外周血和组织炎性细胞在鉴别PSA4～10ng/ml的前列腺癌和前列腺增生中的临床意义

目的:评价外周血和前列腺组织炎性细胞在鉴别前列腺特异性抗原(PSA)4～10 ng/ml的前列腺癌(PCa)和良性前列腺增生(BPH)中的临床意义。方法:回顾性分析我院2013年10月～2018年10月PSA水平4～10 ng/ml的PCa和BPH患者共45例,其中PCa组患者20例,BPH组患者25例。PCa组患者行前列腺癌根治术后病理确诊,BPH组患者行耻骨上经膀胱前列腺摘除术或经尿道前列腺电切术(TURP)后病理确诊。所有患者在行前列腺穿刺活检术前检测血常规,记录患者外周血中WBC、中性粒细胞、淋巴细胞和单核细胞计数,分析外周血淋巴细胞与单核细胞比率(LMR)、中性粒细胞与单核细胞比率(NMR)和中性粒细胞与淋巴细胞比率(NLR)等。同时收集患者术后病理石蜡切片,采用免疫组织化学(IHC)染色法检测前列腺组织中炎性细胞表达情况。结果:PCa组和BPH组患者外周血白细胞、中性粒细胞和淋巴细胞计数等指标比较差异无统计学意义。PCa组单核细胞计数明显低于BPH组,差异有统计学意义(P0.05)。两组LMR、NMR和NLR值比较差异无统计学意义。两组淋巴细胞和中性粒细胞表达比较差异无统计学意义,但BPH组单核细胞标志物CD14表达高于PCa组,差异有统计学意义(P0.05)。结论:检测外周血和组织中单核细胞计数有助于诊断PSA浓度4～10 ng/ml的PCa患者。     

中性粒-淋巴细胞比值与前列腺增生临床进展的相关性研究

目的评估中性粒-淋巴细胞比值(NLR)与前列腺增生(BPH)的相关性,并探讨NLR对BPH患者临床病程进展的影响。方法回顾性分析厦门大学附属第一医院泌尿外科在2015年1月1日至2017年12月31日收治的BPH患者274例的临床资料,采用统计学方法分析NLR与前列腺体积(PV)、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、前列腺特异性抗原(PSA)之间的相关性。按照患者的年龄、PV、IPSS、Qmax、PSA将BPH患者分为高危组和低危组,从而比较高危组和低危组之间临床进展的差异性;并运用ROC曲线分析NLR对高危组的诊断效能。继而根据术后病理是否含有炎性细胞浸润,分为无浸润组和浸润组,并在浸润组之间进行统计学分析。结果NLR与PV、IPSS均呈正相关(r=0.126,P=0.038;r=0.139,P=0.021),与Qmax呈负相关(r=-0.169,P=0.005),而与PSA无相关性(P>0.05)。根据PV及Qmax分组,高危组的NLR值高于低危组,两组之间比较差异有统计学意义(t=2.338,P=0.020;t=2.763,P=0.006);而根据年龄、IPSS及PSA分组,NLR在高危组与低危组之间比较差异无统计学意义(P>0.05)。ROC曲线分析表明,NLR作为BPH临床进展的影响因素预测PV高危组的最佳临界值为1.71,其灵敏度为71.0%,特异度为49.1%;预测Qmax高危组的最佳临界值为1.49,其灵敏度为79.4%,特异度为30.3%。浸润组的NLR值高于无浸润组,两组之间比较差异有统计学意义(t=2.156,P=0.032),且浸润组组间的比较也是有统计学意义(F=9.959,P<0.001)。结论NLR与BPH患者临床病程进展呈正相关性,是BPH临床进展的重要因素之一,可以提供患者的严重信息,并可作为患者随访的指标之一。     

