本文選題：骨鈣素 + 睪酮　； 參考：《廣西醫(yī)科大學(xué)》2015年博士論文

【摘要】：目的：睪酮在陰莖勃起的生理過(guò)程中起到非常重要的作用,但是睪酮與勃起功能障礙(erectile dysfunction, ED)的關(guān)系并不十分清楚,所以我們利用基于普通人群的大樣本流行病調(diào)查數(shù)據(jù),探索血清總睪酮(total testosterone, TT),游離睪酮(free testosterone, FT),以及生物活性睪酮(bio-available testosterone)和ED的關(guān)系。方法：我們納入1776名2009年9月至2009年12月來(lái)廣西防城港市第一人民醫(yī)院參加體檢的男性,年齡范圍在20歲至77歲之間。通過(guò)國(guó)際勃起功能評(píng)估量表(five-item International Index of Erectile Function, IIEF-5)對(duì)ED進(jìn)行評(píng)估。TT,性激素結(jié)合球蛋白(sex hormone binding globulin, SHBG)和其他生化指標(biāo)在檢驗(yàn)科檢測(cè),FT和BT通過(guò)Vermeulen公式來(lái)計(jì)算。其他收集的數(shù)據(jù)還包括吸煙,飲酒,體力活動(dòng)以及代謝綜合征。結(jié)果：ED (IIEF-522)的患病率為47.6%。患有ED的男性比健康男性有較高的年齡,并且有較多的入每天吸煙超過(guò)20支,以及更多的人每周飲酒超過(guò)3次,并且有更多的人同時(shí)有血壓升高(P=0.036),或者血糖升高(P0.001)的表現(xiàn)。SHBG隨年齡增加而升高的趨勢(shì),與SHBG隨ED嚴(yán)重程度增加而升高的趨勢(shì)基本一致(P0.001)。TT隨ED不同程度的變化趨勢(shì)經(jīng)分析沒(méi)有統(tǒng)計(jì)學(xué)意義(P=0.418),但是在年齡校正之后,TT與ED患病率有正相關(guān)關(guān)系[odds ratio (OR)=1.02, 95% CI (confidence internal):1.00-1.04]。在未校正任何協(xié)變量之前,FT、BT與ED患病率是負(fù)相關(guān)關(guān)系(OR=0.14,95%CI: 0.06-0.33; OR=0.92 (95% CI:0.89-0.96, respectively),并且負(fù)相關(guān)關(guān)系獨(dú)立于吸煙,飲酒,體力運(yùn)動(dòng),高血脂,以及高血糖等風(fēng)險(xiǎn)因素。結(jié)論：FT和BT與ED患病率是負(fù)相關(guān),而TT與ED之間的正相關(guān)關(guān)系可能是受到SHBG的影響。目的：睪酮水平的下降和勃起功能障礙(erectile dysfunction, ED)的患病率有關(guān),但是睪酮是否對(duì)ED發(fā)病率有預(yù)測(cè)作用還沒(méi)有確定。為了研究睪酮與ED發(fā)病率之間的關(guān)系,我們基于前期橫斷面研究的結(jié)果,也是利用普通人群的數(shù)據(jù),開(kāi)展這項(xiàng)前瞻性隊(duì)列研究。方法：該隊(duì)列研究納入733名2009年9月至2009年12月來(lái)廣西防城港市第一人民醫(yī)院參加體檢的男性,年齡范圍在20歲至77歲之間,并在4年后進(jìn)行隨訪。ED的評(píng)估還是通過(guò)國(guó)際勃起功能評(píng)估量表(five-item International Index of Erectile Function, IIEF-5)對(duì)ED進(jìn)行評(píng)估。TT,性激素結(jié)合球蛋白(sex hormone binding globulin, SHBG)和其他生化指標(biāo)在檢驗(yàn)科檢測(cè),FT和BT通過(guò)Vermeulen公式來(lái)計(jì)算。其他收集的數(shù)據(jù)還包括吸煙,飲酒和體力活動(dòng)。分析方法采用Cox比例風(fēng)險(xiǎn)模型。結(jié)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),均與ED的低發(fā)病率有關(guān)。在年齡范圍21歲至40歲之間的年輕男性中,隨著FT或BT水平的增加,ED的發(fā)病風(fēng)險(xiǎn)會(huì)顯著降低[adjusted RR and 95%CI: 0.78 (0.67-0.92) and 0.75 (0.62-0.95), respectively]. TT在校正SHBG之后與ED是負(fù)相關(guān)(RR=0.89,95%CI:0.81-0.98),而SHBG在校正TT之后是正相關(guān)(RR=1.04,95%CI:1.02-1.06)。