老年男性2型糖尿病患者胰岛功能与前列腺特异抗原的相关性

The relationship between insulin function and serum prostate-specific antigen levels in type 2 diabetic senior male patients

目的探讨使用不同降糖药物的2型糖尿病(T2DM)老年男性患者胰岛功能与前列腺特异抗原(PSA)的关系。方法选择135例T2DM老年男性患者及45例年龄、体质量指数(BMI)相匹配的健康男性志愿者作为研究对象,检测血清游离PSA(f-PSA)和总PSA(t-PSA)水平,实施口服葡萄糖耐量试验(OGTT)计算胰岛功能的静态指标胰岛素抵抗指数(HOMA-IR)和动态指标时间-血糖/胰岛素/C肽曲线的曲线下面积(AUC),并对胰岛功能与PSA进行相关性分析。结果应用胰岛素治疗的T2DM老年男性患者HOMA-IR、血糖曲线下面积(GAUC)和胰岛素曲线下面积(IAUC)均高于口服降糖药物患者以及正常对照组(均P<0.05)。T2DM老年男性患者血清f-PSA和t-PSA水平均低于正常对照组(均P<0.05),其中胰岛素治疗组f-PSA和t-PSA高于口服降糖药物组(均P<0.05),二甲双胍组IAUC、f-PSA和t-PSA水平低于非二甲双胍组(均P<0.05)。胰岛素治疗组动态指标IAUC与t-PSA呈正相关(r=0.334,P<0.05)。结论二甲双胍可能是前列腺的保护因素,而外源性胰岛素治疗可能对前列腺产生危险作用,因此临床解释T2DM老年男性患者血清PSA水平时应考虑降糖药物的影响。

Objective To investigate the relationship between insulin function and serum prostate-specific antigen(PSA)levels in type 2 diabetic senior male patients treated with different hypoglycemic agents.Methods 135 cases of type 2 diabetic senior male patients and 45 healthy men with matched age and body mass index(BMI)were enrolled in this study.The levels of free PSA(f-PSA)and total PSA(t-PSA)were evaluated,the values of homeostasis model assessment for insulin resistance(HOMA-IR),glucose area under the curve(GAUC),insulin area under curve(IAUC)and C-peptide area under curve(CAUC)were calculated by oral glucose tolerance test(OGTT)in all the subjects.Correlation analysis was carried out between insulin function and PSA.Results The HOMA-IR,GAUC and IAUC values were significantly higher in type 2 diabetic senior male patients with insulin treatment compared with the oral hypoglycemic agents group and the healthy control group(all P<0.05).Compared with healthy control group,type 2 diabetic senior male patients had decreased f-PSA and t-PSA levels(all P<0.05).The levels of f-PSA and t-PSA were significantly higher in insulin group compared to oral hypoglycemic agents(all P<0.05).Metformin group,compared with non-metformin group,had lower IAUC,f-PSA and t-PSA(all P<0.05).The results showed that IAUC was positively correlated with t-PSA in insulin group(r=0.334,P<0.05).Conclusion Metformin may be a protective factor for prostate,while insulin treatment may have dangerous effect on prostate.Serum PSA levels of type 2 diabetic senior male patients treated with different hypoglycemic agents should be carefully interpreted.