老年前列腺癌去势患者性激素水平变化及血栓危险因素分析

Changes of sex hormone and risk factors associated with thrombosis in older men with castrated prostatic cancer

目的研究老年前列腺癌患者去势后性激素水平变化,进一步探讨性激素对血栓危险因素的影响。方法选择247例>65岁老年患者,其中122例去势前列腺癌患者(去势组)、61例行根治性前列腺癌切除术的未去势前列腺癌患者(未去势组)和64例非前列腺癌(非前列腺癌组)患者。分别测定睾酮、雌激素、黄体生成素(LH)、卵泡刺激素(FSH)、泌乳素、孕激素,同时测定了血小板计数(PLT)、花生四烯酸(AA)诱导的血小板聚集率、二磷酸腺苷(ADP)诱导的血小板聚集率、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体(DD)、抗凝血酶-Ⅲ(AT-Ⅲ)、纤维蛋白原(FIB)、国际标准化比值(INR)。结果老年前列腺癌患者接受去势手术治疗后睾酮、雌激素、孕激素水平明显降低,LH、FSH显著升高,但泌乳素无明显变化,雌、雄激素比显著升高;同时AA诱导的血小板聚集率、ADP诱导的血小板聚集率、DD及FIB显著升高,INR显著降低,PT和APTT显著缩短;但PLT和AT-Ⅲ无明显变化。结论老年前列腺癌患者去势治疗后性激素水平紊乱,主要表现为睾酮、雌激素水平明显降低,但雌激素降低幅度小于雄激素;血小板和凝血活性显著增强,提示性激素水平紊乱可能参与凝血系统激活,增加血栓事件危险。

Objective To study the changes of sex hormone levels in old patients with castrated prostatic cancer, and to detect the relationship between changes of sex hormone levels and risk factors for thrombosis. Methods Two hundred forty seven elderly patients aged over 65,including 122 castrated patients,61 radical prostatectomy patients, and 64 non-prostatic cancer patients. Testosterone, estradiol, luteal hormone, follicle stimulating hormone （FSH）, prolactin, progesterone, blood platelets eount（PLT）, aggrega- tion of platelets induced by araehidonic acid （AA）,aggregation of platelets induced by adenosine diphosphate （ADP）,blood prothrombin time（PT）, activated partial thromboplastin time（APTT）, D-dimers（DD）, antithro-m- Ⅲ （AT- Ⅲ ）, fibrinogen（FIB）, international normal- ized ratio（INR） were measured and compared between groups. Results In patients with castrated prostatic cancer,Testosterone,estra- diol, and progesterone levels decreased significantly, LH and FSH increased significantly ,change of prolaetin was not significantly, E2/ T were elevated significantly;Aggregation of platelets induced either by AA or ADP increased significantly;PT and AVFT shortened significantly,INR decreased significantly,DD and FIB elevated significantly. Differences in AT-m and PLT were not significantly. Conclusions Levels of sex hormone in patients experienced castrated prostatic cancer changed greatly,platelets and coagulating fac- tors were activated accordingly. It suggested that there might be relationship between decreased sex hormone levels and risk factors for thrombotic events in old male patients.