双侧睾丸切除后动脉粥样硬化相关生化指标的变化

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=-2.21,P＜0.05]、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＜0.01),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=3.09]、低密度脂蛋白胆固醇(4.1±0.9)mmol/L,t=3.57]、纤溶酶原激活物抑制剂-1(27.02±5.98)μg/L,t=2.33]、纤维蛋白肽A(3.4±1.7)nmol/L,t=3.27]开始较术前明显增加;均P＜0.05,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、空腹胰岛素及血糖、餐后2h胰岛素及血糖水平分别呈直线负相关,睾酮、游离睾酮与胰岛素敏感指数呈直线正相关.结论雄激素水平降低对男性发生动脉粥样硬化的危险因素产生影响,从而可能增加动脉粥样硬化的发生率.

Effect of lower androgen levels on arteriosclerosis

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 alpha 1 (APO alpha 1) and apoprotein beta(APO beta), 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 changed. 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, APO alpha 1, APO beta and fibrinogen were not changed. 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.