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目的探讨老年男性症状量表(AMS)评分预测社区中老年男性血清睾酮相关指标[总睾酮(TT)、性激素结合球蛋白(SHBG)、黄体生成素(LH)、游离睾酮(cFT)、游离睾酮指数(FTI)、睾酮分泌指数(TSI)]异常的价值,以期为临床筛查和诊断迟发性性腺功能减退症(LOH)提供参考依据。方法根据遵义市的经济特征和生活方式,将社区分为城市、城镇、乡村3个层次,于2013年8—9月,采用分层整群抽样方法以1∶10的比例从每层中随机抽取7个社区/居委会/村作为抽样点。选取抽样点20岁及以上男性为调查对象,共收集到1 166份合格数据。以227例20~39岁居民的血清睾酮相关指标水平来确立男性血清睾酮相关指标异常切点值,采用939例40岁及以上居民的数据评价AMS评分预测血清睾酮相关指标异常的价值。采用自制调查问卷对居民进行调查,调查内容包括基本情况、家族史、既往史、AMS评分(设定AMS评分<27分为无LOH症状,≥27分为有LOH症状)。检测居民血清TT、SHBG、LH,计算cFT、FTI、TSI。结果 939例40岁及以上居民中,有LOH症状628例(66.9%),TT异常36例(3.8%,其中有LOH症状25例),SHBG异常203例(21.6%,其中有LOH症状155例),LH异常57例(6.1%,其中有LOH症状53例),cFT异常136例(14.5%,其中有LOH症状110例),FTI异常271例(28.9%,其中有LOH症状213例),TSI异常249例(26.5%,其中有LOH症状200例)。有LOH症状与无LOH症状居民TT比较,差异无统计学意义(P>0.05);有LOH症状居民SHBG、LH高于无LOH症状居民,cFT、FTI、TSI低于无LOH症状居民(P<0.05)。有LOH症状与无LOH症状居民TT异常率比较,差异无统计学意义(P>0.05);有LOH症状居民SHBG、LH、cFT、FTI、TSI异常率大于无LOH症状居民(P<0.05)。以AMS评分27分为临界值,AMS评分预测TT异常的总符合率较低,为34.61%,预测FTI、TSI异常的总符合率较高,分别为49.63%、49.20%。AMS评分预测TT异常的Kappa值为0.003,P=0.739;AMS评分预测SHBG、LH、cFT、FTI、TSI异常的Kappa值分别为0.069、0.049、0.065、0.118、0.123,P值均<0.01。结论 AMS评分预测TT异常的价值较差,预测FTI、TSI异常的价值较好。
Objective To investigate the relationship between serum testosterone and total testosterone (TT), sex hormone binding globulin (SHBG), luteinizing hormone (LH), free testosterone (cFT), free testosterone Index (FTI), testosterone secretion index (TSI)] abnormal value, in order to provide a reference for clinical screening and diagnosis of delayed hypogonadism (LOH). Methods Based on the economic characteristics and lifestyles of Zunyi City, the community was divided into three levels: city, town and village. From August to September in 2013, stratified cluster sampling method Draw 7 communities / neighborhood / village as sampling points. A total of 1,166 qualified data were collected from men aged 20 and over in the sample. Serum testosterone-related index abnormality cut-off value was established in 227 male subjects aged 20-39 years. The value of AMS score of 939 residents aged 40 years and over was used to predict the abnormality of serum testosterone-related index. A questionnaire was used to survey residents. The survey included basic information, family history, past history, AMS score (setting AMS score <27 for no LOH symptom, and> 27 for LOH symptom). Detection of resident serum TT, SHBG, LH, calculated cFT, FTI, TSI. Results There were 628 (66.9%) LOH symptoms, 36 TT abnormalities (3.8%), LOH symptoms (25 cases), SHBG abnormalities 203 cases (21.6%), LOH symptoms ), LH abnormalities in 57 cases (6.1%, LOH symptoms in 53 cases), cFT abnormalities in 136 cases (14.5%, LOH symptoms in 110 cases), FTI abnormalities in 271 cases (28.9%, of which LOH symptoms in 213 cases) TSI abnormalities in 249 cases (26.5%, of which 200 cases of LOH symptoms). There was no significant difference between LOH symptom and TT without LOH (P> 0.05); SHBG and LH were higher in residents with LOH than those without LOH, cFT, FTI and TSI were lower than those without LOH (P < 0.05). There was no significant difference in the abnormal rate of TT among residents with LOH symptoms and without LOH symptoms (P> 0.05). The abnormal rates of SHBG, LH, cFT, FTI and TSI among residents with LOH symptoms were higher than those without LOH symptoms (P <0.05). The AMS score of 27 was divided into the critical values. The AMS score predicted a low total TT coincidence rate of 34.61%. The overall coincidence rate of FTI and TSI abnormalities was 49.63% and 49.20% respectively. The Kappa value predicted by AMS score was 0.003, P = 0.739. The Kappa values predicted by AMS score were 0.069,0.049,0.065,0.118,0.123 and P <0.01 for SHBG, LH, cFT, FTI and TSI respectively. Conclusion The value of AMS score predicting TT anomaly is poor, and the value of predicting FTI and TSI anomalies is better.