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目的:探讨睾酮替代治疗对糖尿病合并迟发性性腺功能减退患者胰岛素抵抗的作用及其临床疗效。方法:82例糖尿病合并迟发性性腺功能减退患者随机分为睾酮治疗组(n=42)和对照组(n=40),两组患者均维持原有降糖、调脂治疗方案,治疗组在此基础上予十一酸睾酮胶丸口服,共治疗6个月,观察两组治疗前后体重指数、腰围、血糖、血脂谱、胰岛素敏感性、生殖激素以及中老年男性症状问卷(AMS)评估的相关症状评分及IIEF-5评分变化。结果:与治疗前相比,治疗组干预后体重指数(26.71±2.39 vs 25.15±2.28,P<0.05)、腰围(cm)(89.96±9.13 vs 85.03±9.58,P<0.05)、糖化血红蛋白(%)(7.73±1.31 vs 7.01±1.25,P<0.05)、甘油三酯(mmol/L)(1.97±0.83 vs 1.41±0.69,P<0.05)显著下降,总睾酮(μmol/L)(7.16±2.21 vs 14.22±2.63,P<0.05)显著升高,稳态模型评估的胰岛素抵抗指数(3.76±1.18 vs 2.55±1.03,P<0.05)和胰岛素敏感指数(96±51 vs 138±53,P<0.05)显著改善,AMS心理和躯体评分显著改善(P<0.05),但IIEF-5评分(13.28±6.38 vs14.95±6.08,P>0.05)改善不明显。结论:睾酮替代治疗可以改善糖尿病合并迟发性性腺功能减退患者胰岛素抵抗并具有确切临床疗效。
Objective: To investigate the effect of testosterone replacement therapy on insulin resistance in patients with diabetes mellitus complicated with delayed hypogonadism and its clinical efficacy. Methods: Eighty-two diabetic patients with delayed hypogonadism were randomly divided into testosterone-treated group (n = 42) and control group (n = 40). Both of the two groups maintained their original hypoglycemic and lipid- On this basis, testosterone undecanoate capsules orally for a total of 6 months, before and after treatment, body mass index, waist circumference, blood glucose, blood lipid profile, insulin sensitivity, reproductive hormones and middle-aged male symptom questionnaire (AMS) Related symptom scores and IIEF-5 score changes. Results: Compared with those before treatment, body mass index (26.71 ± 2.39 vs 25.15 ± 2.28, P <0.05), waist circumference (89.96 ± 9.13 vs 85.03 ± 9.58, P <0.05), HbA1c ) (7.73 ± 1.31 vs 7.01 ± 1.25, P <0.05), triglyceride (mmol / L) (1.97 ± 0.83 vs 1.41 ± 0.69, P < vs 14.22 ± 2.63, P <0.05). Insulin resistance index (3.76 ± 1.18 vs 2.55 ± 1.03, P <0.05) and insulin sensitivity index (96 ± 51 vs 138 ± 53, P <0.05 (P <0.05), but the IIEF-5 score (13.28 ± 6.38 vs 14.95 ± 6.08, P> 0.05) showed no significant improvement. Conclusion: Testosterone replacement therapy can improve insulin resistance in diabetic patients with delayed hypogonadism and have definite clinical curative effect.