前列腺增大与性功能障碍的临床相关性

前列腺直肠指检可以为了解前列腺的生长状态和发现可疑的外周结节提供有用的信息。本实验的目的在于研究经直肠指检发现前列腺增大与性功能障碍（SD）的临床和生化相关性。对一组2379例患者进行回顾性分析。样本（n=1823；平均年龄为54．7±11．4岁）选自无明显前列腺疾病的人群。对几个指标进行了研究。经过校正后，经直肠指检发现的前列腺增大与代谢终合症（HR=1．346[1．129．1．759]；P=0．030）、二型糖尿病（HR=I．489[1．120．1．980]；P=0．006）、低密度脂蛋白胆固醇增高（〉100mgdl^-1；HR=1．354[1．018—1．801]；P=0．037）及平均血压增高（HR=1．017n．007．1．027]每增加1mmHg；P=0．001）的高发病存在相关性。因此，前列腺增大也与动脉性勃起功能障碍及其他的男科疾病的高发病相关，如精索静脉曲张和早泄。在前列腺增大的人群中PSA水平显著高于非前列腺增大的人群（HR=3-318[2．304；4．799]每增加1单位PSA；P〈0．0001）。根据不同标准，动脉性ED也与PSA水平升高相关。结论：我们的研究结果表明对于ED患者，进行前列腺大小的检查，包括临床（DRE）和生化（PSA）检查是必要的，以此能对患者的性功能障碍和代谢及心血管背景有全面的了解。

Clinical correlates of enlarged prostate size in subjects with sexual dysfunction

Digito-rectal examination （DRE） of the prostate provides useful information on the state of prostate growth and on the presence of suspected peripheral nodules. The aim of this study is to describe the clinical and biochemical correlates of finding an enlarged prostate size at DRE in subjects with sexual dysfunction （SD）. A consecutive series of 2379 patients was retrospectively studied. The analysis was focused on a subset of subjects （n = 1823; mean age 54.7± 11.4） selected for being free from overt prostatic diseases. Several parameters were investigated. After adjusting for confounders, the presence of an enlarged prostate size at DRE was associated with a higher risk of metabolic syndrome （HR = 1.346 （1,129-1.759）; P = 0.030）, type 2 diabetes mellitus （HR = 1.489 （1.120-1.980）; P = 0.006）, increased LDL cholesterol （〉100mgdl^-1; HR = 1.354 （1.018-1.801）; P = 0.037） and increased mean blood pressure （BP） values （HR = 1.017 （1.007-1.027） for each mmHg increment; P = 0.001）. Accordingly, enlarged prostate size was also associated with a higher risk of arteriogenic erectile dysfunction （ED）, as well as with other andrological conditions, such as varicocele and premature ejaculation （PE）. PSA levels were significantly higher in subjects with enlarged prostate size when compared to the rest of the sample （HR = 3.318 （2.304; 4.799） for each log unit increment in PSA levels; P 〈 0.0001）. Arteriogenic ED, according to different criteria, was also associated with increased PSA levels. In conclusion, our data support the need to examine prostate size either by clinical （DRE） or biochemical （PSA） inspection in subjects with SD, in order to have insights into the nature of the SD and the metabolic and cardiovascular （CV） background of the patient.