當(dāng)FT低水平合并SHBG高水平的情況下,ED的發(fā)病風(fēng)險(xiǎn)相對(duì)其他情況是最高(adjusted RR=4.61,95%CI:1.33-16.0)。結(jié)論：年輕人的高水平FT和BT均能對(duì)立預(yù)測(cè)ED的發(fā)病風(fēng)險(xiǎn)是下降的。建議更深入的研究來(lái)探索睪酮和ED之間的分子生物學(xué)機(jī)制。目的：骨鈣素可以調(diào)節(jié)能量代謝,也能增加睪酮生成。盡管有研究發(fā)現(xiàn)骨鈣素與睪酮是正相關(guān)關(guān)系,但是代謝因素在兩者之間的關(guān)系中起到什么作用還不清楚。方法：我們納入2400名2009年9月至2009年12月來(lái)廣西防城港市第一人民醫(yī)院參加體檢的男性,年齡范圍在20歲至69歲之間。根據(jù)檢測(cè)的生化指標(biāo)進(jìn)行代謝因素的評(píng)估,其中代謝綜合征(Metabolic syndrome, MetS)的定義是根據(jù)國(guó)際膽固醇教育計(jì)劃成人治療協(xié)作組(National Cholesterol Education Program Adult Treatment Panel)針對(duì)亞洲人制定的標(biāo)準(zhǔn)。血清骨鈣素,總睪酮(total testosterone, TT),以及性激素球蛋白(sex hormone binding globulin, SHBG)在檢驗(yàn)科檢測(cè),游離睪酮(free testosterone, FT)和生物活性睪酮(bioavailable testosterone, BT)通過(guò)Vermeulen公式來(lái)計(jì)算。采用的分析方法是多因素線性回歸。結(jié)果：骨鈣素與TT, FT以及BT在未校正任何協(xié)變量的模型中是正相關(guān)關(guān)系(all P0.001)。在校正年齡之后,骨鈣素與TT之間正相關(guān)關(guān)系依然有統(tǒng)計(jì)學(xué)意義(p=0.17,95%CI=0.14-0.20),并且這種關(guān)系在MetS亞組也沒(méi)有減弱,包括高血脂,高血糖,高血壓以及血脂異常者四個(gè)亞組,而自腹型肥胖這個(gè)亞組,兩者的關(guān)系反而增強(qiáng)(p=0.21,95%CI=0.12-0.30)。在深入分析中校正SHBG之后,骨鈣素依然在腹型肥胖亞組里,與TT, FT, BT保持穩(wěn)定的正相關(guān)關(guān)系(P0.05)。結(jié)論：血清總骨鈣素水平與睪酮水平是正相關(guān)關(guān)系,兩者之間的關(guān)系可能是由于SHBG或者腹型肥胖介導(dǎo)的。目的：骨鈣素低水平是代謝綜合征的危險(xiǎn)因子,而代謝綜合征作為勃起功能障礙(erectile dysfunction, ED)的危險(xiǎn)因子,骨鈣素與ED之間的關(guān)系還沒(méi)有人研究,所以我們開(kāi)展這個(gè)前瞻性隊(duì)列研究,探索骨鈣素水平與ED發(fā)病率之間的關(guān)系。方法：我們納入757名2009年9月至2009年12月來(lái)廣西防城港市第一人民醫(yī)院參加體檢的男性,年齡范圍在20歲至69歲之間,并在2年后進(jìn)行隨訪。ED的評(píng)估還是通過(guò)國(guó)際勃起功能評(píng)估量表(five-item International Index of Erectile Function, IIEF-5)對(duì)ED進(jìn)行評(píng)估。骨鈣素水平在檢驗(yàn)科進(jìn)行檢測(cè)。采用的分析方法是Cox比例風(fēng)險(xiǎn)模型。結(jié)果：新發(fā)ED的男性比兩年內(nèi)沒(méi)有ED發(fā)生的男性,其血清骨鈣素水平偏低(P0.05).最高三分位水平的血糖,與ED升高的發(fā)病率有關(guān)(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,高水平的骨鈣素會(huì)增加ED的發(fā)病率(adjusted RR=2.65,95%CI：1.74-4.02)。相比血糖水平低且骨鈣素水平高的男性,血糖水平高且骨鈣素水平高的男性有最高的ED發(fā)病風(fēng)險(xiǎn)(adjusted RR=2.31,95%CI:1.57-3.42),即使把輕度ED的人群去掉,敏感性分析的結(jié)果依然提示,血糖水平高且骨鈣素水平高相對(duì)其他情況有最高的ED發(fā)病風(fēng)險(xiǎn)(adjusted RR=2.73,95%CI:1.16-6.43)。結(jié)論：高骨鈣素水平,以及高血糖水平,可能是在普通人群中能有效預(yù)測(cè)ED發(fā)病風(fēng)險(xiǎn)的因子,建議更多研究深入探索骨鈣素與ED的關(guān)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R698

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