合并组织学炎症的前列腺增生组织中IL-6、TNF-α表达的研究

目的:通过检测TNF-α、IL-6在单纯BPH与合并组织学炎症的BPH组织中表达的差异及两组BPH患者在临床指标上的异同,探讨炎症与BPH的发生发展的关系。方法:收集TURP术的90份BPH患者标本,用HE染色法将90份标本染色后分单纯组(A组)35份与合并炎症组(B组)55份。采用免疫组织化学方法检测TNF-α、IL-6在各标本中的表达情况,记录90例患者临床指标PSA、体积、年龄、尿流率等数据结果。全部患者均病理检查回报为BPH。结果:B组55例均为慢性炎症,构成比为0.61。与A组相比,B组患者前列腺体积较大,PSA水平也较高,差异有统计学意义(P0.05);而两组患者在年龄和尿流率比较上无统计学意义(P!0.05)。与A组比较,B组TNF-α与IL-6的表达显著增高(P0.05)。IL-6和TNF-α表达结果相关性分析:前列腺体积与患者年龄有相关性,差异有统计学意义(r=0.430,P0.001),前列腺体积与炎症程度也有相关性,差异有统计学意义(r=0.610和r=0.609,P0.001);患者的PSA水平与炎症程度有相关性,差异有统计学意义(r=0.572r=0.487,P0.01),而患者PSA水平与年龄无相关性,差异无统计学意义(r=0.065,P!0.1);通过偏倚相关分析控制年龄因素的影响后,炎症严重水平与BPH体积仍有明显相关性。结论:大部分BPH患者合并有前列腺炎症,并且以慢性炎症为主。合并炎症的BPH患者PSA水平相对较高,前列腺体积相对较大,但是在尿流率和年龄上的差异无统计学意义。IL-6、TNF-α两种促炎性因子可能对BPH和PSA的分泌起着促进作用。     

淋巴细胞与单核细胞比值在肝细胞癌患者中的预后价值分析

背景与目的:通过实验室血样进行评估系统性炎症的临床意义已在多种癌症中被证实。肝细胞癌(HCC)是一种炎症驱动型癌症,炎症已被证实与分化不良、微血管侵犯和微转移相关。本研究旨在探讨淋巴细胞/单核细胞比值(LMR)对HCC患者术后的预后评估价值。方法:回顾性分析2012年1月—2016年12月在南京中医药大学附属南京医院行根治性肝切除术的88例HCC患者的资料。通过ROC曲线分析LMR评估HCC预后的性能,并将其与中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)进行比较。分析LMR与HCC患者临床病理因素的关系,以及与无病生存率(DFS)、总生存率(OS)的关系。用Cox回归模型分析DFS和OS的危险因素。结果:ROC曲线确定LMR最佳诊断界值为2.87,曲线下面积(AUC)为0.757,其评估HCC预后的性能大于NLR(AUC=0.687)和PLR(AUC=0.583)。根据LMR界值将患者分为高LMR组(LMR2.87)与低LMR组(LMR≤2.87)。高LMR组中肿瘤数3的例数明显少于低LMR组(P=0.048);高LMR组的DFS与OS均明显优于低LMR组(均P0.05);在分期分层(BCLCA/B、BCLCC/D;CNLCⅠ/Ⅱ、CNLCⅢ/Ⅳ)比较结果显示,除了在CNLCⅠ/Ⅱ期组患者中,高LMR组与低LMR组的DFS无统计学差异(P=0.132),在其他分期组患者中,高LMR组患者的DFS与OS均明显优于低LMR组(均P0.05)。LMR为DFS的独立影响因素(P=0.001),而BCLC分期(P=0.000)和LMR(P=0.000)为OS的独立影响因素,此外,对LMR、PLR与NLR以连续性变量形式进行校正后,仅LMR具有预后价值(P=0.001)。结论:LMR是HCC患者术后DFS和OS的独立预后因素,且评估价值可能优于NLR和PLR。用LMR结合HCC分期对患者进行危险分级,可能做出更为精准的评估。     

