中国11城市老年科门诊良性前列腺增生现状调查

目的 了解中国老年科门诊伴有下尿路症状的良性前列腺增生(LUTS/BPH)患者的诊断及治疗现状,以及患者对于这一疾病的认知及需求. 方法 2008年2～9月在全国11个城市的34个老年科门诊进行调查.先对在调查时间内前来老年科门诊就诊的全部男性患者进行LUTS/BPH病史的询问.然后在LUTS/BPH患者中选择部分患者进行详细的问卷调查及BPH相关检查.结果 在调查过程中,共有31 371位男性患者来老年科门诊就诊,14 748(47.0%)例有LUTS/BPH病史.其中10 678例(72.4%)曾接受或正在接受药物或手术治疗,4070例(27.6%)第1次诊断LUTS/BPH或以往曾诊断LUTS/BPH但未行药物或手术治疗.患者最常接受的检查是尿常规检查.血清前列腺特异抗原(PSA)检查和经腹前列腺超声检查.在接受药物治疗情况调查的3542例患者中,1155例(32.6%)采用5α还原酶抑制剂单独药物治疗,1239例(35.0%)采用5α还原酶抑制剂+α受体阻滞剂联合药物治疗.对检查及治疗满意的患者分别为1796例(84.5%)和1678例(79.0%). 结论 LUTS/BPH是老年科门诊常见疾病,目前临床应用的检查及药物治疗方案与国际上有一定差异,需要对患者进行相关疾病知识的普及.     

广州地区老年科良性前列腺增生的诊断治疗现状

目的 了解广州地区老年科门诊伴有下尿路症状的良性前列腺增生(LUTS/BPH)患者的基本情况及诊治状况. 方法 对广州地区三家三级甲等医院的老年科门诊进行调查,对诊断为LUTS/BPH的患者进行生活的基本状况的问卷调查,同时对门诊医师开具的检查和治疗药物进行分析统计. 结果 6140例男性门诊患者中1824例拟诊LUTS/BPH,占29.7%.在有效回收的调查问卷的134例患者中,国际前列腺症状评分(IPSS)轻、中及重度者分别占24.5%、72.5%及3.0%.血清前列腺特异性抗原(PSA)异常率为37.3%.患者最常接受的检查是直肠指检(96.8%)、PSA(88.7%)和经腹B超(84.8%).医师开具的药物最常见为单独使用5-α还原酶抑制剂(44.7%);其次为α-受体拮抗剂及5-α还原酶抑制剂联合使用(24.7%)及其他(植物用药)(16.7%).单独使用α-受体拮抗剂和单独使用植物制剂的比例相近(分别为6.8%和7.1%). 结论 LUTS/BPH是老年科男性患者最常见的疾病之一.医师开具的检查不尽合理,对常规的病史询问、IPSS评分等重视不够,医师开具的治疗药物基本合理.     

老年良性前列腺增生患者药物治疗依从性

目的探讨老年良性前列腺增生患者药物治疗的依从性及其影响因素。方法选取2011年6月至2012年6月在该院泌尿科收治的老年良性前列腺增生患者113例。根据患者使用药物的种类分为α受体阻断剂组29例、5α还原酶抑制剂组27例、联合组57例,对三组患者治疗前临床指标、治疗过程中用药情况、不良反应情况进行分析。结果三组患者国际前列腺症状评分、生活质量评分、最大尿流率、前列腺体积之间差异均有统计学意义(P<0.01);5α还原酶抑制剂组患者药物持有率、药物治疗依从性明显好于受体阻断剂组和联合组(P<0.05);服药依次性好的患者治疗有效率明显高于依次性差的患者,不良反应、急性尿潴留发生率均明显低于依次性差的患者(P<0.01)。结论老年良性前列腺增生患者药物治疗依从性好,可能与药物治疗效果好、不良反应少有关;服用5α还原酶抑制剂的依从性好于α受体阻断剂。     

