睾酮水平与绝经后女性2型糖尿病患者颈动脉粥样硬化的关系

目的探讨经颈动脉超声证实患有明确的颈动脉粥样硬化的绝经后女性2型糖尿病患者的性激素水平的变化,旨在初步了解雄激素水平的变化在女性动脉粥样硬化患者中的作用。方法绝经后女性2型糖尿病患者共114例,根据颈动脉超声结果,将患者分为以下两组:不伴颈动脉粥样硬化组(无AS组)患者43例,伴颈动脉粥样硬化组(AS组)患者71例,收集患者一般临床资料,测定患者的血脂、血糖、糖化血红蛋白和血清性激素水平。结果AS组患者的雌二醇和睾酮水平显著低于无AS组患者(均为P<0.05);睾酮水平与年龄(r=-0.305,P=0.049)、腰臀围比(wHR)(r=-0.376,P=0.014)呈显著负相关,与高密度脂蛋白胆固醇(HDL-C)水平(r=0.401,P=0.008)呈显著正相关;血清睾酮水平与颈动脉内膜中层厚度(IMT)之间呈显著负相关(r=-0.331,P=0.056);以有无颈动脉AS为因变量,一般临床资料和性激素水平为协变量行Logistic回归分析,结果显示年龄(OR=1.056,95%CI:1.019～1.132,P<0.01)、wHR(OR=1.81,95% CI:1.721～1.965,P<0.01)和睾酮(OR=0.924,95%CI:0.912～0.987,P<0.01)进入回归方程,提示年龄、wHR和低水平的睾酮可能是颈动脉AS的危险因素或预测因子。结论生理范围内的较高水平的血清睾酮水平可能在绝经后女性2型糖尿病患者的颈动脉AS的发展中起到保护作用。

Relationship between testosterone levels and carotid artery atherosclerosis in postmenopausal women with type 2 diabetes mellitus

Objective To investigate the influence of endogenous androgens on the carotid artery atherosclerosls （AS） in postmenopausal women with type 2 diabetes mellitus. Methods The 114 postmenopausal females with type 2 diabetes mellitus were divided into following 2 groups according to the results of carotid ultrasonography. AS group, 71 patients with AS of carotid artery, and non AS group, 43 patients without. Demographic data were collected and the levels of serum lipids, serum sex hormones, glucose and glycosylated hemoglobin were measured. Results Testosterone levels were lower in AS group than in non AS group （all P 〈 0.05 ）. Testosterone levels were significantly correlated with age （r = -0. 305 ,P = 0. 049 ）, WHR （ r = - 0. 376, P = 0. 014 ）, HDL-C （ r = 0. 401, P = 0. 008 ） and carotid intima-medium thickness （IMT） （ r = - 0. 331, P = 0. 056）. Logistic regression analysis showed that age, WHR and testosterone level were included in the equation. Conclusions Our data indicate that in postmenopausal women with type 2 diabetes mellitus, relatively higher testosterone levels in the physiological range are correlated wtih lower risk of carotid artery atherosclerosis.