代谢综合征及其诊断指标与重度良性前列腺增生症的相关性研究

  目的  综合分析代谢综合征(metabolic syndrome, MetS)及其诊断指标与重度良性前列腺增生症(benign prostatic hyperplasia, BPH)患者前列腺体积(total prostate volume, TPV)及年前列腺生长量(annual prostate growth volume, APV)、下尿路症状(lower urinary tract symptoms, LUTS)、尿动力学指标、前列腺特异性抗原(prostate specific antigen, PSA)的相关性。  方法  回顾性收集并分析2013年9月至2018年6月于北京大学人民医院确诊且行手术治疗的重度BPH患者的临床资料。根据是否合并MetS，将纳入的BPH患者分为BPH合并MetS组(研究组)、BPH未合并MetS组(对照组)。比较是/否合并MetS及不同MetS诊断指标的BPH患者前列腺临床指标的差异。采用Spearman相关性分析及多元线性回归分析MetS及其诊断指标与BPH患者TPV及APV、LUTS、尿动力学指标、PSA 4个方面的相关性。  结果  共309例符合纳入和排除标准的BPH患者入选本研究，其中研究组143例(46.28%)，对照组166例(53.72%)。研究组吸烟比率及体质量、体质量指数、收缩压、舒张压、空腹血糖(fasting blood glucose, FBG)、甘油三酯明显高于对照组(P均＜0.001)，腰围长于对照组(P＜0.001)，高密度脂蛋白胆固醇明显低于对照组(P＜0.001)，两组年龄、身高、饮酒比率差异无统计学意义(P均＞0.05)。FBG升高的BPH患者TPV大于FBG未升高者(P＜0.05)。Spearman相关性分析显示，FBG与TPV(r_s=0.189，P=0.004)及APV(r_s=0.164，P=0.014)均呈正相关; FBG≥5.6 mmol/L与TPV增大(r_s=0.174，P=0.009)相关，有/无糖尿病史及其余MetS诊断指标变化与BPH临床指标均无线性相关。多元线性回归分析显示，FBG对TPV(β=0.143，P=0.032)及APV(β=0.136，P=0.043)有显著性影响，其余MetS诊断指标对BPH临床指标均无显著性影响。  结论  在手术治疗的重度BPH患者中，BPH合并MetS较常见。FBG升高可能与BPH患者TPV、APV增大有关，暂未发现是/否合并MetS及其余MetS诊断指标变化与BPH临床指标具有相关性。

Correlation between Diagnostic Indicators of Metabolic Syndrome and Severe Benign Prostatic Hyperplasia

  Objective  To investigate the correlation of metabolic syndrome (MetS) and its diagnostic indicators with the total prostate volume (TPV), annual prostate growth volume(APV), lower urinary tract symptoms (LUTS), urodynamic parameters, and prostate specific antigen (PSA) in patients with severe benign prostatic hyperplasia (BPH).  Methods  The medical records of patients with severe BPH diagnosed and treated surgically in the urology department of Peking University People's Hospital from September 2013 to June 2018 were retrospectively reviewed. The patients were divided into two groups according to whether they were complicated with MetS. Compare the differences of prostate-related indicators in BPH patients with or without MetS and different diagnostic indicators. Then Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlation of MetS and its diagnostic indicators with prostate-related factors.  Results  A total of 309 BPH patients who met the inclusion and exclusion criteria were selected for this study. Among them, 143 cases (46.28%) were in the group of BPH with MetS, and 166 cases (53.72%) in the group of BPH without MetS. The smoking rate, body mass, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG) and triglyceride of the group of BPH with MetS were significantly higher than those of the group of BPH without MetS (all P < 0.001); the waist circumference (WC) of the group of BPH with MetS was longer than that of the group of BPH without MetS (P < 0.001). In the group of BPH with MetS, high-density lipoprotein cholesterol (HDL-C) was significantly lower than that of the group of BPH without MetS(P < 0.001). There was no statistically significant difference in age, height, and drinking rate between the two groups (P > 0.05). The TPV of BPH patients with elevated FBG was greater than that of those without elevated FBG (P < 0.05). Spearman correlation analysis showed that FBG was positively correlated with TPV (r_s=0.189, P=0.004) and APV(r_s=0.164, P=0.014); FBG≥5.6 mmol/L was related to TPV (r_s =0.174, P=0.009); history of diabetes and the rest of MetS diagnostic indicators were not related to prostate-related factors. Multiple linear regression analysis showed that FBG had a significant effect on TPV (β=0.143, P=0.032) and APV (β=0.136, P=0.043), and the rest of MetS diagnostic indicators had no significant effects on all prostate-related factors.  Conclusions  In patients with severe BPH requiring surgery, BPH complicated with MetS was common. Elevated FBG might be related to the increase of TPV and APV in patients with BPH. It has not been discovered other diagnostic indicators of MetS were correlated with prostate-related factors.