长沙市三家医院老年病科门诊良性前列腺增生患者药物治疗情况分析

目的 了解长沙市3家医院老年病科门诊良性前列腺增生(BPH)患者的基本情况及药物应用情况. 方法 采用BPH诊断情况日报表、BPH患者就医需求问卷、国际前列腺症状评分(IPSS)表、BPH患者生活质量量表(BPHQLS)对单月在湘雅医院、湘雅二医院、长沙市三医院3家医院老年病科门诊就诊的BPH患者进行调查. 结果 2008年单月3家医院老年病科门诊患者总计657人,其中男性456人,女性201人.诊断为BPH者289人,占老年病科就诊患者的44.0%,占男性患者的63.4%.完成全部调查项目者145人,平均年龄(77.2±5.7)岁,前列腺体积平均值(41.44±21.00)ml,血清前列腺特异抗原(PSA)中位数值2.24 μg/L,最大尿流率(12.65±5.74)ml/S,IPSS评分(14.80±8.11)分,BPHQLS评分(2.56±1.36)分.145例患者中,药物治疗率为66.21%(96/145),α受体阻滞剂单用率为6.90%(10/145),5α还原酶抑制剂单用率为8.97%(13/145),联合治疗方案采用率达26.90%(39/145). 结论 3家医院的门诊BPH患者为高进展风险人群,患者目前治疗方案以药物治疗为主,药物的选择基本合理.     

老年人良性前列腺增生与心血管疾病的关系

目的 了解老年良性前列腺增生(BPH)患者临床特点及用药情况,探讨BPH与心血管疾病的关系. 方法 搜集本院老年病科100例BPH患者临床资料,采用国际前列腺症状评分表(IPSS)、生活质量量表(QOL)对患者进行评价,所有患者均详细询问心血管病史,并检测前列腺特异性抗原(PSA)水平,采用腹部超声测量前列腺体积(PV). 结果 老年BPH患者PV和PSA随年龄增长而升高;疾病严重程度以中度(IPSS 8～19分)多见;BPH患者高血压、冠心病和糖尿病患病率高,冠心病者PV显著高于非冠心病者(P＜0.05);我院BPH患者服用5-α还原酶抑制剂和α-受体阻滞剂者多见,治疗依从性好. 结论 老年BPH患者严重程度与年龄、冠心病发病相关;药物干预治疗以5-α还原酶抑制剂使用率最高.     

老年病科门诊良性前列腺增生症患者诊治现况

目的 了解<中国良性前列腺增生症诊断治疗指南>公布以来老年病科门诊BPH诊断与治疗的基本情况.方法 采用BPH诊断情况日报表(A表)、BPH良患者就医需求问卷(B表)、国际前列腺症状评分表(International Prostate Symptom Score,IPSS)、(C表)、BPH患者生活质量量表(QOL)(D表),对单月在湘雅二医院老年病科门诊就诊的BPH患者进行调查.结果 2008年2月湘雅二医院老年病科门诊患者总计263人(女106人,男157人),其中诊断为BPH患者111人.医生开具的检查项目中病史询问、IPSS评分、生活质量评分(Quality Of Life,QOL)、腹部超声、PSA测定等均达到了100%.初诊患者与复诊组比较,确诊时间、IPSS评分、QOL评分、前列腺体积以及最大尿流率均有统计学差异.前列腺体积与PSA值在所有患者以及70岁、80岁人群组具正相关性,同时80岁组中前列腺体积与最大尿流率也具正相关.采用药物治疗者占58%.结论 湘雅二医院老年病科门诊BPH患者的主要构成人群特征均与全国的情况基本接近,门诊医生能较好地遵从BPH诊疗指南来诊断与评估患者病情,但尚需要提高对于直肠指诊重要性的认识,在药物治疗选择上,以α受体阻滞剂使用率最高,其次为中药和植物制剂,5α还原酶抑制剂最低,α受体阻滞剂与5α还原酶抑制剂合用率也低于服用中药植物制剂率.     

