Based On The Theory Of "kidney Should Be Winter", The Effects Of Winter And Summer Changes On Gonadotropin Levels In Middle-aged And Elderly Men Were Studied

ObjectiveThe theory of "kidney corresponding with winter" is a very important part of Zang-Fu theory and the system of four seasons and five organs.It expressly pointed out that kidney is related to winter.The kidney of traditional chinese medicine is not only connected with the winter,but also has physiological characteristics of storing essence and controlling reproduction.The cognition and research of modern medicine is focused on the positive and negative feedback regulation of hypothalamic-pituitary-gonad axis,and related disease of late-onset hypogonadism(LOH)has become the focus of medical and scientific research workers.In this study,under the guidance of adaptive regulation of "kidney corresponding with winter" and traditional chinese medicine theory of "Kidney producing marrow","Kidney storing essence",we observe the effect of seasonal variation on the hormone levels of the hypothalamic-pituitary-gonad axis in middle aged men,explore the TCM basic theory mechanism of LOH,provide theoretical support for clinical diagnosis and prevention of TCM;we investigate the effect of LOH on insulin resistance index in male patients by observing the insulin resistance index.Moreover,the relationship between male sex hormone and ADAM score and TCM syndrome type(kidney yin deficiency and kidney yang deficiency)was preliminarily investigated by small sample observation.MethodsAccording to the accepted standard,this study selected 60 male patients from Guang’anmen Hospital(between January 2015 and July 2017)and there were 30 cases in each of the experimental group 1(Diabetes mellitus associated with LOH),experimental group 2(Diabetes mellitus without LOH)and control group(No diabetes mellitus and LOH).The sex hormone levels(total testosterone,follicle stimulating hormone,luteinizing hormone,estradiol)and blood glucose related indicators(fasting blood glucose,fasting insulin,homeostasis model assessment insulin resistance(HOMA-IR)and ADAM symptom score)were detected at 7 o’clock within 1 weeks of the winter solstice and the summer solstice in each group.Input all of the data into the database for statistical analysis,and explore the effects of seasonal variation on sex hormones in men.At the same time,the experimental group lwas given a small sample of TCM classification,to explore the correlation between male sex hormone levels and ADAM symptoms score and TCM Syndrome TypesAfter 6 months,serum samples were collected and related indexes were determined by automatic analyzer:1.fasting blood glucose,fasting insulin,homeostasis model assessment insulin resistance(HOMA-IR)2.sex hormone levels(total testosterone,follicle stimulating hormone,luteinizing hormone,estradiol).Contents1.Serum levels of sex hormones were measured to determine the effects of seasonal variation on male sex hormones.2.The blood glucose,fasting insulin and insulin resistance index were measured to investigate the correlation between insulin resistance index and sex hormones in diabetic patients.3.After the grouping of TCM syndromes in the experimental group 2,the male sex hormones and ADAM symptom scores were observed in the two groups,and the correlation between different syndromes and male sex hormones and ADAMsymptoms was studied.Results1.Healthy male sex hormones change in winter and summer.LH level is higher in winter than in the summer,LH in winter:9.21±1.12IU/L,In summer:7.73±1.01IU/L,testosterone and estradiol level are both higher in summer than in winter,estosterone in winter:14.2 ± 1.5 nmol/L,in summer:16.0±1.1 nmol/L,estradiol in winter:10.6±1.1pmol/L,in summer:13.5±2.1pmol/L,The above three indicators between groups are statistically significant differences(P<0.05);FSH in winter:10.1 ± 1.2 IU/L,In summer:10.8± 1.01 IU/L.There is no statistically significant difference in FSH levels(P>0.05).2.Sex hormone levels in male patients with type 2 diabete appear to higher Testosterone level in summer than in winter,and there is a statistically significant difference.Testosterone in summer:15.2± 1.02 nmol/L,in winter:13.2±0.51 nmol/L(P<0.05);Estradiol level is higher in winter than in the summer,and there is a statistically significant difference.Estradiol in winter:16.66±1.1 pmol/L,In summer:12.5±1.3pmol/L(P<0.05);LH level is higher in winter than in the summer,and there is a statistically significant difference.LH in winter:9.11±1.02 IU/L,In summer:7.33 ±1.01 IU/L(P<0.05);There is no statistically significant difference in FSH levels(P>0.05).3.Type 2 diabetes mellitus complicated with LOH appear to higher testosterone level in summer than in winter,and there is a statistically significant difference.Testosterone in summer:10.9 ± 1.02 nmol/L,in winter:9.12 ± 1.23 nmol/L(P<0.05);Estradiol level is higher in winter than in the summer,and there is a statistically significant difference.Estradiol in winter:19.6±1.1 pmol/L,In summer:18.5±2.1 pmol/L(P<0.05);There is no statistically significant difference in FSH and LH level(P>0.05).4.Insulin resistance index increased in patients of T2DM and T2DM with LOH.HOMA-IR inT2DM:5.62±1.0,HOMA-IR in T2DM with LOH:6.72±1.2;HOMA-IR in healthy individuals:2.59±1.1,The above three indicators between groups are statistically significant differences(P<0.05);Insulin resistance index increased inmale patients with low testosterone levels,The difference between the two experimental groups is statistically significant.5.The correlation analysis between TCM syndrome differentiation and hormone levels is as follows:In 30 cases of type 2 diabetes mellitus complicated with LOH,the levels of hypothalamic pituitary hormone in patients with kidney yang deficiency group is significantly increased,which showed significant increase in LH and FSH(P<0.05);meanwhile,E2 increased significantly(P<0.05).In TT level,there is no significant difference between the two groups(P>0.05).6.The correlation analysis between TCM syndrome differentiation and ADAM score is as follows:In 30 cases of type 2 diabetes mellitus complicated with LOH,physical symptoms,sexual dysfunction symptoms,mental symptoms of kidney yang deficiency is significantly higher than kidney yin deficiency group,the differences between groups were statistically significant(P<0.05);vasomotor symptoms of kidney yang deficiency is significantly lower than kidney yin deficiency group,the differences between groups were statistically significant(P<0.05).Conclusion1.Seasonal variations of winter and summer have an effect on male sex hormone levels of healthy males.T2DM with or without LOH.Testosterone levels in LOH patients were seasonal,and pituitary levels of hormones were higher in winter,and target organ levels of total hormone testosterone were higher in summer.This phenomenon is consistent with the theory "kidney corresponding with winter|、"Kidney storing essence".This change may play a part in alternative treatment.2.Male with low testosterone levels have higher insulin resistance indices,one of the physiological functions of testosterone is to change body composition and regulate body fat distribution,The decrease in serum testosterone results in an increase in visceral fat accumulation,which leads to insulin resistance increases.3.In T2DM with LOH,the levels of LH,FSH and E2 in kidney yang deficiency type were significantly higher than those in kidney yin deficiency type.In the ADAM score,the levels of physical symptoms,sexual dysfunction and mental psychological symptoms of patients with kidney yang deficiency type were significantly higher than those of kidney yin deficiency,and the movement symptoms of kidney yang deficiency type patients were significantly lower than those of kidney yin deficiency type.