highest risk of ED (adjusted RR=2.31,95%CI:1.57-3.42) with high blood glucose levels and high osteocalcin levels. The results of sensitivity analysis still suggest high levels of blood sugar and higher osteocalcin levels than others. The case has the highest risk of ED (adjusted RR=2.73,95%CI:1.16-6.43). Conclusion: high osteocalcin level and high blood sugar level may be an effective factor in predicting the risk of ED in the general population. More studies are suggested to explore the relationship between osteocalcin and ED.
【学位授予单位】：广西医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R698

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