摘要目的探讨前列腺癌患者接受手术去势治疗后由于雄激素水平降低对动脉粥样硬化危险因素的影响.方法对接受去势手术的30例局限于包膜内的原发性前列腺腺癌患者,于术前、术后1周及1、4和8个月分别测定其血睾酮(T)、游离睾酮(FT)、脱氢表雄酮(DHEA)、性激素结合蛋白(SHBG)、前列腺特异抗原(PSA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白α1(APOα1)及载脂蛋白β(APOβ)、纤维蛋白肽A(FPA)、纤维蛋白原、纤溶酶原激活物抑制剂-1(PAI-1)、空腹及餐后胰岛素、空腹及餐后血糖.结果本组患者去势术后1周,血T、FT、PSA较术前显著降低(21.12±15.11 ng/ml vs 383.9±62.6 ng/ml,P<0.001;4.08±3.29 pmol/L vs 34.11±11.59 pmol/L,P<0.001;14.34±7.77 ng/ml vs 23.51±6.57 ng/ml,P=0.001),此后继续下降.DHEA、SHBG手术前后无显著变化.TG、空腹胰岛素、空腹血糖、餐后2小时胰岛素及血糖于术后1个月开始较术前显著增高(1.84±0.61 mmol/L vs 1.30±0.40 mmol/L, P<0.05;18.16±5.57 mU/L vs 9.47±3.81 mU/L,P<0.05;4.77±0.66 mmol/L vs 3.92±0.34 mmol/L,P<0.05;65.52±14.78 mU/L vs 36.94±17.12 mU/L,P<0.01; 6.98±0.79 mmol/L vs 6.01±0.23 mmol/L,P=0.001),TC和LDL-C、PAI-1、FPA则于术后4个月开始较术前明显增加(6.56±0.99 mmol/L vs 5.29±0.75 mmol/L, P<0.01;4.09±0.86 mmol/L vs 3.04±0.15 mmol/L, P<0.01; 27.02±5.98 ng/ml vs 21.78±3.16 ng/ml,P<0.05;3.39±1.67 nmol/L vs 1.48±0.50 nmol/L,P<0.01),此后均呈上升趋势.胰岛素敏感指数(ISI)于术后1个月显著降低(-4.42±0.36 vs -3.50±0.39,P<0.001),此后呈下降趋势.HDL-C、APOα1、APOβ、纤维蛋白原手术前后无明显改变.血FT和T与TG、TC、LDL-C、PAI-1、FPA、空腹胰岛素及血糖、餐后2小时胰岛素及血糖水平分别呈直线负相关(r=-0.311, -0.384, -0.385, -0.339, -0.353, -0.381, -0.303, -0.460, -0.395, P<0.05;r=-0.308, -0.309, -0.356, -0.320, -0.430, -0.453, -0.435, -0.483, -0.512, P<0.05),T、FT与ISI呈直线正相关(r=0.555, 0.501; P<0.001).结论前列腺癌患者去势术后随访8个月,观察到由于雄激素降低而影响动脉粥样硬化的危险因素,从而可能增加动脉粥样硬化的发生率.

abstractsObjective To analyze the effect of castration on risk factors for arteriosclerosis of patients with prostate cancer. Methods Thirty patients with primary regional prostate adenocarcinoma limited to the prostate theca were selected in this study. Serum levels of testosterone (T), free testosterone (FT), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), prostatic specific antigen (PSA), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), apoprotein α1 (APOα1) and apoprotein β (APOβ), insulin, plasma fibrinopeptide A (FPA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined just prior to, 1 week and 1, 4 and 8 months after castration.Results T, FT and PSA decreased significantly 1 week after castration (21.12±15.11 ng/ml vs 383.9±62.6 ng/ml, P<0.001; 4.08±3.29 pmol/L vs 34.11±11.59 pmol/L, P<0.001; 14.34±7.77 ng/ml vs 23.51±6.57 ng/ml, P=0.001, respectively) and continued to decrease until reaching their lowest levels 8 months after castration. DHEA and SHBG did not undergo any changes. TG, fasting insulin and glucose, 2-hour insulin and glucose levels were significantly elevated 1 month after castration (1.84±0.61 mmol/L vs 1.30±0.40 mmol/L, P<0.05; 18.16±5.57 mU/L vs 9.47±3.81 mU/L, P<0.05; 4.77±0.66 mmol/L vs 3.92±0.34 mmol/L, P<0.05; 65.52±14.78 mU/L vs 36.94±17.12 mU/L, P<0.01; 6.98±0.79 mmol/L vs 6.01±0.23 mmol/L, P=0.001, respectively). TC, LDL-C, FPA and PAI-1 levels were elevated 4 months after castration (6.56±0.99 mmol/L vs 5.29±0.75 mmol/L, P<0.01; 4.09±0.86 mmol/L vs 3.04±0.15 mmol/L, P<0.01; 3.39±1.67 nmol/L vs 1.48±0.50 nmol/L, P<0.01; 27.02±5.98 ng/ml vs 21.78±3.16 ng/ml, P<0.05, respectively), continuing to increase after that point. Insulin sensitive index (ISI) decreased significantly 1 month after surgery (-4.42±0.36 vs -3.50±0.39, P<0.001), and continued to decrease from that point forward. HDL-C, APOα1, APOβ and fibrinogen remained at pre-operative levels. There was a negative linear correlation between FT and TG, TC, LDL-C, PAI-1, FPA, fasting insulin and glucose, 2-hour insulin and glucose (r=-0.311, -0.384, -0.385, -0.339, -0.353, -0.381, -0.303, -0.460 and -0.395, respectively; P<0.05). A similar phenomenon occurred with T (r=-0.308, -0.309, -0.356, -0.320, -0.430, -0.453, -0.435, -0.483 and -0.512, respectively; P<0.05). T and FT were positively associated with ISI (r=0.555 and 0.501; P<0.001).Conclusions At 8 months follow-up of the study subjects, we found that lower androgen levels have adverse effects on lipid metabolism, coagulative function and insulin sensitivity, related to arteriosclerosis in men.