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目的:探究基于我国社区人口资料的迟发性性腺功能减退症(LOH)患病率以及ADAM问卷和AMS量表(分别简称ADAM和AMS)在我国人群的敏感性、特异性及适用性。方法:1498例中老年健康男性研究对象填写了ADAM和AMS,其中434例进行了生殖激素浓度测定,利用血清总睾酮(tT)和计算的游离睾酮(fT)切点计算LOH的筛查阳性率、雄激素水平低下率、LOH临床患病率、筛查量表的敏感性和特异性等。利用ROC曲线优选AMS评分症状评价的切点值。结果:研究对象中仅有5例曾经不规范地补充过雄激素,调查时没有研究对象补充或主动寻求激素治疗。利用ADAM或AMS筛查40～69岁人群,LOH的平均筛查阳性率分别为80.77%和32.34%;以tT或fT为切点计算出的40～69岁人群平均雄激素水平低下率分别为14.02%和43.69%,ADAM阳性或者AMS阳性研究对象的平均LOH临床患病率分别为37.85%和15.42%;使用fT切点评定的ADAM、AMS的敏感性分别为86.63%和35.29%,特异性分别为24.48%和63.49%。ROC曲线优选的AMS评分症状评价的切点值为19.5分。结论:基于我国人群的ADAM、AMS的敏感性、特异性与国际上的多数研究结论基本一致,LOH筛查阳性率、雄激素水平低下率和临床患病率则明显高于其他研究报道。对于我国人群来说,两个筛查量表具有较好的适用性;ADAM敏感性高,省时、易操作,可作为筛查量表使用,而AMS可作为疗效监测量表使用。
Objective: To investigate the prevalence of late hypogonadism (LOH) based on community population data of China and the sensitivity, specificity and applicability of ADAM questionnaire and AMS scale (ADAM and AMS for short) in Chinese population. Methods: A total of 1498 middle-aged and elderly healthy male subjects were enrolled in ADAM and AMS, of which 434 were tested for reproductive hormone concentration. The screening positive rate of LOH was calculated by using total serum testosterone (tT) and calculated free testosterone (fT) , Low androgen levels, LOH clinical prevalence, screening scale sensitivity and specificity. The ROC curve was used to optimize the cut-off value of AMS score symptom evaluation. RESULTS: Only 5 of the study subjects had non-normatively replenished androgens, and none of the subjects were recruited or volunteered for hormone therapy at the time of the survey. The positive screening rate of LOH was 80.77% and 32.34% respectively in patients aged 40-69 by using ADAM or AMS. The average low androgen levels of 40- to 69-year-old population calculated by tT or fT were 14.02% and 43.69% respectively. The average prevalence of LOH in ADAM-positive or AMS-positive subjects was 37.85% and 15.42%, respectively. The sensitivity of ADMS and AMS assessed by fT cut point was 86.63% and 35.29% Respectively 24.48% and 63.49%. The cutoff value for the ROC curve-preferred AMS score symptom evaluation was 19.5 points. Conclusion: The sensitivity and specificity of ADMS and AMS based on Chinese population are basically the same as those of most international studies. The positive rate of LOH screening, low androgen level and clinical prevalence were significantly higher than those reported in other studies. For our population, the two screening scales have good applicability; ADAM high sensitivity, time-saving, easy to operate, can be used as a screening scale, and AMS can be used as a curative effect monitoring scale.