老年科良性前列腺增生的诊治现状

目的 了解良性前列腺增生(benign prostate hyperplasia,BPH)在老年科的诊断和治疗现状,促进BPH诊断和治疗的规范化.方法 抽取我国23个城市的老年科门诊BPH患者,完成老年科BPH门诊登记调查表.问卷内容包括患者的基本情况、诊疗情况和治疗效果.结果 对4001份调查问卷的分析显示,患者平均国际前列腺症状评分(IPSS)(18.8±5.9)分,中、重度症状患者分别占53.8％和42.0％.并存疾病的患病率依次为高血压(63.9％)、冠心病(40.4％)、糖尿病(32.4％)和高脂血症(25.7％).BPH相关并发症的发生率依次为尿路感染(21.0％)、尿路结石(8.3％)、反复血尿(1.8％)、肾积水(1.7％)和疝气(0.6％).医师采用的诊疗手段中,未进行直肠指诊的占27.2％,未进行血清前列腺特异性抗原(PSA)检查的占89.5％.在药物治疗的患者中,68.1％的患者处方中有a受体阻滞剂,92.9％的处方中有5α还原酶抑制剂,11.8％的处方中有中药和植物制剂,0.4％的处方中有M受体阻滞剂.首次处方中,单药治疗的占51.1％,2种药物联合治疗的占46.6％.在中重度症状患者中,遵医嘱规律服药的占60.6％,已停药的占13.9％.需要调整处方的原因依次为药物疗效差(23.4％)、不良反应多(5.4％)、价格昂贵(3.5％)、服用不方便(2.9％)等.结论 老年科门诊BPH患者以中重度症状为主,BPH治疗的同时还需考虑并存的疾病和BPH相关并发症;医师需进一步认识直肠指诊和PSA检查的重要性,联合治疗对于改善患者下尿路症状效果显著,长期治疗效果更好.     

老年良性前列腺增生与慢性阻塞性肺疾病的关系

目的 观察老年良性前列腺增生(BPH)合并慢性阻塞性肺疾病(COPD)患者的临床特点及用药情况,探讨BPH与COPD的关系.方法 回顾性分析100例BPH患者临床资料,采用国际前列腺症状评分表(IPSS)、生活质量量表(QOL)对患者进行评价,所有患者均详细询问病史,并检测前列腺特异性抗原(PSA)水平,超声测量前列腺体积(PV).结果 老年BPH患者PV和PSA随年龄增长而增高;疾病严重程度以中度(IPSS 8～19分)多见;COPD者合并BPH较其他呼吸疾病合并BPH者多见,COPD组PV显著高于非COPD组合并BPH者(P＜0.05);我院BPH患者服用5-α还原酶抑制剂和α受体阻滞剂者多见,治疗依从性好.结论 老年BPH患者严重程度与年龄、COPD相关;药物治疗以5-α还原酶抑制剂使用率最高.     

中药穴位贴敷配合红外线治疗器照射治疗老年良性前列腺增生86例

目前,良性前列腺增生(BPH)的治疗主要包括观察等待、药物治疗、微创治疗及手术治疗4大类[1].主要药物有α1-受体阻滞剂、5-α还原酶抑制剂和植物花粉制剂,但均具有疗程长、副作用多、药价昂贵等缺点.微创治疗及手术治疗因受到多种因素的限制,很多老年患者不愿接受.笔者对中药穴位贴敷配合红外线治疗器照射治疗老年BPH进行了临床观察.     

