本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2781

摘要内容如下：

背景

循环性激素是否调节老年男性的死亡率和心血管疾病（CVD）风险是有争议的。

目的

阐明性激素与这些结果的关系。

数据源

系统文献回顾至2019年7月，桥梁搜索至2024年3月。

研究选择

对社区居住的男性进行前瞻性队列研究，使用质谱分析法测量性类固醇，并进行至少5年的随访。

数据提取

自变量为睾酮、性激素结合球蛋白（SHBG）、黄体生成素（LH）、双氢睾酮（DHT）和雌二醇浓度。主要转归为全因死亡率、CVD死亡和偶发CVD事件。协变量包括年龄、身体质量指数、婚姻状况、饮酒、吸烟、体力活动、高血压、糖尿病、肌酐浓度、总胆固醇与高密度脂蛋白胆固醇的比率以及调脂药物的使用。

数据综合

9项研究提供了个体参与者数据（IPD）（255830个参与者年）。11项研究提供了汇总估计值（n=24109）。两阶段随机效应IPD荟萃分析发现，基线睾酮浓度低于7.4 nmol/L（<213 ng/DL）、LH浓度高于10 IU/L或雌二醇浓度低于5.1 pmol/L的男性全因死亡率较高，睾酮浓度低于5.3 nmol/L（<153 ng/DL）的男性心血管疾病死亡风险较高。较低的SHBG浓度与较低的全因死亡率相关（五分位数1[Q1]vs.Q5的中位数为20.6 vs.68.3 nmol/L；校正风险比[HR]，0.85[95%CI，0.77至0.95]）和较低的CVD死亡率（校正HR，0.81[CI，0.65至1.00]）。基线DHT浓度较低的男性全因死亡率风险较高（Q1和Q5的中位数分别为0.69和2.45 nmol/L；校正HR，1.19[CI，1.08至1.30]）和CVD死亡率（校正HR，1.29[CI，1.03至1.61]），并且风险也随着DHT浓度高于2.45 nmol/L而增加。DHT浓度低于0.59 nmol/L的男性发生CVD事件的风险增加。

局限性

观察性研究设计、研究之间的异质性和缺失数据的估算。

结论

低睾酮、高黄体生成素或极低雌二醇浓度的男性全因死亡率增加。SHBG浓度与全因死亡率和CVD死亡率呈正相关，DHT浓度与全因死亡率和CVD死亡率呈非线性相关。

主要资金来源

医学研究未来基金、西澳大利亚政府和劳利制药公司。（普洛斯彼罗：CRD42019139668）。

英文原文如下：

Abstracts

BACKGROUND  Whether circulating sex hormones modulate mortality and cardiovascular disease (CVD) risk in aging men is controversial.

PURPOSE  To clarify associations of sex hormones with these outcomes.

DATA SOURCES  Systematic literature review to July 2019, with bridge searches to March 2024.

STUDY SELECTION  Prospective cohort studies of community-dwelling men with sex steroids measured using mass spectrometry and at least 5 years of follow-up.

DATA EXTRACTION  Independent variables were testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone (DHT), and estradiol concentrations. Primary outcomes were all-cause mortality, CVD death, and incident CVD events. Covariates included age, body mass index, marital status, alcohol consumption, smoking, physical activity, hypertension, diabetes, creatinine concentration, ratio of total to high-density lipoprotein cholesterol, and lipid medication use.

DATA SYNTHESIS  Nine studies provided individual participant data (IPD) (255 830 participant-years). Eleven studies provided summary estimates (n = 24 109). Two-stage random-effects IPD meta-analyses found that men with baseline testosterone concentrations below 7.4 nmol/L (<213 ng/dL), LH concentrations above 10 IU/L, or estradiol concentrations below 5.1 pmol/L had higher all-cause mortality, and those with testosterone concentrations below 5.3 nmol/L (<153 ng/dL) had higher CVD mortality risk. Lower SHBG concentration was associated with lower all-cause mortality (median for quintile 1 [Q1] vs. Q5, 20.6 vs. 68.3 nmol/L; adjusted hazard ratio [HR], 0.85 [95% CI, 0.77 to 0.95]) and lower CVD mortality (adjusted HR, 0.81 [CI, 0.65 to 1.00]). Men with lower baseline DHT concentrations had higher risk for all-cause mortality (median for Q1 vs. Q5, 0.69 vs. 2.45 nmol/L; adjusted HR, 1.19 [CI, 1.08 to 1.30]) and CVD mortality (adjusted HR, 1.29 [CI, 1.03 to 1.61]), and risk also increased with DHT concentrations above 2.45 nmol/L. Men with DHT concentrations below 0.59 nmol/L had increased risk for incident CVD events.

LIMITATIONS  Observational study design, heterogeneity among studies, and imputation of missing data.

CONCLUSION  Men with low testosterone, high LH, or very low estradiol concentrations had increased all-cause mortality. SHBG concentration was positively associated and DHT concentration was nonlinearly associated with all-cause and CVD mortality.

PRIMARY FUNDING SOURCE  Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。