李秀 男秦 张浚鹏 马传宇 王行立 吴东军 陈骁驰

[摘要] 目的 分析比卡鲁胺联合戈舍瑞林不同给药方式治疗晚期前列腺癌患者的效果及对患者血清前列腺特异性抗原（PSA）、血管内皮生长因子（VEGF）和miRNA-34a（miR-34a）的影响。 方法 选取2015年2月～2016年12月大连医科大学附属第一医院接诊的80例晚期前列腺癌患者作为研究对象，按照随机数字表法分为研究组和对照组，每组各40例。研究组患者口服比卡鲁胺并皮下注射戈舍瑞林，当PSA<0.2 ng/mL时停止服用这两种药物，而当PSA>4 ng/mL时则继续服用这两种药物，而对照组患者给予持续性给药。检测并记录治疗前后两组患者血清PSA、VEGF、miR-34a以及排尿梗阻情况，以及比较两组治疗效果、不良反应发生率、平均治疗费用。 结果 治疗后3、6、9个月以及12个月两组患者血清PSA、VEGF、miR-34a及排尿梗阻發生率均较治疗前降低，差异有统计学意义（P < 0.05），而两组比较，差异无统计学意义（P > 0.05）。治疗后，研究组的总缓解率明显高于对照组，差异有统计学意义（P < 0.05）；研究组患者的治疗费用明显低于对照组，差异有统计学意义（P < 0.05）；两组患者均有不同程度的不良反应出现，但二者比较，差异无统计学意义（P > 0.05）。 结论 比卡鲁胺联合戈舍瑞林间歇以及持续给药方式均可以改善晚期前列腺癌患者血清PSA、VEGF和miR-34a，而间歇型给药方式效果更加明显，效果良好。

[关键词] 比卡鲁胺；戈舍瑞林；前列腺癌；血清前列腺特异性抗原；血清VEGF

[中图分类号] R737.25 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0053-04

Comparison of the effects of different ways of giving Bicalutamide combined with Goserelin in the treatment of advanced prostate cancer and influence on the expression of serum PSA， VEGF and miR-34a

LI Xiunan QIN Jie ZHANG Junpeng MA Chuanyu WANG Xingli WU Dongjun CHEN Xiaochi

Department of Urology， the First Affiliated Hospital of Dalian Medical University， Liaoning Province， Dalian 116600， China

[Abstract] Objective To analyze the effects of different ways of giving Bicalutamide combined with Goserelin in the treatment of advanced prostate cancer and influence on the expression of serum prostate-specific antigen （PSA）， vascular endothelial growth factor （VEGF） and miRNA-34a （miR-34a）. Methods From February 2015 to December 2016， 80 patients with advanced prostate cancer in the First Affiliated Hospital of Dalian Medical University were selected as research objects， and divided into study group and control group by random number table， with 40 cases in each group. The study group was treated with oral Bicarbonide and subcutaneous injection of Goserelin， when PSA< 0.2 ng/mL， stop taking these two drugs， and when PSA>4 ng/mL， continue to take these two drugs. The control group was given continuous medication. The serum PSA， VEGF， mir-34a and the incidence of urinary tract obstruction were detected and recorded before and after treatment， and the treatment effect， the incictence of adverse effects， the average treatment cost between two groups were compared. Results The serum PSA， VEGF， mir-34a and urinary obstruction of patients in the two groups after treatment for 3， 6， 9 months and 12 months were all lower than those before treatment， the differences were statistically significant （P < 0.05）， and the two groups were compared， the differences were not statistically significant （P > 0.05）. After treatment， the overall response rate in the study group was higher than control group， the difference was statistically significant （P < 0.05）， the average treatment cost in the study group was lower than control group， the difference was statistically significant （P < 0.05）， both groups had different levels of adverse reactions， but they were compared， the difference was not statistically significant （P > 0.05）. Conclusion Bicalutamide combined with Goserelin intermittent and continuous administration all can improve the serum PSA， VEGF and miR-34a in patients with advanced prostate cancer， while the effect of intermittent administration is more obvious， and the effect is good.

[Key words] Bicalutamide； Goserelin； Prostate cancer； Serum prostate-specific antigen； Serum VEGF

有调查表明，前列腺癌是常出现在全球老年男性前列腺组织中的一种恶性肿瘤[1]。前列腺特异性抗原（PSA）是一种由前列腺腺泡及导管上皮分泌的蛋白酶，可以用于前列腺癌诊断及判断内分泌治疗效果及预后情况，是临床上常用的一种检测指标；血管内皮生长因子（VEGF）是一种多功能细胞生长因子，能特异性作用于血管内皮细胞，促进生成肿瘤血管；……