上海市社区糖尿病男性患者性激素水平对大血管并发症的影响  

Effect of sex hormone levels on macrovascular complications in community-dwelling male patients with diabetes mellitus in Shanghai

作　　者：王驰誉 王宁荐[1] 王禹盈 万亨 张坤 陈奕[1] 夏芳珍[1] 张雯 陈小曼 陆颖理[1] Wang Chiyu;Wang Ningjian;Wang Yuying;Wan Heng;Zhang Kun;Chen Yi;Xia Fangzhen;Zhang Wen;Chen Xiaoman;Lu Yingli(Department of Endocrinology and Metabolism, Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院内分泌代谢科,200011

出　　处：《中华内分泌代谢杂志》2019年第6期460-467,共8页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市卫计委公共卫生三年行动计划重点学科建设项目(15GWZK0202).

摘　　要：目的探究性激素水平[总睾酮、雌二醇、雌二醇/总睾酮比值与脱氢表雄酮(DHEA)]是否与上海社区糖尿病男性患者的大血管并发症相关。方法依托上海浦江两岸环境污染物暴露与糖脂代谢疾病关系研究(METAL研究,ChiCTR1800017573, www.chictr.org.cn),从10个社区招募了2 147例糖尿病男性参与者。通过颈动脉超声检测颈动脉斑块和管径,心血管疾病(CVD)患病则由问卷调查中自报曾诊断为CVD,包括冠心病、心肌梗死或中风。结果(1)本研究中CVD的患病率为36.0%,CVD患者的高血压和血脂异常率高于无CVD患者。(2)经校正多种变量后,糖尿病男性患者DHEA水平与CVD患病率呈负相关,而雌二醇水平与CVD患病率和斑块发生率呈正相关,雌二醇/总睾酮比值与CVD患病率呈正相关。(3)在有单侧/双侧颈动脉斑块的亚组中,经校正多种变量后,总睾酮水平与颈动脉管径大小呈负相关。结论血清总睾酮和DHEA水平较高、雌二醇水平较低的男性糖尿病患者大血管并发症发生率较低,提示性激素水平可能是糖尿病大血管并发症诊治的一个窗口。Objective We aimed to investigate whether sex hormone levels including total testosterone, estradiol, estradiol/total testosterone, and dehydroepiandrosterone (DHEA) were associated with macrovascular complications among Shanghai community-dwelling diabetic men. Methods Relying on the Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study (ChiCTR1800017573, www.chictr.org.cn), 2 147 male diabetic participants were recruited from 10 communities. Carotid plaques and common carotid artery (CCA) diameters were detected by carotid ultrasound. Cardiovascular disease (CVD) was defined as a self-reported diagnosis of CVD, including coronary heart disease, myocardial infarction, or stroke. Results (1) The prevalence of CVD in this study was 36.0%, and patients with CVD had higher rates of hypertension and dyslipidemia than those without CVD.(2) After controlling for multiple factors, serum DHEA levels were negatively correlated with the prevalence of CVD while estradiol levels were positively correlated with both the prevalences of CVD and carotid plaque, estradiol/total testosterone ratio was also positively correlated with the prevalence of CVD.(3) In subgroup with unilateral/bilateral CCA plaque, and after controlling for multiple factors, total serum testosterone was negatively associated with the mean CCA diameter. Conclusion The incidence of macrovascular complications was lower in male diabetic patients with higher serum total testosterone and DHEA levels and lower estradiol levels, suggesting that sex hormone levels may be a window for the diagnosis and treatment of diabetic macrovascular complications.

关 键 词：糖尿病 大血管并发症 性激素 颈动脉斑块 

分 类 号：R587.2[医药卫生—内分泌]