手术去势与晚期前列腺癌患者胰岛素抵抗的相关性研究

Insulin resistance in patients with advanced prostate cancer who received surgical castration

目的 探讨手术去势与晚期前列腺癌患者胰岛素抵抗的相关性。方法67例晚期前列腺癌患者根据体重指数（BMI）分为肥胖组（30例）和非肥胖组（37例），两组患者均采用手术去势的治疗方法；并在治疗前、治疗后6个月、治疗后12个月分别测定患者空腹血糖（FBG）、空腹胰岛素，并计算胰岛素抵抗指数（IRI）。结果肥胖组空腹胰岛素在治疗后6个月[（23．21±5．78）mU/L]及12个月[（24．34±5．37）mU/L]比治疗前[（20．01±4．82）mU/L]均升高。非肥胖组空腹胰岛素在治疗后12个月[（22．19±6．14）mU／L]比治疗前[（17．36±6．01）mU/L]升高。肥胖组IRI在治疗后6个月（2．94±0．79）及12个月（3．10±0．73）比治疗前（2．53±0．64）均升高。非肥胖组IRI在治疗后12个月（2．79±0．75）比治疗前（2．17±0．73）升高，上述差异均有统计学意义。结论手术去势会促使晚期前列腺癌患者胰岛素抵抗的发生，并会进一步导致心血管并发症和2型糖尿病的发生。

Objective To investigate the role of insulin resistance in patients with prostate cancer who received surgical castration. Methods Sixty-seven patients with advanced prostate cancer who received with surgical castration were divided into obesity group [30 cases, BMI （26.85 ±1.22） kg/m^2] and non-obesity group[37 cases, BMI（22.72 ±1.28） kg/m^2]. The fasting blood glucose （FBG） and the fasting serum insulin, while evaluated the insulin resistance index （IRI） were determined before treatment, 6 months after treatment and 12 months after treatment. Results The levels of fasting serum insulin were significantly higher 6 months [ （23.21 ± 5.78 ）mU/L ] and 12 months [ （24.34 ± 5.37 ） mU/L ] after treatment than that before treatment[ （20.01 ± 4.82） mU/L] in obesity group, but 12 months after treatment [ （22.19 ± 6.14） mU/L ]was higher than that before treatment [ （ 17.36 ±6.01 ） mU/L ] in non-obesity group （P 〈 0.01 ）. The IRI were significantly higher 6 months （2.94 ±0.79） and 12 months （3.10 ± 0.73 ） after treatment than that before treatment （2.53 ± 0.64） in obesity group, but 12 months after treatment （2.79 ± 0.75 ） was higher than that before treatment（2.17 ±0.73） in non-obesity group（P〈 0.01 ）. Conclusion The current data suggests that the patients with prostate cancer who received surgical castration is at risk for developing insulin resistance, thus leading to increasing risk of cardiovascular disease and type 2 diabetes mellitus.