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目的 了解前列腺癌去势术与骨质疏松的关系 ,为临床治疗提供依据。 方法 患者分两组。去势组 31例 ,为前列腺癌患者 ,行去势治疗 ;药物组 33例 ,为良性前列腺增生 (BPH)患者 ,连续 6个月口服 5α 还原酶抑制剂。两组患者均在治疗前和治疗后 6个月时行骨密度 (BMD)、X线片、血清睾酮、血生化及尿钙、磷检查 ,依照WHO骨质疏松诊断标准进行评估。 结果 去势组术后6个月时血清睾酮由术前 (1 6 .2± 4 .2 )nmol/L降至 (0 .4± 0 .2 )nmol/L ,P <0 .0 1。药物组治疗 6个月时血清睾酮 (1 5 .4± 4 .0 )nmol/L ,与治疗前的 (1 5 .8± 4 .1 )nmol/L相比差别无显著性意义 (P >0 .0 5)。去势组术后 6个月时 4个部位所测BMD平均值与术前结果比较差别有显著性意义 (P <0 .0 1 ) ;药物组治疗 6个月时BMD平均值与治疗前相比差别无显著性意义 (P >0 .0 5)。去势组术后 6个月血钙较术前明显降低 ,P <0 .0 5 ;术后 6个月时BMD平均值低于同性别BMD峰值 2 .5个标准差 ,同期X线检查显示骨小梁疏松、变细 ,符合骨质疏松诊断。 结论 前列腺癌去势术后血清睾酮的急剧降低可导致骨质疏松发生率明显升高 ,需引起重视并予积极的治疗干预。与骨质疏松发生有关的雄性激素主要是血清睾酮而非双氢睾酮
Objective To understand the relationship between prostate cancer castration and osteoporosis and provide the basis for clinical treatment. Methods Patients were divided into two groups. Castration group of 31 cases of prostate cancer patients underwent castration treatment; 33 cases of drug group, benign prostatic hyperplasia (BPH) patients, oral administration of 5α reductase inhibitor for 6 months. The BMD, X-ray, serum testosterone, blood biochemistry, urinary calcium and phosphorus were measured in both groups before and 6 months after treatment. The diagnostic criteria of WHO osteoporosis were evaluated. Results At 6 months after operation, the level of serum testosterone decreased from (16.2 ± 4.2) nmol / L to (0.4 ± 0.2) nmol / L, P <0.01. There was no significant difference of serum testosterone (1.54 ± 4.0) nmol / L after treatment for 6 months in drug group compared with (15.8 ± 4.1) nmol / L before treatment (P> 0 .0 5). At 6 months after operation in castrated group, the average BMD measured at 4 sites was significantly different from preoperative results (P <0.01) No significant difference (P> 0.05). At 6 months after operation, the level of serum calcium in the castration group was significantly lower than that before the operation (P <0.05). The mean BMD at 6 months after the operation was lower than the standard deviation of 2.5 standard BMD peak by X-ray examination Trabecular bone loose, thinner, in line with osteoporosis diagnosis. Conclusions The sharp decrease of serum testosterone after castration of prostate cancer can lead to a significant increase of the incidence of osteoporosis, which needs attention and positive treatment intervention. Androgen associated with osteoporosis is mainly serum testosterone rather than dihydrotestosterone