睪酮補充治療對中老年男性胰島素抵抗療效與安全性的系統評價_《中國循證醫學雜志》

作者：

姚慧 , 趙翠平 ,  康冬梅

安徽醫科大學附屬省立醫院干部病房四病區（合肥?230001）;

關鍵詞：

睪酮胰島素抵抗系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20110052

視頻：

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目的　系統評價睪酮補充治療對中老年男性胰島素抵抗的療效及安全性。
方法　計算機檢索PubMed（1966.1～2010.7）、EMbase（1984.1～2010.7）、Cochrane圖書館臨床對照試驗資料庫（2010年第3期）和CBM（1978～2010.7）、CNKI（1994.1～2010.7）、萬方數據庫（1994～2010.7）、維普信息資源系統（1989～2010.7），收集國內外所有關于睪酮治療中老年男性胰島素抵抗的隨機對照試驗。按Cochrane系統評價方法選擇試驗和評價質量后，對同質研究采用RevMan 5.0軟件進行Meta分析。對不能進行Meta分析的數據，則只進行描述性的定性分析。
結果　共納入9個隨機對照試驗，合計573例患者，其中睪酮治療308例，使用安慰劑治療265例，各研究基線具有可比性。Meta分析結果顯示：治療后，睪酮治療組在胰島素抵抗指數（HOMA-IR）［WMD= –0.56，95%CI（–0.75，–0.37）］和空腹胰島素（FINS）［WMD= –2.40，95%CI（–3.25，–1.56）］方面優于安慰劑組，而兩組前列腺特異抗原（PSA）水平差異無統計學意義［WMD= –0.02，95%CI（–0.22，0.18）］。
結論　睪酮補充治療在改善中老年男性糖尿病患者胰島素抵抗方面優于安慰劑，而對PSA的影響與安慰劑相比差異無統計學意義。由于納入研究質量有限，樣本量又較少，上述結論尚需進一步開展大樣本、多中心的隨機雙盲安慰劑對照試驗加以驗證。

引用本文： 姚慧,趙翠平,康冬梅. 睪酮補充治療對中老年男性胰島素抵抗療效與安全性的系統評價. 中國循證醫學雜志, 2011, 11(3): 314-319. doi: 10.7507/1672-2531.20110052 復制

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2.	Stern MP. Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes , 1995, 44: 369-74.
3.	Barret T, Connor E, Bhasin S, et al . Time for (more research on) testosterone. J Clin Endocrinol Metab , 2004, 89: 501-502.
4.	Rajala UM, Keina SM, Hirsso PK, et al . Associations of total testosterone and sex hormone-binding globulin levels with insulin sensitivity in middle-aged Finnish men. J Diabetes Care , 2007, 30: e4-e13.
5.	Grossmann M, Thomas MC, Panagiotopoulos S, et al . Low testosterone levels are common and associated with insulin resistance in men with diabetes. J Clin Endocrinol Metab , 2008, 93: 1834-1840.
6.	Malkin CJ, Pugh PJ, Jones RD, et al . The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab , 2004, 89(7): 3313-3318.
7.	Grossmann M, Gianatti EJ, Zajac JD. Testosterone and type 2 diabetes. Current Opinion in Endocrinology. Diabetes & Obesity , 2010, 17(3): 247-256.
8.	Schroeder E. Todd, Ling Z, Michelle D, et al . Effects of androgen therapy on adipose tissue and metabolism in older men. J Clin Endocrinol Metab , 2004, 89: 4863-4872.
9.	Emmelot-Vonk MH, Harald JJV, Hamid RNP, et al . Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA , 2008, 299(1): 39-52.
10.	吳泰相, 劉關鍵. 隱蔽分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
11.	Dominique s, Charles MA, Lahlou N, et al . Androgen therapy improves insulin sensitivity and decreases leptin level in healthy adult men with low plasma total testosterone. Diabetes Care , 2001, 24(12):2149-2151.
12.	Kapoor D, Goodwin1 E, Channer KS, et al . Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hyperchol- esterolaemia in hypogonadal men with type 2 diabetes. European Journal of Endocri- nology , 2006, 154: 899-906.
13.	Caminiti G, Maurizio V, Ferdinando I, et al . Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and barore?ex sensitivity in elderly patients with chronic heart failure: a double-blind, placebo-controlled, randomized study. Journal of the American College of Cardiology , 2009, 54(10): 919-927.
14.	Heufelder EA, Saad F, Bunck MC, et al . Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and Improves glycemic Control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. Journal of Andrology , 2009, 30(6): 726-733.
15.	Münzer T, S.Mitchell H, John DS, et al . Growth hormone and sex steroid effects on serum glucose, insulin, and lipid concentrations in healthy older women and men. J Clin Endocrinol Metab , 2009, 94: 3833-3841.
16.	Nair KS, Rizza RA, O’Brien P, et al . DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med , 2006, 355(16): 1647-1659.
17.	Aversa A, Bruzziches R, Francomano D, et al . Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 24-month, randomized, double-blind, placebo-controlled study. The Journal of Sexual Medicine , 2010, 7(10): 3495-3503.

