中老年男性代谢综合征和前列腺增生关系的研究

目的 探讨中老年男性人群中代谢综合征和BPH的关系. 方法 分层随机选择北京市某社区的中老年男性作为研究对象.调查一般情况,包括年龄、身高、体质量、血压、既往史、IPSS 等;抽取空腹静脉血检测血糖、三酰甘油、高密度脂蛋白、PSA;腹部超声测量前列腺体积;测量Qmax.比较代谢综合征组和非代谢综合征组BPH患病率及严重程度;同时比较代谢综合征组内各亚组的差异. 结果 共调查中老年男性440人.代谢综合征组105人,合并BPH者35人(33.3％);非代谢综合征组335人,合并BPH者40人(11.9％).代谢综合征、肥胖和高脂血症组的BPH患病率较高,分别为33.3％、20.4％和25.0％.与非代谢综合征组相比,代谢综合征组中重度LUTS患病率较高(P＜0.05),IPSS、前列腺体积和血清PSA差异有统计学意义(P＜0.05),Qmax差异无统计学意义(P=0.069).肥胖、高血脂症和糖尿病是BPH的危险因素(OR值分别为1.75、3.36和2.08,P值分别为0.041、0.037和0.045). 结论 代谢综合征患者的BPH患病率较高,代谢综合征影响BPH患者的IPSS、前列腺体积和PSA.肥胖、高血脂症、糖尿病是BPH的危险因素;BPH患者诊疗的同时还需考虑是否合并代谢综合征.     

中老年男性代谢综合征与前列腺增生关系的研究

目的 探讨中老年男性人群中代谢综合征和前列腺增生(benign prostatic hyperplasia, BPH)的关系。方法 随机选择2015年5月至2016年2月本院体检中心体检的中老年男性350例作为研究对象。调查所有研究对象的一般情况,包括年龄、身高、体质量、血压、既往史、国际前列腺症状评分(IPSS)等;抽取空腹静脉血检测血糖、三酰甘油、高密度脂蛋白和前列腺特异性抗原(PSA);腹部超声测量前列腺体积, 并检测Qmax。比较代谢综合征组和非代谢综合征组BPH患病率及严重程度。结果 代谢综合征组100例,合并BPH者30例（30%）;非代谢综合征组250例,合并BPH者35例（14%）。代谢综合征组的BPH患病率较高,与非代谢综合征组相比,代谢综合征组IPSS、前列腺体积和血清PSA值存在差异,差异有统计学意义（P<0.05）,两组间Qmax差异无统计学意义（P=0.057）。结论 代谢综合征患者的BPH患病率较高,代谢综合征影响BPH患者的IPSS、前列腺体积和PSA。肥胖、高脂血症、高血压、空腹血糖高或糖尿病是BPH的危险因素。BPH患者诊疗的同时还需要考虑是否合并代谢综合征。     

50岁以下BPH 患者前列腺体积与代谢综合征的关系

目的 代谢综合征(MS)被认为是老年良性前列腺增生症(BPH)患者的重要影响因素,但针对相对年轻的国人中前列腺体积与代谢综合征的关系,尚无相关报道.本研究旨在分析MS 与50 岁以下国人前列腺体积的关系.方法 对55 例年龄小于50 岁(含50 岁)的BPH 患者临床资料进行回顾性研究,经直肠超声检查(TRUS)确定前列腺体积,采集包括身高、体重、空腹血糖、餐后2 h 血糖、糖化血红蛋白、TC、TG、HDL-C、LDL-C 等数据进行分析,评价MS 及MS 相关指标与前列腺体积的关系.结果 伴发MS 的前列腺增生症患者与无伴发MS 组之间前列腺体积无统计学差异(32.5依3.6 ml vs 30.8依4.5 ml,P=0.122).对MS 相关指标的分层研究,体重指数(BMI)异常组(≥25 kg/m2)较正常组(<25 kg/m2)的前列腺体积明显增大,两者之间具有统计学差异(32.6依4.0 ml vs 29.2依3.6 ml,P=0.007),对组内MS 各项指标进行多因素logistic 回归法分析,其中仅有BMI成为导致BPH 的独立危险因素(P<0.05,OR =2.114,95%CI 1.24~3.604);其他如空腹血糖(FPG)、血压(SBP)、空腹血浆TG 以及空腹HDL-C 等与前列腺体积无明显的关联(P>0.05).结论 相对年轻的BPH 患者(<50 岁),是否伴发MS 对前列腺体积无明显的影响,但体重指数(BMI)却是导致BPH 的独立危险因素.体重指数(BMI)应被认为是相对年轻的BPH 患者的重要预测指标.     

