Endogenous testosterone level and testosterone supplementation therapy in chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis.
Endogenous testosterone level and testosterone supplementation therapy in chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2013-003127
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发表时间：
2013-08-13
期刊：
影响因子：
2.9
通讯作者：
Smith S
中科院分区：
文献类型：
--
作者：
Atlantis E;Fahey P;Cochrane B;Wittert G;Smith S
低睾酮水平可能是慢性阻塞性肺疾病（COPD）患者功能障碍和恶化的可逆性危险因素。我们试图系统地评估内源性睾酮水平和睾酮治疗对COPD患者运动能力和健康相关生活质量（HRQoL）结局的影响，并为指南和实践提供信息。系统回顾和荟萃分析.我们检索了PubMed、Scopus、科克伦图书馆、CINAHL、Health Source Nursing和PsychINFO以及2012年5月之前发表的检索文章的参考文献列表。慢性肺病患者内源性睾酮水平与对照组比较的观察性研究，或COPD患者睾酮治疗运动能力和/或HRQoL结局的随机对照试验（RCT）符合条件。使用随机效应荟萃分析提取并汇总内源性总睾酮（TT）值的平均差异以及运动能力和HRQoL值的平均差异数据。在2918例COPD男性患者中开展的9项观察性研究报告TT水平始终低于对照组（加权平均差异为-3.21 nmol/L（95%CI-5.18至-1.23））。 287名参与者的6项RCT产生了5项关于峰值肌肉力量和峰值心肺功能结局（峰值摄氧量（VO2）和工作负荷）的研究和3项关于HRQoL结局的研究。替吉奥疗法显著改善了峰值肌肉力量（标准化平均差异（SMD）为0.31（95% CI 0.05 - 0.56））和峰值工作负荷与对照条件相比（SMD为0.27（95% CI 0.01 - 0.52））（除一人外，所有人均使用安慰剂），但未使用峰值VO2（SMD为0.21（95% CI − 0.15至0.56））或HRQoL（SMD为-0.03（95% CI − 0.32至0.25））。患有COPD的男性具有临床相关的低于正常的TT水平。在以男性为主的COPD患者中进行的短期研究证据不足，表明睾酮治疗可改善运动能力结局，即峰值肌肉力量和峰值工作负荷。
Low testosterone level may be a reversible risk factor for functional disability and deterioration in patients with chronic obstructive pulmonary disease (COPD). We sought to systematically assess the endogenous testosterone levels and effect of testosterone therapy on exercise capacity and health-related quality of life (HRQoL) outcomes in COPD patients, as well as to inform guidelines and practice. Systematic review and meta-analysis. We searched PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing and PsychINFO and the reference lists of retrieved articles published before May 2012. Observational studies on endogenous testosterone levels in people with chronic lung disease compared with controls, or randomised controlled trials (RCTs) on testosterone therapy for exercise capacity and/or HRQoL outcomes in COPD patients were eligible. Data on the mean difference in endogenous total testosterone (TT) values, and the mean difference in exercise capacity and HRQoL values were extracted and pooled using random effects meta-analysis. Nine observational studies in 2918 men with COPD reported consistently lower levels of TT compared with controls (weighted mean difference was –3.21 nmol/L (95% CI −5.18 to −1.23)). Six RCTs in 287 participants yielded five studies on peak muscle strength and peak cardiorespiratory fitness outcomes (peak oxygen uptake (VO2) and workload) and three studies on HRQoL outcomes. Testosterone therapies significantly improved peak muscle strength (standardised mean difference (SMD) was 0.31 (95% CI 0.05 to 0.56)) and peak workload (SMD was 0.27 (95% CI 0.01 to 0.52)) compared with control conditions (all but one used placebo), but not peak VO2 (SMD was 0.21 (95% CI −0.15 to 0.56)) or HRQoL (SMD was –0.03 (95% CI −0.32 to 0.25)). Men with COPD have clinically relevant lower than normal TT levels. Insufficient evidence from short-term studies in predominately male COPD patients suggests that testosterone therapy improves exercise capacity outcomes, namely peak muscle strength and peak workload.
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