Effects of hypogonadism and testosterone administration on depression indices in HIV-infected men
Effects of hypogonadism and testosterone administration on depression indices in HIV-infected men
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DOI：
10.1210/jc.85.1.60
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发表时间：
2000-01-01
影响因子：
5.8
通讯作者：
Klibanski, A
中科院分区：
文献类型：
--
作者：
Grinspoon, S;Corcoran, C;Klibanski, A
性腺功能减退症在人类免疫缺陷病毒感染的男性中很普遍，据报道他们的生活质量显著降低，情绪紊乱。以前的研究没有调查抑郁评分和性腺功能之间的关系，在这些患者。我们首先比较了患有获得性免疫缺陷综合征（AIDS）消瘦的性腺功能减退（n = 52）和性腺功能正常（n = 10）患者的抑郁评分，匹配体重和疾病状态，然后在患有AIDS消瘦的性腺功能减退男性组中进行了一项随机、双盲、安慰剂对照研究，调查了睾酮给药对抑郁评分的影响。所有比较的主要终点是贝克抑郁量表。与性腺功能正常、年龄、体重和疾病状态匹配的受试者相比，性腺功能减退患者的Beck量表评分显著增加（15.5 +/- 1.1 vs. 10.6 +/- 1.4平均值+/- SEM，P = 0.02）。在性腺功能减退和性腺功能正常者中，Beck评分与游离睾酮（r =-0.41，P < 0.01）和血清总睾酮（r =-0.43，P < 0.001）呈显著负相关。Beck评分和睾酮水平之间的关系仍然非常显著，控制体重，病毒载量，CD 4计数和抗睾酮使用（游离睾酮P < 0.01，总睾酮P < 0.001）。此外，当受试者根据Beck评分大于18或小于或等于18分为两组时，Beck评分大于18的受试者血清总睾酮和游离睾酮水平显著较低，而体重、病毒载量、CD 4计数或Karnofsky状态无差异。完成随机化、安慰剂对照研究的39例患者的研究结束数据可用。Beck评分仅在接受睾酮治疗的受试者中显著降低（-5.8 +/-1.3，P < 0.001），但在随机接受安慰剂的受试者中没有显著降低（-2.7 +/-1.3，P > 0.05）。经回归分析，Beck评分变化与体重变化呈显著正相关（P < 0.01）。这些数据表明，在AIDS消瘦的男性中，抑郁评分增加与性腺功能减退相关，与体重、病毒学状态和其他疾病因素无关。在这些患者中，给予睾酮导致抑郁量表评分显著改善。这种作用可能是睾酮的直接作用，或者与睾酮对体重和/或其他人体测量指标的积极作用有关。需要进一步的研究来评估睾酮对人类免疫缺陷病毒感染患者临床抑郁指数的影响。
Hypogonadism is prevalent among human immunodeficiency virus-infected men, in whom significantly reduced quality of life and mood disturbances have been reported. Previous studies have not investigated the relationship between depression score and gonadal function among such patients. We first compared depression scores in hypogonadal (n = 52) and eugonadal (n = 10) patients with acquired immunodeficiency syndrome (AIDS) wasting, matched for weight and disease status, and then investigated the effects of testosterone administration on depression score in a randomized, double-blind, placebo-controlled study among the group of hypogonadal men with AIDS wasting. The primary end point in all comparisons was the Beck Depression Inventory. Hypogonadal patients demonstrated significantly increased scores on the Beck inventory compared with eugonadal-, age-, weight-, and disease status-matched subjects (15.5 +/- 1.1 vs. 10.6 +/- 1.4 mean +/- SEM, P = 0.02). Among the combined hypogonadal and eugonadal subjects, a significant inverse correlation was seen between the Beck score and both free (r = -0.41, P < 0.01) and total serum testosterone levels (r = -0.43, P < 0.001). The relationship between the Beck score and testosterone levels remained highly significant, controlling for weight, viral load, CD4 count, and anti-depressant use (P < 0.01 for free testosterone, P < 0.001 for total testosterone). Furthermore, when subjects were divided into two groups, based on a Beck score greater than 18 or less than or equal to 18, serum total and free testosterone levels were significantly lower in the subjects with a Beck score greater than 18, whereas there were no differences in weight, viral load, CD4 count, or Karnofsky status. End of study data were available in 39 patients who completed the randomized, placebo-controlled study. Beck score decreased significantly only in the subjects receiving testosterone (-5.8 +/- 1.3, P < 0.001), but not in subjects randomized to placebo (-2.7 +/- 1.3, P > 0.05). In a regression analysis, the change in Beck score was related significantly to change in weight (P < 0.01). These data demonstrate increased depression score in association with hypogonadism in men with AIDS wasting, independent of weight, virologic status, and other disease factors. In such patients, administration of testosterone results in a significant improvement in depression inventory score. This effect may be a direct effect of testosterone or related to positive effects of testosterone on weight and/or other anthropometric indices. Additional studies are needed to assess the effects of testosterone on clinical depression indices in human immunodeficiency virus-infected patients.