双侧睾丸切除后动脉粥样硬化相关生化指标的变化

Effect of lower androgen levels on arteriosclerosis

目的 探讨男性去势手术对动脉粥样硬化相关生化指标的影响。 方法 对接受双侧睾丸切除手术的 30例前列腺癌患者 ,于术前、术后 1周及术后 1、4、8个月分别测定血清雄激素、前列腺特异抗原及与动脉粥样硬化有关的血脂、血糖、胰岛素和纤溶酶原激活物抑制剂 1、纤维蛋白肽A等生化指标 ,并进行分析。 结果 去势术后 1周 ,血睾酮、游离睾酮、前列腺特异抗原较术前显著降低。术后 1个月甘油三酯 [(1 8± 0 6 )mmol/L ,t=- 2 2 1,P <0 0 5 ]、空腹胰岛素及血糖、餐后 2h胰岛素及血糖开始较术前明显增高 ,差异有显著意义 ;而胰岛素敏感指数显著降低 (- 4 4± 0 4,t =3 72 ,P <0 0 1) ,差异有非常显著意义。术后 4个月 ,总胆固醇 [(6 6± 1 0 )mmol/L ,t=3 0 9]、低密度脂蛋白胆固醇 [(4 1± 0 9)mmol/L ,t =3 5 7]、纤溶酶原激活物抑制剂 1[(2 7 0 2± 5 98) μg/L ,t =2 33]、纤维蛋白肽A[(3 4± 1 7)nmol/L ,t =3 2 7]开始较术前明显增加 ;均P <0 0 5 ,差异有显著意义。脱氢表雄酮、性激素结合蛋白、高密度脂蛋白胆固醇、载脂蛋白α1及载脂蛋白 β、纤维蛋白原手术前后无明显改变。睾酮、游离睾酮与甘油三酯、总胆固醇、低密度脂蛋白胆固醇、纤溶酶原激活物抑制剂 1、纤维蛋白肽A。

Objective To analyse the effect of lower androgen levels on risk factors for arteriosclerosis of men. Methods In 30 cases of primary prostate carcinoma (stage A), 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), fibrinogen were determined before and 1 week,1,4,8 months after castration. Results T, FT, PSA decreased significantly 1 week after castration, and kept on decreasing afterwards. DHEA and SHBG were not changesd. TG, fasting insulin and glucose, 2 hour insulin and glucose elevated significantly 1 month after castration. TG, LDL C, FPA and PAI 1 elevated 4 months after castration. Insulin sensitive index(ISI) decreased significantly 1 month after operation (-4 4±0 4 vs. -3 5±0 4, P <0 01). HDL C, APOα1, APOβ and fibrinogen were not changesd. There was a negative linear correlation between FT and TG, TC, LDL C, PAI 1, FPA, fasting insulin and glucose, 2 h insulin and glucose, so did T. Conclusion Lower androgen levels have adverse effect on lipid metabolism, coagulative function and insulin sensitivity, which are related to arteriosclerosis of men.