老年良性前列腺增生症单药治疗无效的危险因素

目的通过分析α-受体阻滞剂治疗老年良性前列腺增生症(BPH)无效的危险因素,明确初诊老年BPH的药物选择。方法回顾研究96例老年BPH患者,其中单用α-受体阻滞剂坦索罗新治疗组42例,与5α-还原酶抑制剂非那雄胺联合治疗组54例,比较两组国际前列腺症状评分(IPSS)、生活质量指数(QOL)、最大尿流速(Qmax)、残余尿量(PVR)、前列腺体积及血清前列腺特异性抗原(PSA)。结果联合用药与单药治疗组比较,前列腺体积、Qmax和IPSS具有统计学差异;多元回归分析显示IPSS(P<0.001)及前列腺体积(P<0.05)与老年BPH单药治疗无效密切相关。结论老年BPH患者单药及联合治疗均能改善病情,对于初诊时具有较高的IPSS评分及严重的前列腺体积增大者应给予药物联合治疗。     

The economics of medical therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia

Medical therapy is currently the most popular treatment choice for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Because medical therapy of BPH-related LUTS is considered a life-long strategy, short- and long-term cost considerations should play a major role in therapeutic decision-making. The effectiveness in terms of long and short amelioration of symptoms, flow rate, and quality of life are well documented for 5α-blockers and 5α-reductase inhibitors as well as for the gold standard treatment for BPH, transurethral resection of the prostate and minimally invasive therapies. Short-and long-term safety concerns also are well documented for these various treatment options. On the contrary, short- and long-term costs have been less well studied and comparisons depend on the model or analyses undertaken in the few studies available. However, the economic studies based on prospective clinical trial data that have become available throughout the past several decades allow us to rationalize our use of α-blockers, 5α -reductase inhibitors, and combination therapy, taking into consideration age, severity of symptoms, prostate volume, prostate-specific antigen, and the differential response of the various medications (and combination) in selected patients. Based on current studies, 5α -blockers generally provide cost-effective therapy for most patients, whereas 5α-reductase therapy and combination therapy provide cost-effective treatment for patients with larger prostate glands or higher baseline prostate-specific antigen levels.     

Combination 5-α-reductase inhibitors and α-blockers for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Open or transurethral resection of the prostate was once the only option for men afflicted with symptomatic benign prostatic hyperplasia (BPH). In the past 10 to 15 years, however, medical management has become a common step in the treatment of BPH, often postponing or eliminating the need for surgical intervention. The two drug classes used in the medical management of BPH are α-blockers and 5-α-reductase inhibitors. This paper reviews major studies related to the use of these medications in combination and discusses patient populations best served by combination therapy.     

Influence of Age and Obesity on 5α-Reductase 2 Gene Expression

The most common non-malignant, age-related disease in men is the benign prostatic hyperplasia (BPH). Androgens and genetic predisposition play important roles in normal prostate growth and in BPH progression. However, accumulating evidence indicates that factors such as aging and obesity also can contribute to the BPH etiology. Management of BPH includes medical treatment or surgery. Currently, the drug therapy uses the alpha1-blockers and/or inhibitors of the 5-alpha reductase enzyme (5ARIs). Latest studies demonstrated that a fraction of patients (up to 30 %) are resistant to this therapy. This article reviews the new risk factors in BPH etiology as well as the mechanisms of resistance to 5ARI therapy.     

Benigne Prostatahyperplasie

A profound knowledge of pathogenesis and natural history enables a differentiated therapy for elderly men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). The role of phytotherapy is still controversially discussed and, therefore, not clearly recommended by any BPH-guideline. alpha(1)-blockers are the therapy of choice for symptomatic patients at a low risk of disease progression (prostate volume <30-40 ml). 5alpha-reductase inhibitors (5ARI) reduce the prostate volume by 20-25% and the risk for acute urinary retention/surgery by more than 50% compared to placebo. Combination therapy (alpha(1)-blocker plus 5ARI) is superior to either monotherapy, though this advantage is only demonstrable after a prolonged treatment period (>12 months).     