膀胱内前列腺突出程度与良性前列腺增生临床评价指标的相关性

目的:探讨在良性前列腺增生(BPH)患者中,应用经腹超声测量的前列腺向膀胱内突出(IPP)程度与BPH常用临床评价指标的相关性。方法:对275例因下尿路症状就诊的BPH患者行经腹超声通过中线矢状面测量IPP,并且将IPP程度分别与患者年龄、前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率和排尿后残余尿量进行相关分析。结果:275例BPH患者的IPP程度与年龄(r=0.210,P<0.01)、前列腺体积(r=0.534,P<0.01)和排尿后残余尿量(r=0.314,P<0.01)呈正相关关系,与最大尿流率(r=-0.364,P<0.01)呈负相关关系,而与IPSS(r=0.064,P=0.299)无明显相关。结论:IPP程度可能与症状性BPH患者的年龄和前列腺体积存在一定相关性。经腹超声测量IPP可能是一种评价BPH患者膀胱出口梗阻状态及程度的有价值的无创性方法。     

术前外周血NLR和PLR与原发性胃癌病程进展的关系

目的:探讨外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)与原发性胃癌病程进展的关系。方法:回顾性分析2015年2月—2016年2月收治的188例原发性胃癌患者的临床资料,分析肿瘤不同浸润深度、淋巴结分期及TNM分期组间患者NLR值和PLR值的差异及相关性。结果:原发性胃癌不同浸润深度、淋巴结分期及TNM分期患者NLR值和PLR值差异均有统计学意义(P0.001);高NLR组、PLR组胃癌患者肿瘤浸润深度、淋巴结分期和TNM分期均较低NLR组、PLR组高,差异有统计学意义(P0.001);NLR与PLR呈明显正性相关(r=0.379,P0.001);多重线性回归进一步分析显示上述因素对术前NLR、PLR有显著影响(P0.05)。结论:术前外周血NLR和PLR升高对胃癌进展具有一定的预测价值,NLR值和PLR值越高提示胃癌病程越晚,预后越差。     

血小板、中性粒细胞、血小板平均体积与淋巴细胞比值在急性深静脉血栓形成诊断中的价值

目的评价血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)和血小板平均体积/淋巴细胞比值(mean platelet volumeto-lymphocyte ratio,MPVLR)等指标对急性下肢深静脉血栓形成(deep vein thrombosis,DVT)的诊断价值。方法选取92例急性下肢DVT的患者作为病例组,86名健康体检者作为对照组,通过比较两组的血液相关指标来评价其对急性DVT的诊断价值。结果病例组的白细胞计数、中性粒细胞计数、血小板平均体积(mean platelet volume,MPV)值、PLR值、NLR值和MPVLR值均高于对照组,淋巴细胞计数低于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,NLR(OR=9.690,P<0.001)和MPVLR(OR=7.162,P<0.006)是急性下肢DVT发病的独立预测因素。NLR和MPVLR的曲线下面积(area under curve,AUC)值分别为0.871和0.963。NLR对急性DVT诊断的最佳截断值为2.15,灵敏度89.1%,特异度84.9%,MPVLR的最佳截断值为6.88,灵敏度42.4%,特异度84.9%。下肢肿胀天数>7 d组患者的MPVLR水平低于肿胀天数≤7 d组,差异有统计学意义(P=0.025)。结论MPVLR、NLR、MPV对急性下肢DVT有较大的诊断价值。NLR和MPVLR是DVT相关的独立预测因素,MPVLR在急性下肢DVT的早期诊断价值更大。     

