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目的:探讨前列腺癌患者手术去势后,雄激素水平降低对机体胰岛素抵抗及胰岛素释放节律的影响。方法:36例患者经前列腺穿刺.病理诊断为前列腺癌,Gleason评分7～9分.临床分期Ⅲ～Ⅳ期,行双侧睾丸切除.术前无Ⅱ型糖尿病史。术前、术后1个月、3个月、6个月及1年分别测定血消睾酮(T).血清游离睾酮(FT).空腹及餐后0.5 h、1 h、2 h、3 h胰岛素.空腹及餐后0.5 h、1 h、2 h、3 h血糖。计算胰岛素抵抗指数及绘制胰岛素释放曲线。结果:本组患者去势术后1个月血清T、FT较术前显著下降[(0.45±0.05)ng/ml vs.(4.88±0.23)ng/ml.P<0.001;(2.07±0.19)pmol/L vs.(35.10±4.37)pmol/L.P<0.001]。此后继续下降.术后6个月左右达到最低,并维持低水平。空腹血糖、空腹胰岛素、餐后2 h血糖及胰岛素于术后1个月显著升高[(5.63±0.78)mmol/L vs.(5.11±0.21)mmol/L,P<0.05;(10.48±3.68)μIU/ml vs.(7.56±2.58)μIU/ml,P<0.05;(6.66±0.72)mmol/L vs.(5.78±0.33)mmol/L,P<0.01;(1 6.31±0.45)μIU/ml vs.(13.21±0.35)μIU/ml,P<0.01)].此后仍呈上升趋势.胰岛素释放曲线示餐后0.5 h峰值低于空腹时5倍或峰值后移。胰岛素抵抗指数(空腹胰岛素×空腹血糖÷22.5)术后1个月开始显著升高(2.62±0.13 vs.1.72±0.02.P<0.05)(HOMA法,稳定模型法),此后呈上升趋势。结论:双侧睾丸切除后.雄激素水平下降而导致胰岛素抵抗增加.且胰岛素释放曲线峰值下降或后移,Ⅱ型糖尿病发生风险显著增加。
OBJECTIVE: To investigate the effects of androgens on the body’s insulin resistance and insulin-releasing rhythm after surgical castration in patients with prostate cancer. Methods: Thirty-six patients underwent prostate biopsy and pathological diagnosis of prostate cancer, Gleason score of 7 to 9. Clinical stage Ⅲ to Ⅳ, bilateral orchiectomy. No preoperative type Ⅱ diabetes history. Blood testosterone (T) was measured preoperatively, 1 month, 3 months, 6 months and 1 year after operation.Serum free testosterone (FT) was measured in fasting and postprandial 0.5 h, 1 h, 2 h, 3 h Insulin fasting and postprandial 0.5 h, 1 h, 2 h, 3 h blood glucose. Calculate insulin resistance index and plot insulin release curve. Results: The levels of T and FT in serum of the patients at one month after castration were significantly lower than those before operation [(0.45 ± 0.05) ng / ml vs. (4.88 ± 0.23) ng / ml, P <0.001; (2.07 ± 0.19) pmol / L vs. (35.10 ± 4.37) pmol / LP <0.001]. Continued to decline after 6 months to reach the lowest, and maintain a low level. Fasting blood glucose, fasting insulin, postprandial 2-h blood glucose and insulin increased significantly at 1 month after operation (5.63 ± 0.78 mmol / L vs. 5.11 ± 0.21 mmol / L, P <0.05; 10.48 ± 3.68 (P <0.05); (6.66 ± 0.72) mmol / L vs. (5.78 ± 0.33) mmol / L, P <0.01; (1 6.31 ± 0.45) μIU / (13.21 ± 0.35) μIU / ml, P <0.01) .There was an upward trend thereafter.The insulin release curve showed that the peak value of 0.5 h after meal was lower than the fasting time by 5 times or the peak value was backward. Insulin resistance index (fasting insulin × fasting blood glucose ÷ 22.5) began to increase significantly from 1 month after surgery (2.62 ± 0.13 vs.1.72 ± 0.02.P <0.05) (HOMA method, stable model method), and then increased. CONCLUSION: After bilateral orchiectomy, the level of androgen decreases, leading to the increase of insulin resistance, and the peak of insulin release curve decreases or shifts backwards, and the risk of type Ⅱ diabetes increases significantly.