title: Serum testosterone levels and androgen receptor CAG polymorphism correlate with hepatitis B virus (HBV)-related acute liver failure in male HBV carriers.
abstract: BACKGROUND
  Augmentation of androgen/androgen receptor (AR) pathway may influence chronic hepatitis B (CHB) more likely in males. AR activity is modulated by a polymorphic CAG repeat sequence in AR exon 1. This study aimed to investigate the relationship between serum testosterone levels, CAG repeat numbers and hepatitis B virus (HBV)-related acute liver failure (ALF).
  
  
  METHODS
  Three hundred and seventy eight male CHB patients with ALF and 441 asymptomatic HBV carriers (AsCs) were recruited. AR CAG repeats numbers were analyzed. The serum testosterone levels of AsCs, ALFs and patients with hepatitis B flare groups, and sequential serum samples, were assessed quantitatively.
  
  
  RESULTS
  The median CAG repeat (M-CAG) frequency was significantly higher in ALF patients than AsCs (P<0.001). Patients with M-CAG alleles (P<0.001, OR 3.0, 95% CI 2.1-4.2) had the highest risk for ALF. Serum testosterone levels were significantly higher (P<0.001) at hepatitis flare point (8.2 ± 3.0 ng/mL) than inactive phase (6.4 ± 2.0 ng/mL). CHB (8.30 ± 2.71 ng/mL, P = 7.6 × 10(-6)) and ALF group (2.61 ± 1.83 ng/mL, P = 1.7 × 10(-17)) had significantly different levels of testosterone in comparison with AsCs group (6.56 ± 2.36 ng/mL). The serum testosterone levels sharply decreased from hepatitis flare phase to liver failure phase, and tended to be normal at the recovery phase. Male AsCs with M-CAG alleles had significantly lower serum testosterone levels (P<0.05).
  
  
  CONCLUSIONS
  There was a serum testosterone fluctuation during hepatitis B flare and HBV-related ALF, and the median CAG repeats in AR gene exon 1 were associated with lower serum testosterone levels in asymptomatic HBV carriers and an increased susceptibility to HBV-related ALF.
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Research of Infectious Diseases, Chongqing, China.
authors.forename: Bao-Yan
authors.initials: BY
authors.lastname: Xu
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Research of Infectious Diseases, Chongqing, China.
authors.forename: Wen-Ting
authors.initials: WT
authors.lastname: Tan
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Research of Infectious Diseases, Chongqing, China.
authors.forename: Shun
authors.initials: S
authors.lastname: Tan
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Research of Infectious Diseases, Chongqing, China.
authors.forename: Yun-Jie
authors.initials: YJ
authors.lastname: Dan
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Research of Infectious Diseases, Chongqing, China.
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Luo
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Research of Infectious Diseases, Chongqing, China ; Institute of Immunology, Third Military Medical University, Chongqing, China.
authors.forename: Guo-Hong
authors.initials: GH
authors.lastname: Deng
mesh_terms: D016022:Case-Control Studies; D002681:China; D017931:DNA Primers / Q000235:genetics; D006509:Hepatitis B / Q000097:blood* / Q000150:complications; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D011110:Polymorphism, Genetic / Q000235:genetics*; D011944:Receptors, Androgen / Q000235:genetics*; D013739:Testosterone / Q000097:blood*; D018911:Trinucleotide Repeats / Q000235:genetics*
chemical_list: D017931:DNA Primers; D011944:Receptors, Androgen; D013739:Testosterone