本文選題：前列腺癌 + 內(nèi)分泌治療　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過(guò)觀察≥70歲前列腺癌患者應(yīng)用戈舍瑞林緩釋植入劑聯(lián)合比卡魯胺行MAB(maximal androgen blockade，全雄激素阻斷治療)治療前及治療后3、6、9個(gè)月代謝水平及外周血相關(guān)指標(biāo)的變化，以及MS（metabolic syndrome，代謝綜合征）發(fā)病率，從而探討高齡前列腺癌患者使用MAB治療后可能出現(xiàn)的代謝及相關(guān)副作用及其安全性。方法：通過(guò)空軍總醫(yī)院病歷系統(tǒng)篩選2005年1月1日～2013年10月1日就診住院的前列腺癌患者72名，經(jīng)過(guò)納入及排除標(biāo)準(zhǔn)，共收集34例≥70歲前列腺癌患者。觀察該組患者使用戈舍瑞林緩釋植入劑聯(lián)合比卡魯胺行MAB治療前及治療后3、6、9個(gè)月的TG(triglyceride，甘油三酯)，LDL-C（low-density lipoprotein cholesterol，低密度脂蛋白膽固醇）、HDL-C（high-density lipoprotein cholesterol高密度脂蛋白膽固醇）、BMI（body mass index，體重指數(shù)）、PSA（prostate specific antigen，前列腺特異性抗原）、睪酮水平、前列腺體積、Hb（hemoglobin，血紅蛋白）、HCT （red blood cell specific volume，紅細(xì)胞比容)、血糖、血壓等數(shù)據(jù)。通過(guò)國(guó)際糖尿病協(xié)會(huì)(IDF)診斷標(biāo)準(zhǔn)統(tǒng)計(jì)治療前后患者M(jìn)S發(fā)病率。對(duì)上述指標(biāo)的治療前后變化應(yīng)用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：全激素阻斷治療前后比較，PSA、前列腺體積、睪酮較治療前均有顯著降低且存在顯著差異，，PSA（治療前vs治療后3、6、9月均為p=0.01），前列腺體積（治療前vs治療后3、6、9月后分別為p=0.05，p=0.05, p=0.045）,睪酮水平（治療前vs治療后3、6、9月均為p=0.01）。外周血方面Hb（治療前vs治療后6、9月后分別為p=0.027，p=0.032）、HCT（治療前vs治療后3、6、9月后分別為p=0.030，p=0.024，p=0.038）均顯著降低,代謝方面LDL-C顯著增高（治療前vs治療后3、6、9月后分別為p=0.035，p=0.041，p=0.031）。HDL-C、TG、BMI、血糖、血壓均無(wú)顯著統(tǒng)計(jì)學(xué)差異,代謝綜合征發(fā)病率隨著治療時(shí)間的延長(zhǎng)由治療前的35.2%逐漸升高為至第9月時(shí)的82.3%，并且具有顯著差異（p=0.001）。結(jié)論：≥70歲前列腺癌患者使用戈舍瑞林緩釋植入劑聯(lián)合比卡魯胺MAB治療后PSA、睪酮及前列腺體積顯著降低，證明在治療前列腺癌有效且內(nèi)分泌治療使睪酮達(dá)到去勢(shì)水平的前提下患者外周血水平Hb及HCT較治療前明顯降低，且隨著治療時(shí)間的延長(zhǎng)，其程度愈發(fā)嚴(yán)重；代謝方面，代謝綜合征的發(fā)病率明顯升高，且發(fā)病率呈逐漸上升趨勢(shì)。LDL-C較治療前升高。對(duì)使用MAB的高齡前列腺癌患者需密切隨訪以上指標(biāo)，同時(shí)需預(yù)防因應(yīng)用MAB治療導(dǎo)致的相關(guān)并發(fā)癥發(fā)生。
[Abstract]:Objective: To observe the changes of metabolic level and peripheral blood related indexes in 3,6,9 months before and after treatment with MAB (maximal androgen blockade, total androgen blockade) and the incidence of MS (metabolic syndrome, metabolic syndrome) by observing the use of the slow-release implants of the prostatic cancer patients over 70 years of age and the combination of the specific androgen blockade of BCA (blockade, androgen blockade), and the incidence of MS (metabolic syndrome, metabolic syndrome). Metabolic and associated side effects and safety of the elderly prostate cancer patients after MAB treatment were discussed. Methods: 72 patients with prostate cancer hospitalized from January 1, 2005 to October 1, 2013 were screened by the medical record system of General Hospital of the Air Force PLA. Through inclusion and exclusion criteria, 34 cases of prostate cancer patients aged 70 and 70 years old were collected and observed. The patients were treated with TG (triglyceride, triglyceride), LDL-C (low-density lipoprotein cholesterol, low density lipoprotein cholesterol) and HDL-C (high-density lipoprotein cholesterol high density lipoprotein cholesterol) before and after MAB treatment and 3,6,9 months after treatment with the slow-release slow-release implant. Index), PSA (prostate specific antigen, prostate specific antigen), testosterone level, prostate volume, Hb (hemoglobin, hemoglobin), HCT (red blood cell specific volume, red cell specific volume), blood glucose, blood pressure and other data. SPSS13.0 software was used for statistical analysis before and after treatment. Results: before and after the total hormone blockage treatment, PSA, prostate volume, and testosterone were significantly lower than before treatment and there were significant differences, PSA (p=0.01 before 3,6,9 months after the treatment of VS), and the volume of prostate (before the treatment vs treatment was p=0.05, p=0.05, p=0. after 3,6,9 months, respectively. 045), the level of testosterone (3,6,9 months after vs treatment was p=0.01). Hb (p=0.027, p=0.032) in peripheral blood (p=0.027, p=0.032) in 6,9 months after treatment (before the treatment of VS). 041, p=0.031).HDL-C, TG, BMI, blood glucose and blood pressure have no significant difference. The incidence of metabolic syndrome gradually increases with the treatment time from 35.2% before treatment to ninth months, and it has a significant difference (p=0.001). Conclusion: the prostatic cancer patients over 70 years of age use the slow-release implant of the SDR combined with BCA MAB. After treatment, PSA, testosterone and prostate volume decreased significantly. It was proved that the level of peripheral blood Hb and HCT decreased significantly on the premise of effective and endocrine therapy for the treatment of prostate cancer and the level of testosterone, and the degree became more severe with the time of treatment; metabolism, the incidence of metabolic syndrome was obviously increased. The incidence of.LDL-C is higher than that before treatment. The older prostate cancer patients who use MAB need to follow these indicators closely and prevent related complications due to the use of MAB.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.25

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本文編號(hào)：1919592