【原创论文】前列腺组织弹性成像与间质中I、III型胶原纤维的关系

本文探讨前列腺弹性成像显示的组织硬度情况与I、III型胶原纤维的含量及二者相互走行方式的关系。对62例患者进行经直肠组织弹性成像检查（TRTE）,常规12针系统穿刺活检后,对前列腺进行TRTE引导下靶向穿刺,所取组织进行天狼腥红染色,观察I、III型胶原纤维的的分布情况,并分别计算二者的容积指数（CVF）。结果得出I型胶原纤维的CVF在质硬、软组分别为：0．05±0．02和0．02±0．01;两组之间的差异显著（P=0．002）;III型胶原纤维的CVF在质硬、软组分别为：0．05±0．04与0．07±0．03;两组之间的差异不显著（P=0．13）。圆分布的统计结果表明胶原纤维在质软组和质硬组均走行紊乱,I型胶原和III型胶原之间主要呈相互交叉走行,部分呈平行走行,二者的相互走行关系在质软、质硬组之间的差异显著（P=0．03）。前列腺弹性成像显示的组织硬度主要取决于组织中I型胶原纤维的含量,另外,I型、III型胶原纤维的相互走行方式也可影响组织的弹性。     

炎症小体与前列腺炎及代谢综合征所致良性前列腺增生关系的研究进展

良性前列腺增生(BPH),是影响中老年男性排尿的常见疾病,其发病率与年龄增长呈明显的正相关。BPH的发病原因及发病机制迄今尚未阐明。最近研究发现其发病与炎症以及代谢综合征(MetS)有关。炎症小体是多种蛋白质组成的蛋白复合体,其在胞内激活后,可活化半胱氨酸天冬氨酸蛋白酶-1以诱导IL-1β、IL-18等炎性介质的成熟和分泌,促进炎症反应的发生。目前研究显示在前列腺炎及MetS所致BPH中均发现有不同程度炎症小体的表达和激活,其功能异常可能导致BPH的发生发展。本文就炎症小体的结构,活化以及其在BPH中的作用作一综述,以期为BPH的发病机理以及防治提供新的思路和有效靶点。     

上海市部分社区中老年男性下尿路症状与良性前列腺增生特性的调查研究

目的:调查上海市社区40～70岁中老年男性下尿路症状(LUTS)的患病率及前列腺各项参数随增龄变化的规律。方法:2009年11月至2010年6月对上海市9个居委1 000例40～70岁的常住居民,运用整群及年龄分层的流行病学随机抽样方法,通过国际前列腺症状评分(IPSS)调查该人群中LUTS的患病率;经直肠超声检测其前列腺及移行带的左右径、前后径、上下径,并拟合前列腺随年龄的生长规律。结果:在40～49岁、50～59岁和60～70岁年龄组中,中、重度LUTS(IPSS≥8)患病率分别为10.0%、15.0%和28.7%,LUTS症状随年龄增加而明显上升。超声检测显示:前列腺及其移行带的左右径、前后径、上下径和体积均随年龄增长而增大,各年龄组存在统计学意义(P<0.05);对左右径、前后径和上下径各参数值拟合生长速度方程分别为Y=1.6×10-5X3-0.002 1X2+0.074 6X+0.677 2、Y=-2.4×10-5X3+0.003 3X2-0.131 2X+1.269、Y=1.6×10-5X3-0.001 8X2+0.073X-0.690 9。显示前列腺的左右径及前后径生长速度较为均衡,在60岁以前左右径的生长速度明显快于上下径,而60岁以后上下径的生长速度迅速上升且超过左右径的速度。结论:上海市社区中老年男性LUTS患病率接近于国内外情况,前列腺各径线生长速度呈现不均衡性,60岁以前以左右径生长为主,而60岁以后则以上下径生长为主。     

