Klinefelter 综合征的轻度肝功能异常与腹部肥胖和血脂升高有关,但与睾酮治疗无关。

IF 5.4 2区 医学 Q1 Medicine Journal of Endocrinological Investigation Pub Date : 2024-12-01 Epub Date: 2024-05-30 DOI:10.1007/s40618-024-02394-3
C M Øzdemir, L O Ridder, S Chang, J Fedder, J Just, C H Gravholt, A Skakkebæk
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引用次数: 0

摘要

背景:克莱因费尔特综合征(KS)与高促性腺激素性性腺功能减退症有关,这导致了包括代谢改变在内的特征性表型表现。大量研究表明,雄激素与肝功能之间存在重要关联:调查患有 KS 的男性(包括接受治疗(T-KS)和未接受治疗(U-KS)的男性)以及健康对照组男性的代谢参数、性激素和肝功能之间的关系:方法:共招募了 65 名 KS 男性患者,其中 32 人接受了睾酮替代疗法(TRT)。此外,还招募了 69 名健康对照者。我们使用丙氨酸氨基转移酶(ALAT)、碱性磷酸酶和 PP(凝血酶原-转化酶时间比)作为主要的肝脏标记物。在三个组内进行了多变量回归。所有统计数据均使用 STATA 进行计算。主成分分析用于展示所有测量的生物标志物之间的相互联系模式,并阐明不同组别与这些模式之间的联系:结果:与对照组相比,U-KS 的主要肝脏标志物水平更高,但 U-KS 和 T-KS 之间无显著差异。与 U-KS 相比,T-KS 的腹部脂肪、总胆固醇和低密度脂蛋白胆固醇含量更低。使用多变量模型,U-KS 的 ALAT 变异可由 HOMA2%S 解释;T-KS 的 ALAT 变异可由 BMI 和 SHBG 解释;对照组的 ALAT 变异可由臀围和雌二醇解释。我们没有发现多变量模型可以解释 U-KS 中 PP 的变化;在 T-KS 中,BMI 和低密度脂蛋白胆固醇可以解释 PP 的变化,而在对照组中,总胆固醇可以解释 PP 的变化。通过主成分分析,U-KS 与 D1(肥胖特征,也包括 ALAT)呈正相关,而对照组与 D1(非肥胖特征)呈负相关:结论:KS 男性有轻度肝功能异常,主要肝脏标志物显著增加,白蛋白下降。所提供的数据强调了代谢状况(包括肥胖、胰岛素抵抗和不利的血脂状况)在 KS 男性肝功能指标升高中的主要作用。TRT 是否能改善 KS 患者的肝功能还有待进一步研究。我们的研究结果强调,肝功能评估应成为 KS 男性患者临床治疗的一部分。
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Mild liver dysfunction in Klinefelter syndrome is associated with abdominal obesity and elevated lipids but not testosterone treatment.

Context: Klinefelter syndrome (KS) is associated with hypergonadotropic hypogonadism, which contributes to characteristic phenotypical manifestations including metabolic alterations. Extensive research has demonstrated important associations between androgens and liver function.

Objectives: Investigation of the association between metabolic parameters, sex hormones and liver function in males with KS, both treated (T-KS) and untreated (U-KS) and healthy control males.

Methods: A total of 65 KS males were recruited, of which 32 received testosterone replacement therapy (TRT). Also, 69 healthy controls were recruited. We used alanine aminotransferase (ALAT), alkaline phosphatase and PP (prothrombin-proconvertin time ratio) as the main liver markers. Multivariable regression was performed within the three groups. All statistics were calculated using STATA. Principal component analysis was utilized to demonstrate the interconnected patterns among all measured biomarkers, and to elucidate how the different groups were linked to these patterns.

Results: Higher levels of main liver markers were observed in U-KS compared to controls, with no significant differences between U-KS and T-KS. T-KS had lower abdominal fat, total cholesterol, and LDL cholesterol than U-KS. Using multivariable models, variation in ALAT in U-KS was explained by HOMA2%S; in T-KS by BMI and SHBG; and in controls by hip circumference and estradiol. We found no multivariable models explaining variation in PP in U-KS; in T-KS, PP was explained by BMI and LDL cholesterol, and in controls by total cholesterol. Using principal component analysis U-KS was positively associated to D1 (an obese profile, which also included ALAT) and controls negatively associated with D1 (non-obese profile).

Conclusion: KS males have mild liver dysfunction reflected by a significant increase in the main liver markers and decrease in albumin. The presented data underscore a primary role of metabolic conditions including obesity, insulin resistance and unfavourable lipid profile, in the elevated liver function markers seen in males with KS. Whether TRT can improve liver function in KS warrants further studies. Our findings, highlight that an evaluation of the liver function should be part of the clinical care in males with KS.

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来源期刊
Journal of Endocrinological Investigation
Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
8.10
自引率
7.40%
发文量
242
期刊介绍: The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.
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