中国11城市医院老年科就诊良性前列腺增生患者患病情况及相关因素分析

目的 调查就诊于老年科的老年人中良性前列腺增生(BPH)患者的患病情况.方法 采用分层整群随机抽样的方法,对11个城市医院老年科2125例60岁及以上的就诊老年人进行横断而流行病学调查.结果 BPH占就诊疾病的构成比为47.0%,BPH患者按年龄分组60～、70～、80～岁的构成比分别为18.1%、49.4%、32.5%,BPH患者各年龄组构成比差异有统计学意义(x2=83.68,P<0.001);BPH患者职业分布存在差别,国家机关人员和专业技术人员构成比较高,分别为66.4%和18.0%,农林牧副渔业人员构成比较低为14.7%(x2=410.27,P<0.001).BPH患者下尿路症状严重程度[国际前列腺症状评分(IPSS)]在城市间不同(x2=101.00,P相似文献   

2010年北京地区老年人前列腺疾病超声检查结果分析

目的 分析北京地区老年人前列腺疾病的分布情况,探讨超声检查在其检查中的价值.方法 选用PHLIIPS iU22超声诊断仪,经直肠超声检查.观察前列腺疾病在老年组和中年组的分布差异.结果 老年组3289例中,前列腺增生、前列腺结石、前列腺囊肿和前列腺炎分别为2324例(70.7%)、1022例(31.1%)、468例(14.2%)和49例(1.5%);中年组1627例中,分别为549例(33.7%)、212例(13.0%)、73例(4.5%)和148例(9.1%),两组差异均具有统计学意义(P＜0.05).前列腺增生、结石和前列腺炎在不同年龄段分布差异具有统计学意义(P＜0.05).Spearman相关分析结果显示,前列腺增生(r=0.36,P＜0.05)和前列腺结石(r=0.41,P＜0.05)的发病率随年龄的增长而升高,而前列腺炎(r=-0.31,P＜0.05)的发病率随年龄的增长而下降.结论 前列腺增生和前列腺结石是老年人最常见的前列腺疾病,并随着年龄的增长而升高,经直肠超声检查在前列腺疾病检查中具有重要价值.

Abstract：

Objective To analyze the distribution of prostate diseases in the elderly in Beijing, and explore the clinical value of ultrasound in the detection of prostate diseases Methods Prostatic diseases were screened by transrectal ultrasonography by PHLIIPS iU22. The distribution of prostate diseases was compared between the elderly and the middle-aged. Results Benign prostatic hyperplasia, prostatic stone, prostate cyst and prostatitis accounted for 70.7%, 31.1%, 14.2% and 1.5% in elderly group, respectively, and the corresponding data were 33.7%, 13.0%, 4.5% and 9.1% in middle-aged group, respectively. They showed a statistical significance between the groups (P＜0.05). Benign prostatic hyperplasia, prostatic stone and prostatitis were associated with age (P＜0.05). The incidence of benign prostatic hyperplasia and prostatic stone increased sharply with increasing age by Spearman correlative analysis (P＜0.05), and the prostatitis decreased with ageing (P＜0.05). Conclusions Benign prostatic hyperplasia and prostatic stone were the very common prostate diseases in the elderly, and their incidence grows with the age. It has great clinical value to use transrectal ultrasonography in the detection of prostate diseases.     

The use of baseline clinical measures to predict those at risk for progression of benign prostatic hyperplasia

Although histologic changes of benign prostatic hyperplasia (BPH) begin in men when they are in their thirties, symptomatic BPH characterized by lower urinary tract symptoms (LUTS) typically do not develop for several decades. Progression of BPH may lead to significant voiding symptoms, acute urinary retention, and the need for prostate surgery. However, developing LUTS is not inevitable for men with histologic evidence of BPH. The ability to predict those men who are risk for BPH progression is increasingly important because of recent evidence provided by the Medical Therapy of Prostate Symptoms study. This landmark study demonstrated that 5α-reductase inhibitors, alone or in combination with selective α-blockers, can delay or prevent the progression of BPH. In addition, the most important and consistent predictive factors for BPH progression are baseline prostatespecific antigen and prostate volume. Integration of these clinical parameters into clinical practice is influencing the decision regarding which men should observe or initiate treatment. This article highlights recent studies regarding the use of baseline clinical parameters on predicting BPH progression.