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目的通过观察老年男性迟发性性腺功能减退症(late onset of hypogonadism,LOH)患者的血清性激素变化情况,探讨性激素对LOH的诊断意义。方法 2009年11月至2014年6月,采用分层多阶段整群抽样方法,选择上海市及浙江省嘉善县17个社区3000例40~80岁中老年男性作为调查对象,分别记录国际勃起功能(IIEF-5)问卷及老年男性症状(AMS)量表,同时测定其血清总睾酮(TT)、黄体生成素(LH)、性激素结合球蛋白(SHBG),计算睾酮游离指数(TSI)、游离睾酮(FT)及生物活性睾酮(Bio-T)。结果研究对象平均年龄为(58.47±8.15)岁,AMS量表筛查LOH的阳性率为34.92%(937/2683)。LOH阳性组人群的TT和LH水平与阴性组比较差异无统计学意义(P>0.05);FT、TSI在LOH阳性组较阴性组明显降低(P<0.05);SHBG及Bio-T在2组间差异亦有统计学意义(P<0.01)。Pearson相关分析显示:TSI、SHBG及Bio-T与LOH显著相关,FT与LOH弱相关,而TT及LH与LOH无明显相关性。结论 SHBG及Bio-T对LOH患者的诊断价值优于TT,Bio-T的下降及SHBG的增高应作为LOH患者重要的诊断指标。
Objective To investigate the changes of serum sex hormones in late onset of hypogonadism (LOH) in elderly men and to explore the diagnostic value of sex hormones for LOH. Methods From November 2009 to June 2014, stratified multistage cluster sampling method was used to select 3000 middle-aged and elderly men aged 40 to 80 in 17 communities in Shanghai and Jiashan County, Zhejiang Province as subjects, and recorded the international erectile function (IIEF-5) questionnaire and the Aging Scale of Aged Men (AMS) were measured. The levels of total testosterone (TT), luteinizing hormone (LH), sex hormone binding globulin (SHBG), free testosterone (TSI) Testosterone (FT) and bioactive testosterone (Bio-T). Results The mean age of the subjects was (58.47 ± 8.15) years. The positive rate of LOH screening by AMS was 34.92% (937/2683). The levels of TT and LH in LOH-positive group were not significantly different from those in the negative group (P> 0.05); FT and TSI were significantly lower in LOH-positive group than in the negative group (P <0.05); SHBG and Bio- There was also a significant difference between the two groups (P <0.01). Pearson correlation analysis showed that TSI, SHBG and Bio-T were significantly correlated with LOH, FT was weakly correlated with LOH, while TT and LH were not significantly correlated with LOH. Conclusion The diagnostic value of SHBG and Bio-T in patients with LOH is better than that of TT. The decrease of Bio-T and the increase of SHBG should be regarded as important diagnostic criteria for patients with LOH.