Anabolic deficiency in men with chronic heart failure - Prevalence and detrimental impact on survival
Anabolic deficiency in men with chronic heart failure - Prevalence and detrimental impact on survival
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DOI：
10.1161/circulationaha.106.649426
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发表时间：
2006-10-24
期刊：
影响因子：
37.8
通讯作者：
Ponikowski, Piotr
中科院分区：
文献类型：
--
作者：
Jankowska, Ewa A.;Biel, Bartosz;Ponikowski, Piotr
背景--男性中与年龄相关的循环合成代谢激素的下降与发病率和死亡率的增加有关。我们研究了慢性心力衰竭（CHF）男性中循环总睾酮（TT）和游离睾酮、硫酸脱氢表雄酮（DHEAS）和胰岛素样生长因子-1（IGF-1）缺乏的患病率和预后后果。方法和结果-用免疫测定法测定了208例CHF男性的血清TT、DHEAS和IGF-1水平（中位年龄63岁;中位左心室射血分数33%;纽约心脏协会I/II/III/IV级，19/102/70/17）和366名健康男性。根据TT和性激素结合球蛋白水平估计血清游离睾酮水平（eFT）。DHEAS、TT、eFT和IGF-1的缺陷定义为血清水平等于或低于健康同龄人的第10百分位数，在CHF男性的所有年龄组中均观察到。DHEAS、TT和eFT与任何原因引起的纽约心脏协会分级呈负相关（均P < 0.01）。DHEAS与左室射血分数呈正相关，与N末端脑钠肽前体呈负相关（均P < 0.01）。在多变量模型中，当校正已确定的预后因素时，循环TT、eFT、DHEAS和IGF-1水平是预后标志物（均P < 0.05）。患有CHF且所有合成代谢激素水平正常的男性3年生存率最高（83%，95% CI 67%至98%），与1（74%生存率，95% CI 65%至84%），2（55%生存率，95% CI 45%至66%），或全部3种（27%存活率，95% CI 5%至49%）结论：在男性CHF患者中，合成代谢激素缺乏是常见的，每种合成代谢激素缺乏是预后不良的独立标志。缺乏> 1合成代谢激素鉴定组具有较高的死亡率。
Background - The age-related decline of circulating anabolic hormones in men is associated with increased morbidity and mortality. We studied the prevalence and prognostic consequences of deficiencies in circulating total testosterone (TT) and free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor-1 (IGF-1) in men with chronic heart failure (CHF).Methods and Results - Serum levels of TT, DHEAS, and IGF-1 were measured with immunoassays in 208 men with CHF (median age 63 years; median left ventricular ejection fraction 33%; New York Heart Association class I/II/III/IV, 19/102/70/17) and in 366 healthy men. Serum levels of free testosterone were estimated (eFT) from levels of TT and sex hormone binding globulin. Deficiencies in DHEAS, TT, eFT, and IGF-1, defined as serum levels at or below the 10th percentile of healthy peers, were seen across all age categories in men with CHF. DHEAS, TT, and eFT were inversely related to New York Heart Association class irrespective of cause (all P < 0.01). DHEAS correlated positively with left ventricular ejection fraction and inversely with N-terminal pro-brain natriuretic peptide (both P < 0.01). Circulating TT, eFT, DHEAS, and IGF-1 levels were prognostic markers in multivariable models when adjusted for established prognostic factors (all P < 0.05). Men with CHF and normal levels of all anabolic hormones had the best 3-year survival rate (83%, 95% CI 67% to 98%) compared with those with deficiencies in 1 (74% survival rate, 95% CI 65% to 84%), 2 (55% survival rate, 95% CI 45% to 66%), or all 3 (27% survival rate, 95% CI 5% to 49%) anabolic endocrine axes (P < 0.0001).Conclusions - In male CHF patients, anabolic hormone depletion is common, and a deficiency of each anabolic hormone is an independent marker of poor prognosis. Deficiency of > 1 anabolic hormone identifies groups with a higher mortality.