代谢综合征合并不育患者的甲状腺超声以及功能状况与性激素分析

目的探讨代谢综合征合并不孕症患者甲状腺结构和功能异常的特点,并寻求合理的治疗方案,以提高助孕成功率以及新生儿出生质量。方法2002年3月至2010年12月在本院就诊的代谢综合征合并不孕患者共322例,这部分患者来自全国各地,以山东省内各地为主。根据病史、体征对可能存在胰岛素抵抗的患者进行糖耐量及胰岛素释放试验、血脂等检查确定代谢综合征（metabolicsyndrome,MS）,对这类患者进行相关的体格检查、生化测定指标及辅助检查。根据甲状腺超声及甲状腺功能和抗体测定将患者分为超声正常组、结节性甲状腺肿组（结甲组）及桥本氏甲状腺炎组（桥本组）。对三组的一般情况、基础生殖内分泌水平及甲状腺功能各项指标进行比较和分析。结果代谢综合征患者按甲状腺超声结果分为正常组54．04％（174／322）和异常组45．96％（148／322）,各种异常占甲状腺超声异常总数（148）百分比分别为：结节性甲状腺肿66．89％（99／148）;桥本氏甲状腺炎14．86％（22／148）;甲状腺滤泡囊肿6．76Yoo（10／148）;甲状腺癌0．68％（1／148）;甲状腺腺瘤2．03％（3／148）;其他异常8．11％（12／148）。将超声正常组（174）,结甲组（99）及桥本组（22）各项指标进行比较后发现桥本组的脂肪肝患者比例（95．45％）较高,高雄激素血症患者比例（40．91％）较低（P〈0．05）;基础生殖内分泌测定各组间并无统计学差异;桥本组TSH升高,与正常超声组及结甲组相比有统计学差异（P〈0．05）。结论代谢综合征合并不孕不育患者是甲状腺结构异常的高发人群,应该做甲状腺结构以及功能的筛查,以做到早期诊断及治疗。     

经尿道前列腺电切综合征的过去与现在

良性前列腺增生症(BPH)是导致老年男性下尿路症状(LUTS)并影响其生活质量的最常见的疾病之一。良性前列腺增生症与年龄相关,从40岁开始增生,60岁患病率大于50%,而80岁可达90%。在美国,1998年用于治疗男性下尿路症状的费用高达40亿美元,其中包括观察治疗、药物     

Semen inflammatory markers and Chlamydia trachomatis infection in male partners of infertile couples

Previous studies have given conflicting results about the effect of generally infection and Chlamydia trachomatis on seminal ILs and semen parameters. The aim of this study was to investigate the relationship between semen quality and the level of seminal interleukins (ILs) in infertile couples with C. trachomatis. Blood, first void urine (FVU) and semen were obtained from 250 infertile men who had failed to conceive after 12 months of trying. Serological analysis for specific IgA, IgM and IgG antibodies to C. trachomatis in serum, the presence of C. trachomatis in FVU and semen sample and semen analysis were carried out. The main results are as follows: (i) elevated IL‐6 and IL‐8 are observed in C. trachomatis‐positive men, but this is not significant and it varies by diagnostic method; and (ii) IL‐6 and IL‐8 levels were correlated with each other and the concentration of leucocytes, but IL‐8 was correlated with semen volume and patient's age. This study showed that men with such an infection in FVU samples (PCR positive) had only lower semen volume compared with men without infection.     

Colonisation of the male reproductive tract in asymptomatic infertile men: Effects on semen quality

The objective was to explore presence/detection of microorganisms in the male reproductive tract (PMMRT) in asymptomatic patients undergoing infertility treatment and their effects on semen quality in our region. This study enrolled 205 men (mean age, 35.9 years) in a single-centre, tertiary university hospital from December 2015 to December 2016. We used the modified Meares–Stamey test, real-time polymerase chain reaction (rt-PCR) and the National Institutes of Health Chronic Prostatitis Sympton Index (NHI-CPSI) questionnaire to address this issue. No patient met the prostatitis criteria by the modified Meares–Stamey 4-sample test, 33 (16.1%) were positive for rt-PCR in the first-voided urine for any of the Mycoplasma (Ureaplasma urealyticum/parvum, Mycoplasma hominis/genitalium) and C. trachomatis was detected in two cases (1%), and three for rt-PCR in semen for HPV high-risk genotypes non-16/18 (1.5%). Significant statistical differences were reported among patients with and without PMMRT in terms of lower rate of progressive spermatozoa (PR) (p < .034), total motile sperm count (p < .028), normal morphologic forms, especially in the sperm head (p < .001) and highest viscosity (p < .012). It was concluded that PMMRT, specially Mycoplasmas, in asymptomatic infertility men, affects semen quality. The NIH-CPSI questionnaire was not a valid initial screening to subsequently evaluate the presence of prostatitis/PMMRT.     

