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JAMA:睾酮水平较低的老年男性,睾酮治疗竟增大冠状动脉斑块体积!

2017-04-18 吴星 环球医学

2017年2月,发表在《JAMA》的一项由美国科学家进行的研究考察了,在睾酮水平较低的老年男性中,睾酮治疗能否延缓冠状动脉斑块体积进展。 重要性:近期的研究对睾酮治疗是否会增加心血管风险得出了不同的结论。 目的:考察“睾酮水平较低的老年男性使用睾酮治疗可延缓非钙化冠状动脉斑块体积进展”的假设。 设计、地点和受试者:在美国9个学术医疗中心开展的双盲、安慰剂对照试验。受试者为睾酮试验中,2010

2017年2月,发表在《JAMA》的一项由美国科学家进行的研究考察了,在睾酮水平较低的老年男性中,睾酮治疗能否延缓冠状动脉斑块体积进展。

重要性:近期的研究对睾酮治疗是否会增加心血管风险得出了不同的结论。

目的:考察“睾酮水平较低的老年男性使用睾酮治疗可延缓非钙化冠状动脉斑块体积进展”的假设。

设计、地点和受试者:在美国9个学术医疗中心开展的双盲、安慰剂对照试验。受试者为睾酮试验中,2010年6月24日至2014年6月9日期间纳入的788例中的170例男性(82例男性被分配至安慰剂组,88例男性被分配至睾酮组),这些患者年龄在65岁或以上、平均血清睾酮水平低于275 ng/dL、且性腺功能减退。

干预:睾酮凝胶,调整剂量以维持在年轻男性睾酮正常范围水平,或安慰剂凝胶,为期12个月。

主要结局和测量指标:主要结局为非钙化冠状动脉斑块体积,通过冠状动脉计算机断层扫描(CT)血管造影确定。次要结局包括冠状动脉斑块总体积和冠状动脉钙化评分(范围为0~>400个Agatston单位,数值越高表明动脉粥样硬化越严重)。

结果:在纳入的170例男性中,138例(73例患者使用睾酮治疗,65例使用安慰剂治疗)患者完成了这项研究,并接受了初步分析。在138例男性中,平均(标准差)年龄为71.2(5.7)岁,81%为白种人。基线时,70例(50.7%)男性的冠状动脉钙化评分高于300个Agatston单位,表明动脉粥样硬化严重。就主要结局而言,与安慰剂相比,睾酮治疗与基线至12个月时非钙化冠状动脉斑块体积显着增大相关(分别为,中位值204 mm3~232 mm3 vs 317 mm3~325 mm3;估算的差值,41 mm3;95% CI,14~67 mm3;P=0.003)。就次要结局而言,从基线至12个月,睾酮组的中位斑块总体积从272 mm3增加至318 mm3 vs安慰剂组从499 mm3增加至541 mm3(估算差值,47 mm3;95% CI,13~80 mm3;P=0.006),睾酮组中位冠状动脉钙化评分从255个Agatston单位变为244个Agatston单位vs安慰剂组从494个Agatston单位变为503个Agatston单位(估算差值,-27个Agatston单位;95% CI,-80~26个Agatston单位)。两组均没有出现重大不良心血管事件。

结论:在症状性性腺机能减退的老年男性中,与安慰剂相比,为期1年的睾酮凝胶治疗与冠状动脉计算机断层造影确定的冠状动脉非钙化斑块体积显着增大相关。需要更大型的研究,以理解这些结果的临床启示。

原始出处:

Budoff MJ, Ellenberg SS, Lewis CE, Mohler ER 3rd, et al. Testosterone Treatment and Coronary Artery Plaque Volume in Older Men With Low Testosterone.JAMA. 2017 Feb

 

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    2017-04-19 1ddf3e1dm99(暂无匿称)

    学习了,谢谢

    0

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    2017-04-18 houer12345

    受教受教

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    2017-04-18 明心见性

    学习了,谢谢分享

    0

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    2017-04-18 ideal肿瘤医

    学习了,牛杂志

    0

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