高龄前列腺癌患者全雄激素阻断治疗前后代谢及外周血指标变化的研究

发布时间：2018-05-21 14:40

本文选题：前列腺癌 + 内分泌治疗　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：通过观察≥70岁前列腺癌患者应用戈舍瑞林缓释植入剂联合比卡鲁胺行MAB(maximal androgen blockade，全雄激素阻断治疗)治疗前及治疗后3、6、9个月代谢水平及外周血相关指标的变化，以及MS（metabolic syndrome，代谢综合征）发病率，从而探讨高龄前列腺癌患者使用MAB治疗后可能出现的代谢及相关副作用及其安全性。方法：通过空军总医院病历系统筛选2005年1月1日～2013年10月1日就诊住院的前列腺癌患者72名，经过纳入及排除标准，共收集34例≥70岁前列腺癌患者。观察该组患者使用戈舍瑞林缓释植入剂联合比卡鲁胺行MAB治疗前及治疗后3、6、9个月的TG(triglyceride，甘油三酯)，LDL-C（low-density lipoprotein cholesterol，低密度脂蛋白胆固醇）、HDL-C（high-density lipoprotein cholesterol高密度脂蛋白胆固醇）、BMI（body mass index，体重指数）、PSA（prostate specific antigen，前列腺特异性抗原）、睾酮水平、前列腺体积、Hb（hemoglobin，血红蛋白）、HCT （red blood cell specific volume，红细胞比容)、血糖、血压等数据。通过国际糖尿病协会(IDF)诊断标准统计治疗前后患者MS发病率。对上述指标的治疗前后变化应用SPSS13.0软件进行统计学分析。结果：全激素阻断治疗前后比较，PSA、前列腺体积、睾酮较治疗前均有显著降低且存在显著差异，，PSA（治疗前vs治疗后3、6、9月均为p=0.01），前列腺体积（治疗前vs治疗后3、6、9月后分别为p=0.05，p=0.05, p=0.045）,睾酮水平（治疗前vs治疗后3、6、9月均为p=0.01）。外周血方面Hb（治疗前vs治疗后6、9月后分别为p=0.027，p=0.032）、HCT（治疗前vs治疗后3、6、9月后分别为p=0.030，p=0.024，p=0.038）均显著降低,代谢方面LDL-C显著增高（治疗前vs治疗后3、6、9月后分别为p=0.035，p=0.041，p=0.031）。HDL-C、TG、BMI、血糖、血压均无显著统计学差异,代谢综合征发病率随着治疗时间的延长由治疗前的35.2%逐渐升高为至第9月时的82.3%，并且具有显著差异（p=0.001）。结论：≥70岁前列腺癌患者使用戈舍瑞林缓释植入剂联合比卡鲁胺MAB治疗后PSA、睾酮及前列腺体积显著降低，证明在治疗前列腺癌有效且内分泌治疗使睾酮达到去势水平的前提下患者外周血水平Hb及HCT较治疗前明显降低，且随着治疗时间的延长，其程度愈发严重；代谢方面，代谢综合征的发病率明显升高，且发病率呈逐渐上升趋势。LDL-C较治疗前升高。对使用MAB的高龄前列腺癌患者需密切随访以上指标，同时需预防因应用MAB治疗导致的相关并发症发生。
[Abstract]:Objective: To observe the changes of metabolic level and peripheral blood related indexes in 3,6,9 months before and after treatment with MAB (maximal androgen blockade, total androgen blockade) and the incidence of MS (metabolic syndrome, metabolic syndrome) by observing the use of the slow-release implants of the prostatic cancer patients over 70 years of age and the combination of the specific androgen blockade of BCA (blockade, androgen blockade), and the incidence of MS (metabolic syndrome, metabolic syndrome). Metabolic and associated side effects and safety of the elderly prostate cancer patients after MAB treatment were discussed. Methods: 72 patients with prostate cancer hospitalized from January 1, 2005 to October 1, 2013 were screened by the medical record system of General Hospital of the Air Force PLA. Through inclusion and exclusion criteria, 34 cases of prostate cancer patients aged 70 and 70 years old were collected and observed. The patients were treated with TG (triglyceride, triglyceride), LDL-C (low-density lipoprotein cholesterol, low density lipoprotein cholesterol) and HDL-C (high-density lipoprotein cholesterol high density lipoprotein cholesterol) before and after MAB treatment and 3,6,9 months after treatment with the slow-release slow-release implant. Index), PSA (prostate specific antigen, prostate specific antigen), testosterone level, prostate volume, Hb (hemoglobin, hemoglobin), HCT (red blood cell specific volume, red cell specific volume), blood glucose, blood pressure and other data. SPSS13.0 software was used for statistical analysis before and after treatment. Results: before and after the total hormone blockage treatment, PSA, prostate volume, and testosterone were significantly lower than before treatment and there were significant differences, PSA (p=0.01 before 3,6,9 months after the treatment of VS), and the volume of prostate (before the treatment vs treatment was p=0.05, p=0.05, p=0. after 3,6,9 months, respectively. 045), the level of testosterone (3,6,9 months after vs treatment was p=0.01). Hb (p=0.027, p=0.032) in peripheral blood (p=0.027, p=0.032) in 6,9 months after treatment (before the treatment of VS). 041, p=0.031).HDL-C, TG, BMI, blood glucose and blood pressure have no significant difference. The incidence of metabolic syndrome gradually increases with the treatment time from 35.2% before treatment to ninth months, and it has a significant difference (p=0.001). Conclusion: the prostatic cancer patients over 70 years of age use the slow-release implant of the SDR combined with BCA MAB. After treatment, PSA, testosterone and prostate volume decreased significantly. It was proved that the level of peripheral blood Hb and HCT decreased significantly on the premise of effective and endocrine therapy for the treatment of prostate cancer and the level of testosterone, and the degree became more severe with the time of treatment; metabolism, the incidence of metabolic syndrome was obviously increased. The incidence of.LDL-C is higher than that before treatment. The older prostate cancer patients who use MAB need to follow these indicators closely and prevent related complications due to the use of MAB.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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