【摘要】 目的 探讨总睾酮（TT）、雌二醇（E2）与代谢相关脂肪性肝病（MAFLD）的相关性。方法 选取2013年6月至2014年9月北京平谷地区代谢性疾病调查队列数据库中研究对象3172名，分为<50岁男性（n=628）、≥50岁男性（n=618）、未绝经女性（n=1011）和绝经女性（n=915），将上述4组人群进一步分为MAFLD亚组和非MAFLD（Non-MAFLD）亚组。比较不同人群中亚组的一般资料和生化指标，有序Logistic回归分析不同人群中TT、E2对MAFLD影响。结果 <50岁男性、≥50岁男性、未绝经女性、绝经女性中，MAFLD患病率分别为27.2%、23.8%、15.3%、23.7%，未绝经女性MAFLD患病率最低（P<0.05）。4组人群中，MAFLD亚组DM比例、BMI、WC、谷丙转氨酶、谷草转氨酶、FPG、HbA₁c、FIns、TG、胰岛素抵抗指数均高于Non-MAFLD亚组（P<0.05）,HDL-C均低于Non-MAFLD亚组（P<0.05）。<50岁男性人群、未绝经女性人群、绝经女性人群中，MAFLD亚组高血压病比例、TC、血尿酸均高于Non-MAFLD亚组（P<0.05）。男性人群中，MAFLD亚组TT均低于Non-MAFLD亚组（P<0.05），女性人群中MAFLD亚组TT均高于Non-MAFLD亚组（P<0.05）。<50岁男性人群中，MAFLD亚组血肌酐高于Non-MAFLD亚组（P<0.05）。未绝经女性人群中，MAFLD亚组LDL-C高于Non-MAFLD亚组（P<0.05）,E2低于Non-MAFLD亚组（P<0.05）。绝经女性人群中，MAFLD亚组E2高于Non-MAFLD亚组（P<0.05）。有序Logistic回归分析显示，校正年龄后，男性随TT水平上升，MAFLD患病风险递减(P_{for trend}<0.05)，随E2水平上升，MAFLD患病风险递增(P_{for trend}<0.05)；女性随TT水平上升，MAFLD患病风险增加(P_{for trend}<0.05)，未绝经女性随E2水平升高，MAFLD患病风险递减(P_{for trend}<0.05)；绝经女性随E2水平升高，MAFLD患病风险递增(P_{for trend}<0.05)。校正代谢相关因素后，<50岁男性15.925～20.170 nmol/L TT组（OR 0.470,95%CI 0.245～0.889）和≥50岁男性14.448～18.430 nmol/L TT组（OR 0.516,95%CI 0.291～0.904）MAFLD患病风险降低；未绝经女性0.620～0.900 nmol/L TT组和绝经女性0.330～0.585 nmol/L TT组的MAFLD患病风险增加（OR 1.803、1.832,95%CI 1.035～3.1779、1.086～3.124）；绝经女性随E2水平升高，MAFLD患病风险递增(P_{for trend}<0.05)。结论 TT与MAFLD的相关性受性别和年龄影响，男性高TT水平与MAFLD风险降低相关，女性高TT水平与MAFLD风险增加相关，E2对MAFLD影响尚不明确。更多还原

【Abstract】 Objective To explore the correlation between total testosterone（TT）,estradiol（E2） and metabolism associated fatty liver disease（MAFLD）. Methods This study included a total of 3172 research subjects from the metabolic disease investigation cohort database in Pinggu District,Beijing with data collected between June 2013 and September 2014. All the participants were divided into men with age <50 years（n=628）,men with age≥50 years（n=618）,premenopausal women（n=1011）,and menopausal women（n=915）. The above four populations were further divided into the MAFLD subgroup and the Non-MAFLD subgroup. The general data and biochemical indicators were compared between different groups. Ordered Logistic regression was used to analyze the effects of TT and E2 on MAFLD in different groups. Results The prevalence rates of MAFLD were 27. 2%,23. 8%,15. 3% and 23. 7% in men under 50 years old,men ≥50 years old,premenopausal women and postmenopausal women respectively. The prevalence rate of MAFLD was the lowest among premenopausal women（P<0. 05）. Among the four populations,DM proportion,body mass index,waist circumference,alanine aminotransferase,aspartate aminotransferase,FPG,fasting plasma glucose,hemoglobin A₁c,fasting insulin,triglyceride and insulin resistance index were all higher（P<0. 05）,while high density lipoprotein were lower in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）. Among men with age <50 years,the premenopausal women and the menopausal women groups,hypertension proportion,total cholesterol and blood uric acid were all higher in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）. In men group,the TT was lower in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）,while in the women group,the TT was higher in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）. Among the men with age <50 years,the serum creatinine was higher in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）. Among premenopausal women,the low density lipoprotein cholesterol was higher,while the E2 was lower in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）. Among postmenopausal women,the E2 level was higher in the MAFLD subgroup than in the Non-MAFLD subgroup（P<0. 05）. Ordered Logistic regression analysis showed that after adjusting for age,the risk of MAFLD decreased with the increase of TT level(P_{for trend} <0. 05),and increased with the increase of E2 level(P_{for trend}<0. 05) in men group. In women,the risk of MAFLD increased with the increase of TT level(P_{for trend}<0. 05),and for premenopausal women,the risk of MAFLD decreases with the increase of E2 level(P_{for trend}<0. 05). In postmenopausal women,the risk of MAFLD increased with the rise of E2 levels(P_{for trend}<0. 05). After adjusting for metabolism-related factors,the risk of MAFLD is reduced in the 15. 925～20. 170 nmol/L TT group for men <50 years old（OR 0. 470,95%CI 0. 245～0. 889） and the 14. 448～18. 430 nmol/L TT group for men ≥50 years old（OR 0. 516,95%CI 0. 291～0. 904）. The risk of MAFLD increased in the 0. 620～0. 900 nmol/L TT group of premenopausal women and the 0. 330～0. 585 nmol/L TT group of menopausal women（OR 1. 803,1. 832,95%CI 1. 035～3. 1779,1. 086～3. 124）. In postmenopausal women,the risk of MAFLD increases with the rise of E2 levels(P_{for trend}<0. 05). Conclusions The correlation between TT and MAFLD is influenced by sex and age. High TT levels are associated with a reduced risk of MAFLD in men,while high TT levels are associated with an increased risk of MAFLD in women. The impact of E2 on MAFLD remain unclear.更多还原