BPH患者年龄、睾酮水平、体重指数、前列腺体积及血清前列腺特异性抗原的关系分析

目的:探讨研究BPH患者年龄、睾酮水平、体重指数(BMI)、前列腺体积以及血清前列腺特异性抗原(PSA)之间的关系。方法:回顾性分析2013年2月~2014年9月天津医科大学第二医院泌尿外科333例有下尿路症状并经手术治疗后病理诊断为BPH的患者临床资料,采用SPSS19.0软件总结并分析患者年龄、睾酮水平、体重指数(BMI)、前列腺体积以及血清PSA、f/t之间关系。结果:333例患者平均年龄为(68.93±7.061)岁,平均前列腺体积为(81.06±42.034)ml;平均睾酮值为(3.42±1.761)ng/dl;平均BMI为(23.915±3.291)kg/m2;平均PSA值(5.90±4.666)ng/ml;平均fPSA值(1.059±1.023)ng/ml,f/t平均值(0.191±0.097)。对患者年龄分组后显示睾酮水平随年龄增长而降低(F=20.113,P0.001),BMI水平随年龄增长无明显相关性(F=1.500,P=0.215)。前列腺体积、血清PSA值随患者年龄增长而增加(F=2.792,P=0.041;F=2.978,P=0.032),而f/t值随着年龄的增加而降低(F=11.91,P=0.01);对体积进行分组后血清PSA值随前列腺体积增加而升高(F=24.028,P0.001);对体重指数分组后血清PSA值随体重指数增加无明显变化(F=0.735,P=0.532)。应用Spearman相关分析比较显示PSA、fPSA值均与体积正相关(r=0.494,P0.001;r=0.369,P0.001),然而f/t值与前列腺体积无明显相关性(r=0.05,P=0.363);而PSA、fPSA值均与睾酮呈负相关(r=-0.138,P=0.012;r=-0.188,P=0.001);PSA、fPSA、f/t值与BMI均无明显相关性(r=0.039,P=0.475;r=0.009,P=0.863;r=0.039,P=0.478)。结论:BPH患者血清PSA水平和前列腺体积随患者年龄增长而增加,睾酮水平随年龄增长而降低,BMI水平随年龄增长无明显变化;患者血清PSA与前列腺体积正相关,与睾酮水平呈负相关,而与BMI无明显相关性;f/t值随着年龄的增长逐渐下降,而与前列腺体积、BMI无明显相关性。     

外周血中性粒细胞计数与良性前列腺增生的关系

目的 探讨外周血中性粒细胞计数与良性前列腺增生患者前列腺体积及血清前列腺特异性抗原的关系.方法 回顾性分析100例手术获得的前列腺标本,经病理诊断为良性前列腺增生患者的临床数据.根据外周血中性粒细胞比例,将患者分成两组,即中性粒细胞比例小于70％组和中性粒细胞比例大于70％组,并进一步探讨两组间前列腺体积、血清前列腺特异性抗原之间的关系.结果 中性粒细胞计数与前列腺体积(β=4.68;95％ CI 0.35,9.01;P=0.03)和血清前列腺特异性抗原(β=1.21;95％ CI 0.42,1.98;P=0.003)正相关.中性粒细胞小于70％组的前列腺体积和血清前列腺特异性抗原明显小于中性粒细胞大于70％组的前列腺体积和血清前列腺特异性抗原(52.00mL vs 69.71mL,t =3.73,P＜0.05),(5.22ng/mL vs 9.30ng/mL,t =8.23,P＜0.05).结论 外周血中性粒细胞计数与良性前列腺增生患者前列腺体积及血清前列腺特异性抗原呈正相关.     

前列腺增生组织中4个上调基因的表达及意义

目的良性前列腺增生(BPH)是一种缓慢进展的年龄相关疾病。本研究探究白介素-21受体(IL-21R)、多效生长因子(PTN)、基质重塑相关5(MXRA5)及胰岛素样生长因子(IGF-1)在BPH组织中的定位和表达,分析其与BPH临床进展危险因素的相关性。方法收集经尿道前列腺电切术(TURP)的BPH患者的组织标本104例制备组织芯片,并采用免疫组织化学染色法检测表达。结果相比于正常前列腺组织,IL-21R、PTN、MXRA5及IGF-1在BPH组织中的表达水平显著增加。IL-21R主要表达于前列腺上皮,与BPH患者的前列腺体积(r=0.31,P0.05)、最大尿流率(r=0.14,P0.05)及夜尿次数(r=0.24,P0.05)呈正相关;PTN主要表达于前列腺上皮,与BPH患者的游离PSA水平(r=0.11,P0.05)正相关;MXRA5主要定位于前列腺间质中,与BPH患者的前列腺体积(r=0.27,P0.05)及IPSS评分(r=0.19,P0.01)正相关;IGF-1分布于前列腺上皮及间质中,与BPH患者的前列腺体积(r=0.11,P0.01)及残余尿量(r=0.05,P0.05)正相关。结论 IL-21R、PTN、MXRA5及IGF-1可以单独或联合预测BPH的临床进展。     

