度他雄胺和非那雄胺抑制5α-还原酶对健康年轻男性骨矿物质密度、血清脂蛋白、血红蛋白、前列腺特异性抗原及性功能的影响
The effect of 5alpha-reductase inhibition with dutasteride and finasteride on bone mineral density, serum lipoproteins, hemoglobin, prostate specific antigen and sexual function in healthy young men.
作者信息
Amory John K, Anawalt Bradley D, Matsumoto Alvin M, Page Stephanie T, Bremner William J, Wang Christina, Swerdloff Ronald S, Clark Richard V
机构信息
Department of Medicine, University of Washington, Seattle, Washington, USA.
出版信息
J Urol. 2008 Jun;179(6):2333-8. doi: 10.1016/j.juro.2008.01.145. Epub 2008 Apr 18.
PURPOSE
Dutasteride and finasteride are 5alpha-reductase inhibitors that dramatically decrease serum levels of dihydrotestosterone. Because androgens affect bone, lipids, hematopoiesis, prostate and sexual function, we determined the impact of 5alpha-reductase inhibitors on these end points.
MATERIALS AND METHODS
We conducted a randomized, double-blinded, placebo controlled trial of 99 men 18 to 55 years old randomly assigned to receive 0.5 mg dutasteride (33), 5 mg finasteride (34) or placebo (32) daily for 1 year. Bone mineral density was measured at baseline, after 1 year of treatment and 6 months after drug discontinuation. In addition, markers of bone turnover, fasting serum lipoprotein concentrations, hemoglobin and prostate specific antigen were measured at baseline, after 26 and 52 weeks of treatment, and again 24 weeks after drug discontinuation. Sexual function was assessed at these points by a validated questionnaire.
RESULTS
Significant suppression of circulating dihydrotestosterone levels with the administration of dutasteride or finasteride did not significantly affect bone mineral density or markers of bone metabolism. Similarly serum lipoproteins and hemoglobin were unaffected. Serum prostate specific antigen and self-assessed sexual function decreased slightly during treatment with both 5alpha-reductase inhibitors but returned to baseline during followup.
CONCLUSIONS
Profound suppression of circulating serum dihydrotestosterone induced by 5alpha-reductase inhibitors during 1 year does not adversely impact bone, serum lipoproteins or hemoglobin, and has a minimal, reversible effect on serum prostate specific antigen and sexual function in normal men. Circulating dihydrotestosterone does not appear to have a clinically significant role in modulating bone mass, hematopoiesis or lipid metabolism in normal men.
目的
度他雄胺和非那雄胺是5α-还原酶抑制剂，可显著降低血清二氢睾酮水平。由于雄激素会影响骨骼、脂质、造血、前列腺和性功能，我们确定了5α-还原酶抑制剂对这些终点指标的影响。
材料与方法
我们对99名年龄在18至55岁之间的男性进行了一项随机、双盲、安慰剂对照试验，这些男性被随机分配为每日接受0.5mg度他雄胺（33例）、5mg非那雄胺（34例）或安慰剂（32例），为期1年。在基线、治疗1年后以及停药6个月后测量骨矿物质密度。此外，在基线、治疗26周和52周后以及停药24周后再次测量骨转换标志物、空腹血清脂蛋白浓度、血红蛋白和前列腺特异性抗原。在这些时间点通过一份经过验证的问卷对性功能进行评估。
结果
服用度他雄胺或非那雄胺后，循环二氢睾酮水平受到显著抑制，但对骨矿物质密度或骨代谢标志物没有显著影响。同样，血清脂蛋白和血红蛋白也未受影响。在两种5α-还原酶抑制剂治疗期间，血清前列腺特异性抗原和自我评估的性功能略有下降，但在随访期间恢复到基线水平。
结论
5α-还原酶抑制剂在1年内对循环血清二氢睾酮的深度抑制不会对骨骼、血清脂蛋白或血红蛋白产生不利影响，对正常男性的血清前列腺特异性抗原和性功能仅有轻微的、可逆的影响。循环二氢睾酮在调节正常男性的骨量、造血或脂质代谢方面似乎没有临床显著作用。
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