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目的探讨去势疗法是否会增加前列腺癌(PCa)患者罹患糖尿病的风险。方法系统检索Medline、Embase、Cochrane Library Central关于去势疗法(ADT)应用于PCa并报道该治疗与糖尿病相关性的临床试验研究,对文献进行数据提取及Meta分析。结果共8项临床研究,涉及65 695名应用ADT及91 893名未应用去势疗法(non-ADT)的PCa患者纳入分析。应用ADT的患者其糖尿病的发病率较non-ADT者高出39%[RR=1.39,95%CI(1.27~1.53),P<0.01];亚组分析发现,不同的ADT对糖尿病发病率亦有不同的相关性,促雄性激素释放激素抑制剂能明显增加PCa患者罹患糖尿病的风险[RR=1.45,95%CI(1.36~1.54),P<0.01];促雄性激素释放激素抑制剂联合口服抗雄性激素药物[RR=1.40,95%CI(1.01~1.93),P<0.01],以及睾丸切除术也可明显增加糖尿病患病的风险[RR=1.34,95%CI(1.20~1.50),P<0.01],而单纯服用抗雄性激素的药物则与糖尿病无明显相关性[RR=1.33,95%CI(0.75~2.36),P=0.33]。结论 ADT可明显增加PCa罹患糖尿病的风险,提示临床应用该疗法需考虑采取相应的预防措施。
Objective To investigate whether castration therapy may increase the risk of developing diabetes in prostate cancer (PCa) patients. Methods The clinical trial of Medline, Embase and Cochrane Library Central on the application of castration therapy (ADT) to PCa and the relativity between the treatment and diabetes mellitus was searched systematically. Data extraction and Meta analysis were performed on the literature. Results A total of 8 clinical studies involving 65,695 PCa patients with ADT and 91,893 non-ADT patients were included in the analysis. The incidence of diabetes in ADT patients was 39% higher than that in non-ADT patients (RR = 1.39, 95% CI, 1.27-1.53, P <0.01). Subgroup analysis found that the incidence of diabetes mellitus There are different correlations, androgen androgen releasing hormone inhibitors can significantly increase the risk of PCa patients suffering from diabetes [RR = 1.45,95% CI (1.36 ~ 1.54), P <0.01]; androgen androgen releasing hormone combined with oral Anti-androgenic drugs [RR = 1.40, 95% CI (1.01-1.93, P <0.01], and orchiectomy also significantly increased the risk of diabetes mellitus [RR = 1.34,95% CI 1.20-1.50] P <.01], whereas those taking antiandrogen alone had no significant association with diabetes (RR = 1.33, 95% CI 0.75 to 2.36, P 0.33). Conclusion ADT can significantly increase the risk of PCa diabetes, suggesting that the clinical application of this therapy need to consider taking appropriate preventive measures.