间歇性和持续性最大限度雄激素阻断治疗 对前列腺癌患者代谢的影响

Effect of intermittent and continuous maximum androgen blockade on metabolic in patients with prostate cancer

目的:观察前列腺癌(prostate cancer,PCa)患者接受最大限度雄激素阻断治疗后的代谢改变,比较间歇性和持续性内分泌治疗(continuous hormonal therapy,CHT)对代谢的影响。方法:回顾性分析2013年1月至2016年1月期间于珠海市人民医院接受最大限度雄激素阻断治疗且符合标准的76例PCa患者,其中36例行间歇性内分泌治疗(intermittent hormonal therapy,IHT),为IHT组;40例行CHT,为CHT组。分析两组治疗前、治疗12个月及治疗24个月时的BMI、腰围、收缩压(diastolic blood pressure,DBP)、舒张压(systolic blood pressure,SBP)、空腹血糖(fasting blood glucose,FBG)、TG、TC、HDL和LDL的变化情况。结果:IHT组BMI和腰围在24个月中持续升高;治疗后血压、FBG和TG高于治疗前,但12～24个月无明显改变;TC在12个月时升高,而在24个月时与治疗前无差异;HDL和LDL在治疗前后无明显改变。CHT组BMI,腰围,血压和FBG在24个月中持续升高;治疗后TG和TC高于治疗前,但12～24个月无明显改变;HDL在治疗12个月后无明显改变,但24个月时较治疗前降低;LDL在治疗前后无明显改变。在治疗12个月时,两组间各项参数差异无统计学意义(P>0.05);而在治疗24个月时除LDL外,内分泌治疗对间歇组其他各项指标的影响均显著小于CHT组(P<0.05)。结论:PCa行间歇性和持续性最大限度雄激素阻断治疗均可引起患者体重、腰围、血压、血糖、血脂不同程度的代谢紊乱。但长期治疗时,IHT对患者体内代谢的影响较CHT小。

Objective： To observe the metabolic changes in patients with prostate cancer（PCa） who received maximum androgen blockade, and to compare the effects of intermittent and continuous strategies. Methods： Seventy-six PCa patients receiving maximum androgen blockade from January 2013 and January 2016 in Zhuhai People＇s Hospital and in accordance with the inclusion criteria were retrospectively analyzed, in which 36 patients were treated with intermittent hormonal therapy（IHT） strategy（Group IHT） and 40 patients were treated with continuous hormonal therapy（CHT） strategy（Group CHT）. The changes of BMI, waist circumference, systolic blood pressure（SBP）, diastolic blood pressure（DBP）, fasting blood glucose（FBG）, TG, TC, HDL and LDL before the treatment, 12 and 24 months after the treatment were analyzed. Results： In Group IHT, BMI and WC increased consistently within 24 months; blood pressure, FBG and TG were higher after treatment than that before the treatment, while no significant change was seen between 12 and 24 months after the treatment; TC increased at 12 months after the treatment, while at 24 months the level was the same as that before the treatment; the changes of HDL and LDL were not significant before and after the treatment. In Group CHT, BMI, waist circumference, blood pressure and FBG increased consistently within 24 months; TG and TC were on a higher level post-treatment, while no significant change was seen between the two time points. HDL did not change in 12 months, while decreased in 24 months. LDL remained stable within 24 months. In 12 months, there were no significant difference in all the indexes between the two groups, while in 24 months, except for LDL, the changes of indexes in Group IHT were smaller than that in Group CHT. Conclusion： Both IHT and CHT strategies of MAB caused metabolic disorders at different degrees, but IHT was better than CHT in the long-term treatment.