老年前列腺癌患者去势后性激素水平变化及对凝血和纤溶系统的影响

目的探讨老年前列腺癌患者去势后性激素水平变化及对血液凝血和纤溶系统活性的影响。方法27例早期前列腺癌经手术去势的患者作为研究组,39例非前列腺癌老年患者作为正常对照组。分别测定黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(TT)、游离睾酮(FT)、雌激素(E2)、部分凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fib)、凝血酶原活动度(PA)、纤溶酶原(PLG)活性、α2-抗纤溶酶(α2-PI)活性、抗凝血酶-Ⅲ(AT-Ⅲ)活性、二磷酸腺苷(ADP)活性、D-二聚体(DD)含量、血小板聚集率和黏附率、组织型纤溶酶原激活剂(t-PA)及组织型纤溶酶原激活剂抑制物(PAI-1)抗原浓度。结果研究组中患者TT、FT、E2水平显著降低,E2降低幅度小于TT,LH、FSH、FT/TT、E2/TT显著升高;PT、APTT显著缩短,Fib及DD含量显著增加,血小板聚集率、黏附率及ADP活性均显著升高,PLG、α2-PI活性显著增强,t-PA抗原含量及t-PA/PAI-1显著下降,PAI-1含量显著增加。AT-Ⅲ活性无显著变化。结论前列腺癌患者去势后性激素比例严重失调;血小板活性及血液凝血活性显著增强,纤溶活性显著抑制,提示去势患者存在发生动脉硬化的高度危险性。

Changes of sex hormone levels and coagulative and fibrinolytic activity in castrated prostatic cancer patients

Objective To study the changes of sex hormone levels and the relevant changes of coagulative and fibrinolytic status in castrated prostatic cancer patients.Methods Twenty-seven castrated stable old prostatic cancer patients were included in the study group and 39 noncastrated old patients served as control.Their blood levels of luteal hormone(LH),follicle stimulating hormone(FSH),total testosterone(TT),free testosterone(FT),estradiol(E_2),blood prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),D-dimers(DD),ADP activity,antithrombin Ⅲ (AT-Ⅲ) activity,plasminogen(PLG) and α_2-antiplasmin(α_2-PI) activity,tissue plasminogen activitor(t-PA),plasminogen activitor inhibitor-1(PAI-1)were tested.All patients did not take any medicine that could affect the activity of coagulative and fibrinolytic system within two weeks before the study. Acute heart failure,anemia,acute infectious diseases and dysfunctions of liver and kidney were excluded in all patients.Results In the study group TT,FT and E_2 levels decreased,LH,FSH,FT/TT and E_2/TT were elevated significantly;PT and APTT shortened significantly;Fib and DD levels were elevated significantly;ADP,PLG,α_2-PI activity and platelet(PLT) aggregation rate all increased significantly;PAI-1 levels increased but t-PA and t-PA / PAI-1 decreased significantly.Conclusions Castrated male patients were inclined to have increased activity of coagulation and depressed activity of fibrinolysis and to have the risk for arteriosclerosis.