Reproductive function in middle‐aged males: healthy men versus male partners of infertile couples

The aim of this study was to compare the reproductive parameters and the health‐related, lifestyle and educational factors in middle‐aged healthy men and male partners of infertile couples. Our patient group included 164 male partners of infertile couples with a preceding period of infertility of at least 12 months and 61 men attending a prostate health screening and considering themselves healthy. Significant differences between the groups were found in testicular volume, total sperm output, density and morphology as well as oestradiol levels in serum. The analysis showed significant positive correlations between testicular volume and semen quality, while negative correlations were observed between gonadotrophin levels and sperm parameters in both groups. Physical activity and sexual capability were higher in healthy men, while coital frequency and a history of sexually transmitted diseases were higher in male partners of infertile couples. The impact of physical activity and sexual capability on semen quality for all subjects was revealed. We can conclude that impaired reproductive function, that is, semen quality, in men >45 years is related not only with general male ageing but obvious differences between subjects of infertile couples and healthy middle‐aged men can be seen. Their relations with lifestyle, environmental or physiological factors need further study.     

Serum oestradiol levels in male partners of infertile couples

A prospective clinical study was performed in the reproduction centre of Ichikawa General Hospital (Chiba, Japan) to investigate the relationship between sperm quality and serum oestradiol (E2) level in male partners of infertile couples. The semen parameters and blood samples were assessed in relation to several variables, including body mass index (BMI) and serum oestradiol (E2) levels. Four hundred and nine male partners of infertile couples aged 22–55 years (mean: 36.5 years) were referred to the reproduction centre. In total, 143 patients (35.0%) were included in the low E2 level group (18 pg ml^?1 ≥ E2). Serum E2 levels were slightly correlated with testosterone levels, BMI and serum FSH levels. Total motile sperm count and morphology were decreased in low E2 level group. In multivariate analysis, serum testosterone, E2 levels, existence of varicocele and age were risk factors for decreased semen quality. Serum E2 might be associated with BMI, serum testosterone level and spermatogenesis.     

Relationship of seminal reactive nitrogen and oxygen species and total antioxidant capacity with sperm DNA fragmentation in infertile couples with normal and abnormal sperm parameters

The objective of this study was to investigate the association between the amount of superoxide anion, peroxynitrite as oxidative stress (OS) markers and total antioxidant capacity (TAC) with sperm DNA fragmentation in infertile men with abnormal semen parameters. Semen samples were obtained from 102 infertile couples and divided into groups with normal and abnormal semen parameters according to the World Health Organization (WHO). Peroxynitrite and superoxide anions were detected using spectrofluorometric assays combined with 2,7 dicholorofluorescein (DCF)‐DA and 4‐chloro‐7‐nitrobenzo‐2‐oxa ‐1, 3‐diazole (NBD‐CL). Colorimetric assay was used for evaluation of TAC, while DNA fragmentation was studied by using sperm chromatin dispersion test. Superoxide anion, peroxynitrite and DNA fragmentation were significantly higher in infertile couples with abnormal semen parameters as compared to infertile couples with normal semen (P < 0.01). TAC was significantly lower in infertile men with abnormal semen parameters (P < 0.01). There was also a significant positive correlation between OS markers with sperm DNA fragmentation (r = 0.59, P < 0.01 and r = 0.67, P < 0.01, respectively). We have found that imbalance between superoxide anion and peroxynitrite with antioxidant capacity in infertile men with abnormal sperm parameters is associated with higher sperm DNA fragmentation.     

Semen quality and reproductive endocrinal function related to blood lead levels in infertile painters

Lead causes male reproductive impairment among painters, but information is still limited. Therefore, the effect of lead on semen quality and reproductive endocrinal function in those patients was investigated. A case series of 27 infertile painters were subjected to semen analysis, measuring of blood lead level (PbB) and serum levels of endocrinal parameters including follicle‐stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL). Significantly lower sperm count and motility were found in those with duration of exposure (≥15 years), but no significant difference was found for PbB and serum levels of FSH, LH, PRL and T. A significant negative correlation between PbB and spermatic count and motility was observed, while there was no significant correlation between PbB and all endocrinal parameters. Patients with PbB ≥ 20 μg dl^?1 showed a significant decrease in sperm motility and increase in testosterone alone among all measured hormones. But the observed decrease in sperm count did not reach a significant level. It is concluded that infertile painters are at risk of lead‐related influence on semen quality, especially sperm motility and increased testosterone level without significant affection of other reproductive endocrinal parameters.