1. 1 Reaven GM. Role of insulin resistance in human disease. Diabetes , 1988, 37 (12): 1595-1607.
2. Stern MP. Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes , 1995, 44: 369-74.
3. Barret T, Connor E, Bhasin S, et al . Time for (more research on) testosterone. J Clin Endocrinol Metab , 2004, 89: 501-502.
4. Rajala UM, Keina SM, Hirsso PK, et al . Associations of total testosterone and sex hormone-binding globulin levels with insulin sensitivity in middle-aged Finnish men. J Diabetes Care , 2007, 30: e4-e13.
5. Grossmann M, Thomas MC, Panagiotopoulos S, et al . Low testosterone levels are common and associated with insulin resistance in men with diabetes. J Clin Endocrinol Metab , 2008, 93: 1834-1840.
6. Malkin CJ, Pugh PJ, Jones RD, et al . The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab , 2004, 89(7): 3313-3318.
7. Grossmann M, Gianatti EJ, Zajac JD. Testosterone and type 2 diabetes. Current Opinion in Endocrinology. Diabetes & Obesity , 2010, 17(3): 247-256.
8. Schroeder E. Todd, Ling Z, Michelle D, et al . Effects of androgen therapy on adipose tissue and metabolism in older men. J Clin Endocrinol Metab , 2004, 89: 4863-4872.
9. Emmelot-Vonk MH, Harald JJV, Hamid RNP, et al . Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA , 2008, 299(1): 39-52.
10. 吳泰相, 劉關鍵. 隱蔽分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
11. Dominique s, Charles MA, Lahlou N, et al . Androgen therapy improves insulin sensitivity and decreases leptin level in healthy adult men with low plasma total testosterone. Diabetes Care , 2001, 24(12):2149-2151.
12. Kapoor D, Goodwin1 E, Channer KS, et al . Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hyperchol- esterolaemia in hypogonadal men with type 2 diabetes. European Journal of Endocri- nology , 2006, 154: 899-906.
13. Caminiti G, Maurizio V, Ferdinando I, et al . Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and barore?ex sensitivity in elderly patients with chronic heart failure: a double-blind, placebo-controlled, randomized study. Journal of the American College of Cardiology , 2009, 54(10): 919-927.
14. Heufelder EA, Saad F, Bunck MC, et al . Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and Improves glycemic Control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. Journal of Andrology , 2009, 30(6): 726-733.
15. Münzer T, S.Mitchell H, John DS, et al . Growth hormone and sex steroid effects on serum glucose, insulin, and lipid concentrations in healthy older women and men. J Clin Endocrinol Metab , 2009, 94: 3833-3841.
16. Nair KS, Rizza RA, O’Brien P, et al . DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med , 2006, 355(16): 1647-1659.
17. Aversa A, Bruzziches R, Francomano D, et al . Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 24-month, randomized, double-blind, placebo-controlled study. The Journal of Sexual Medicine , 2010, 7(10): 3495-3503.

《中國循證醫學雜志》

睪酮補充治療對中老年男性胰島素抵抗療效與安全性的系統評價

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《中國循證醫學雜志》

睪酮補充治療對中老年男性胰島素抵抗療效與安全性的系統評價

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