NLR和PLR在腹膜透析相关性感染中的诊断价值探讨

目的探讨外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)对腹膜透析相关性感染的诊断及预测价值。方法回顾性分析71例腹膜透析并发相关感染的患者及102例同期入院行腹膜功能及透析充分性评估的维持性腹膜透析患者的临床资料,分别按照是否发生腹膜透析相关性感染、NLR及PLR的最佳截断值进行分组,分析NLR、PLR等指标与腹膜透析相关性感染的关系。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价NLR、PLR、NLR联合PLR对腹膜透析相关性感染的诊断及预测价值。结果相关性分析提示腹膜透析相关性感染与NLR、PLR、腹透液白细胞计数及hs-CRP呈正相关(均P<0.01);而与血清白蛋白、血镁、血磷呈负相关(均P<0.01)。NLR与腹膜透析相关性感染、PLR、腹透液白细胞计数及hs-CRP呈正相关(均P<0.01);与血镁及血清白蛋白呈负相关(均P<0.01);与血磷无相关性(P>0.05)。PLR与腹膜透析相关性感染、NLR、腹透液白细胞计数及hs-CRP呈正相关(均P<0.01);与血镁、血磷及血清白蛋白呈负相关(均P<0.05)。单因素Logistic回归显示低血清白蛋白(OR=0.808,95%CI 0.748~0.874,P<0.01)、低血镁(OR=0.001,95%CI 0.000~0.015,P<0.01)、低血磷(OR=0.324,95%CI 0.165~0.635,P=0.01)、高hs-CRP(OR=1.246,95%CI 1.149~1.351,P<0.01)、高NLR(OR=1.570,95%CI 1.315~1.815,P<0.01)、高PLR(OR=1.010,95%CI 1.006~1.014,P<0.01)是腹膜透析相关性感染的危险因素;多因素分析显示低血清白蛋白(OR=0.837,95%CI 0.704~0.995,P=0.043)、高hs-CRP(OR=1.296,95%CI 1.149~1.461,P<0.01)及高NLR(OR=1.522,95%CI 1.055~2.195,P=0.025)是腹膜透析相关性感染的危险因素。从ROC曲线可以看出,NLR、PLR、NLR联合PLR及hs-CRP诊断腹膜透析相关性感染的敏感度分别为64.8%、53.5%、94.4%、93.0%,特异度分别为87.3%、87.3%、98.0%、90.2%。结论与腹膜透析未发生相关性感染的患者相比,腹膜透析相关感染人群的NLR、PLR、腹透液白细胞计数及hs-CRP水平明显升高,而白蛋白、血镁、血磷明显降低。且高NLR、高hs-CRP、低血清白蛋白是腹膜透析相关性感染危险因素。此外,NLR联合PLR对腹膜透析相关性感染的临床诊断敏感性及特异性均优于hs-CRP。     

Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia

OBJECTIVE: To determine the validity coefficient of the total prostate gland volume as an expression of the transition zone (TZ) volume. To test the hypothesis of hyperinsulinaemia as a causal factor for the development of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Three hundred and seven consecutive patients with lower urinary tract symptoms were studied. A subgroup of 114 patients were tested with regard to the validity coefficient between the total prostate gland volume and the TZ volume. In the total material of 307 men, a BPH risk factor analysis was performed in which groups of men with the following conditions were related to the annual BPH growth rate: men without or with metabolic disease; men with different components of the metabolic syndrome, and men with low or high fasting plasma insulin values. The prostate gland volume and the TZ volume were determined using ultrasound. The presence of non-insulin-dependent diabetes mellitus (NIDDM) and treated hypertension was obtained from the patients' medical records. Data on blood pressure, waist and hip measurement, body height and weight were collected and body mass index and waist/hip ratio were calculated. Blood samples were drawn from fasting patients to determine the insulin and HDL-cholesterol values. RESULTS: In the subgroup of men subjected to measurement of both the total prostate gland volume and the TZ volume, the correlation coefficient between total prostate gland volume and the TZ volume was r.s. = 0.97 (p < 0.0001) which, thus, constituted the validity coefficient. The median annual BPH growth rate in the total group was 1.03 ml/year. The median annual BPH growth rate was faster in men with metabolic disease (p < 0.0001), NIDDM (p < 0.0001), treated hypertension (p < 0.0001), obesity (p < 0.0001) and dyslipidaemia (p < 0.0001) than in men without metabolic disease. Moreover, the annual BPH growth rate correlated positively with the diastolic blood pressure (r.s. = 0.27; p < 0.001), the BMI (r.s. = 0.22; p < 0.001) and four other expressions of obesity, and negatively with the HDL-cholesterol level (r.s. = -0.15; p < 0.001). The median annual BPH growth rate was faster in men with a high than in men with a low fasting plasma insulin level (p = 0.019). When the patients were divided into quartiles, the median annual BPH growth rate increased statistically significantly with increasing fasting plasma insulin levels. The fasting plasma insulin values correlated with the annual BPH growth rates (p = 0.009). When performing a multivariate analysis using the total prostate gland volume as dependent variable, fasting plasma insulin (p = 0.001) and age (p < 0.001) became statistically significant. CONCLUSION: The results of the present report suggest that the total prostate gland volume constitutes a valid expression of BPH. The findings support the hypothesis that hyperinsulinaemia is causally related to the development of BPH and generate the hypothesis of an increased sympathetic nerve activity in men with BPH.     

The importance of measuring the prostatic transition zone: an anatomical and radiological study.

OBJECTIVE: To assess the accuracy and reliability of measurements of the volume of the transition zone (TZ, representing the hypertrophied benign component) and whole prostate by TRUS in patients with BPH or cancer, by comparing the radiological with pathological findings after surgery. PATIENTS AND METHODS: The study comprised 36 patients with prostate cancer undergoing radical prostatectomy and 34 patients with symptomatic BPH treated using retropubic adenectomy. The weights of the radical prostatectomy specimens and of the enucleated adenomas were correlated with the corresponding volumes of the TZ and of the whole prostate, respectively, measured by TRUS using the prolate ellipsoid method. RESULTS: The mean (sd) TZ volume measured by TRUS was 36.9 (25.48) mL, whereas the weight of the enucleated specimen was 42.7 (33.58) g (correlation coefficient r=0.95, P<0.001). The TRUS estimate of the volume of the whole prostate was 29.2 (9.24) mL, while the radical prostatectomy specimens weighed 34.5 (10.76) g (r=0.78, P<0.001). The variability in the TZ volume estimate ranged from -17% to +18%, whereas the variability for whole prostate was -21% to +30% (P<0.05). CONCLUSIONS: Measurements of the TZ of the prostate by TRUS are more accurate than those for the whole prostate. An assessment of the TZ volume may be sufficiently reliable to be used in the clinical management of BPH and to detect prostate cancer using the prostate-specific antigen density of the TZ as a marker.     

Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia

The purpose of the present study was to perform a BPH risk factor analysis in men, relating the prostate gland volume to components of the metabolic syndrome and to identify clues to the etiology of BPH. Our material comprised a consecutive series of 158 patients with lower urinary tract symptoms with or without manifestations of the metabolic syndrome. In this group, the measured volume of the prostate was related consecutively to potential risk factors. The diagnoses atherosclerosis, non-insulin-dependent diabetes mellitus (NIDDM) and treated hypertension were obtained from the patient's medical history. Data on blood pressure, waist and hip measure, body height and weight were collected and body mass index (BMI) and waist/hip ratio (WHR) were calculated. Blood samples were drawn from fasting patients to determine insulin, cholesterol, triglycerides, HDL and LDL-cholesterol, uric acid and ALAT. The prostate gland volume was determined using ultrasound. Our results show that there was a larger prostate gland in men with NIDDM (P=0.0058), treated hypertension (P=0.0317), obesity (P<0.0001), low HDL-cholesterol levels (P=0.0132) and high insulin levels (P<0.0001) than in men without these conditions. The prostate gland volume correlated positively with the systolic blood pressure (r(s)=0.17; P=0.03), obesity (r(s)=0.34; P<0.0001) and fasting insulin (r(s)=0.38; P<0.0001) and negatively with HDL-cholesterol (r(s)=-0.22; P=0.009). On the basis of our findings, we concluded that NIDDM, treated hypertension, obesity, low HDL-cholesterol levels and high insulin levels constitute risk factors for the development of BPH. The results suggest that BPH is a facet of the metabolic syndrome and that BPH patients may share the same metabolic abnormality of a defective insulin-mediated glucose uptake and secondary hyperinsulinemia as patients with the metabolic syndrome. The findings generate a hypothesis of a causal relationship between high insulin levels and the development of BPH. In a clinical setting, the findings of the present report suggest that, in any patient presenting with BPH, the possible presence of NIDDM, hypertension, obesity, high insulin and low HDL-cholesterol levels should be considered. Conversely, in patients suffering from these conditions, the possibility of a clinically important BPH should be kept in mind.     

术前外周血中淋巴细胞与单核细胞比值对高危非肌层浸润性膀胱癌预后的评估价值

目的探讨术前外周血中淋巴细胞与单核细胞比值（LMR）对高危非肌层浸润性膀胱癌（NMIBC）预后的评估价值。 方法回顾性分析2014年1月至2020年1月本院收治的120例高危NMIBC患者,收集术前血常规检测结果中淋巴细胞、单核细胞计数,按照LMR中位值将120例患者分为高低两组,术后随访,比较高LMR组和低LMR组的临床特征及1~5年无复发生存率情况,并应用Logistic多因素回归分析风险模型分析影响高危非肌层浸润性膀胱癌预后的独立危险因素,评估两组LMR指标与高危NMIBC预后的关系。 结果根据LMR中位值将患者分为低LMR组（<3.14,52例）和高LMR组（≥3.14,68例）,分析表明高LMR组和低LMR组的NLR、PLR、年龄、病理分级、肿瘤分期、肿瘤复发、分化程度之间差异有统计学意义（P<0.05）。低LMR组患者3~5年无复发生存率均明显低于高LMR组（P<0.05）。多因素分析表明LMR是影响肿瘤无复发生存率的独立相关因素（P<0.05）。 结论术前LMR与高危NMIBC患者的预后相关,可以作为判断预后的一项指标。     

术前炎性指标构建的列线图模型预测结直肠癌患者术后生存分析

目的探讨基于术前炎性指标构建的列线图模型预测结直肠癌患者术后生存的价值。方法采用队列研究设计,选取2011年1月至2014年6月空军第986医院行结直肠癌根治术的233例结直肠癌患者,根据5年随访结果,将患者分成生存组(99例)和死亡组(134例)。比较两组患者术前1 d炎性指标水平,单因素和Cox回归分析结直肠癌患者术后5年生存的影响因素,应用R软件建立列线图术后存活预测模型。结果两组患者术前淋巴细胞计数、中性粒细胞计数、血小板计数、C反应蛋白、血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞(NLR)和C反应蛋白/白蛋白比值(CAR)等指标比较,差异有统计学意义(P<0.05),而白细胞计数和白蛋白比较,差异无统计学意义;肿瘤大小(OR=1.379,95%CI:1.094~1.737)、浸润深度(OR=2.020,95%CI:1.126~3.622)、NLR(OR=1.496,95%CI:1.009~2.219)、PLR(OR=1.927,95%CI:1.060~3.504)和CAR(OR=2.326,95%CI:1.479~3.657)是结直肠癌患者术后生存的独立影响因素(P<0.05)。列线图预测术后生存模型的C-index为0.831(95%CI:0.781~0.911),校准预测曲线和理想曲线拟合良好。结论术前NLR、PLR和CAR与结直肠癌术后生存呈负相关,且列线图具有预测结直肠癌患者术后生存情况的潜在价值。     

