J Urol:GnRH激动剂 VS拮抗剂在晚期前列腺癌和心血管疾病患者中的心血管发病率

2020-07-13 MedSci原创 MedSci原创

雄激素剥夺疗法可能会增加患心血管疾病的风险。有限的数据表明,与GnRH激动剂相比,GnRH(促性腺激素释放激素)拮抗剂可能会降低心血管疾病的风险。

雄激素剥夺疗法可能会增加患血管疾病的风险。有限的数据表明,与GnRH激动剂相比,GnRH(促性腺激素释放激素)拮抗剂可能会降低心血管疾病的风险。

 

我们对患有前列腺癌和已有心血管疾病的男性进行了II期随机开放标签研究,将其随机分组,分别接受GnRH激动剂或拮抗剂治疗1年。主要结局是通过EndoPAT 2000装置(Itamar Medical,凯撒利亚,以色列)测量的内皮功能。次要结局是新的心血管事件。追踪患者的心血管疾病发展情况,这些疾病定义为死亡,心肌梗塞,脑血管事件,经冠状动脉支架置入的经皮血管成形术或因心脏事件而住院。

 

结果,共有80位患者参加了研究,包括41位接受GnRH拮抗剂和39位接受激动剂的患者。每组患者的基线特征相似。没有发现组间主要终点(内皮功能)的差异(平均±SD反应性高血症指数2.07±0.15 vs 1.92±0.11,p=0.42)。然而,在试验期间,有15例患者出现新的心血管事件(次要终点)。在病例中,9例出现新的主要心血管和脑血管事件,包括2例死亡,1例心肌梗死,2例脑血管事件,4例经皮血管成形术并插入冠状动脉支架。在随机服用GnRH激动剂的患者中,20%的患者发生了重大心脑血管事件,而服用GnRH拮抗剂的患者只有3%(P=0.013)。使用GnRH拮抗剂12个月时,主要心脑血管事件的绝对风险降低为18.1%(95% CI 4.6-31.2,p=0.032)。

 

据我们所知,这是第一个在接受雄激素剥夺治疗的前列腺癌患者中测试心血管结局的前瞻性研究。研究臂之间的主要终点没有差异。然而,次要终点显示,接受GnRH激动剂治疗的患者发生的主要心血管和脑血管事件明显多于接受GnRH拮抗剂治疗的患者。这些II期结果表明,对于已有心血管疾病的前列腺癌患者,选择雄激素剥夺治疗方式可能会对心脏结局产生不同影响。

 

原始出处:

 

David Margel, Avivit Peer, et al., Cardiovascular Morbidity in a Randomized Trial Comparing GnRH Agonist and GnRH Antagonist Among Patients With Advanced Prostate Cancer and Preexisting Cardiovascular Disease. J Urol. 2019 Dec;202(6):1199-1208. doi: 10.1097/JU.0000000000000384.

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  5. 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    2020-08-07 咻凡

    这个杂志投稿周期多久?

    0

  7. 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