Relationship of prostate-specific antigen and prostate volume in patients with biopsy proven benign prostatic hyperplasia

BACKGROUND: Emerging data suggest a direct correlation between prostate-specific antigen (PSA) and prostate volume in patients with lower urinary tract symptoms (LUTS) and clinical evidence of benign prostatic hyperplasia (BPH). We attempt to confirm that a similar correlation exists between PSA and prostate volume in patients with biopsy-proven BPH. METHODS: Over a 5 year period, 2,270 patients were confirmed to have BPH as the only histological diagnosis after evaluation with serum PSA, trans-rectal ultrasound (TRUS) biopsy, and prostate volume measurement. PSA and prostate volume were statistically analyzed by age-stratified cohorts, including multiple regression analysis and assessment of correlation using the Pearson correlation coefficient (r). RESULTS: Mean PSA and prostate volume increased with each advancing cohort of age, and the correlation of PSA and prostate volume was determined to be statistically significant (P < 0.001) in each cohort with a correlation coefficient ranging from 0.33 to 0.41. CONCLUSIONS: We confirm that the relationship between PSA and prostate volume in a large series of patients with biopsy-proven BPH provides a comparable correlation to data for patients with LUTS and clinical BPH. As such, PSA represents a valuable approximation of prostate volume, and may prove to be clinically useful in the management of patients with BPH.     

Effects of age,sex steroids,and family relationships on volumes of prostate zones in men with and without prostate cancer

Benign prostatic hyperplasia (BPH) and prostate cancer commonly occur together. This suggests that common familial, hormonal, and environmental factors contribute to their development. In men at risk for the development of prostate cancer (at 40 men in 19 families) and aged-matched unrelated controls (n = 46), we have determined whether familial factors, age, and blood hormone concentrations are related to the transition zone (TZ), peripheral zone (PZ), or total volume of the prostate measured by transrectal ultrasound (TRUS). We determined that the influences of age, prostate cancer (n = 15), and familial status did not significantly affect the relationships reported. Therefore, data from all groups were combined for this study. TZ correlated positively with age (P = 0.003) after controlling for family status, but total prostate volume correlated insignificantly with age (P = 0.08). In addition, the ratio of TZ to PZ volumes also correlated significantly with age in the control group (r = 0.27, P = 0.014). Both TZ and PZ volumes correlated highly (r = 0.91, P < 0.0001, n = 86) with total volume. In addition, total volume correlated significantly (r = 0.71, P < 0.001) with the ratio of the TZ/PZ volumes, which also correlated significantly with each other (r = 0.61, P < 0.0001, n = 86). In contrast to the increase of TZ volume related to total prostate volume, PZ volume declined compared with total volume. Prostate volumes up to 50 ml are predominated by the PZ and above 50 ml by the TZ, which may compress and shrink the PZ. Both TZ and total prostate volume correlated positively with serum estrone concentrations (P = 0.04 and P = 0.003, respectively). These results suggest that the risk of prostate cancer does not contribute to generalized overgrowth of the prostate, including the TZ. However, estrogens and age strongly influence TZ but not PZ volume. Both PZ and TZ volumes rise together until the prostate exceeds 50 ml, when the growth of the TZ appears to exceed the PZ and then to compress it.