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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

王姊娟,  杜依青,  张建,  唐旭,  于路平,  张晓威,  刘士军,  徐涛

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文章导航 > 协和医学杂志  > 2020 >  11(6): 703-709
王姊娟, 杜依青, 张建, 唐旭, 于路平, 张晓威, 刘士军, 徐涛. 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[J]. 协和医学杂志, 2020, 11(6): 703-709. doi: 10.3969/j.issn.1674-9081.2020.06.012
引用本文: 王姊娟, 杜依青, 张建, 唐旭, 于路平, 张晓威, 刘士军, 徐涛. 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[J]. 协和医学杂志, 2020, 11(6): 703-709. doi: 10.3969/j.issn.1674-9081.2020.06.012
shu
WANG Zi-juan, DU Yi-qing, ZHANG Jian, TANG Xu, YU Lu-ping, ZHANG Xiao-wei, LIU Shi-jun, XU Tao. Correlation between Diagnostic Indicators of Metabolic Syndrome and Severe Benign Prostatic Hyperplasia[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(6): 703-709. doi: 10.3969/j.issn.1674-9081.2020.06.012
Citation: WANG Zi-juan, DU Yi-qing, ZHANG Jian, TANG Xu, YU Lu-ping, ZHANG Xiao-wei, LIU Shi-jun, XU Tao. Correlation between Diagnostic Indicators of Metabolic Syndrome and Severe Benign Prostatic Hyperplasia[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(6): 703-709. doi: 10.3969/j.issn.1674-9081.2020.06.012
shu

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

doi: 10.3969/j.issn.1674-9081.2020.06.012

  • 北京大学人民医院泌尿外科，北京 100044

基金项目: 

国家自然科学基金 81472393

北京市科技计划项目 z161100000116094

详细信息
    通讯作者:

    徐涛  电话：010-88325986，E-mail: xutao@medmail.com.cn

  • 中图分类号: R587.1;R697+.32

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

  • Department of Urology, Peking University People's Hospital, Beijing 100044, China

More Information

    摘要
  • 摘要:   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(rs=0.189，P=0.004)及APV(rs=0.164，P=0.014)均呈正相关; FBG≥5.6 mmol/L与TPV增大(rs=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。
    Abstract:   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 (rs=0.189, P=0.004) and APV(rs=0.164, P=0.014); FBG≥5.6 mmol/L was related to TPV (rs =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.
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  • 表  1  研究组与对照组患者临床资料比较

    指标 研究组(n=143) 对照组(n=166) t/Z/χ2值 P值
    一般资料
        年龄[M(P25, P75), 岁] 73(67, 77) 71(65, 76) -1.457 0.145
        身高[M(P25, P75), cm] 170(167, 173) 170(168, 173) 0.324 0.746
        体质量[M(P25, P75), kg] 72.00(67.00, 82.00) 66.50(60.00, 74.25) -5.348 ＜0.001
        BMI(x±s, kg/m2) 25.56±3.02 23.37±2.92 6.466 ＜0.001
        吸烟[n(%)] 42(29.37) 30(18.07) 5.487 0.019
        饮酒[n(%)] 23(16.08) 16(9.64) 2.894 0.089
    MetS诊断指标
        WC[M(P25, P75), cm] 95.00(90.00, 100.00) 89.00(86.00, 93.25) -8.148 ＜0.001
        收缩压[M(P25, P75), mm Hg] 134.00(121.00, 148.00) 125.50(120.00, 136.00) -3.958 ＜0.001
        舒张压[M(P25, P75), mm Hg] 80.00(73.00, 86.00) 77.00(71.75, 81.00) -2.916 ＜0.001
        FBG[M(P25, P75), mmol/L] 5.76(5.07, 6.40) 4.99(4.64, 5.37) -6.746 ＜0.001
        TG[M(P25, P75), mmol/L] 1.18(0.86, 1.90) 0.96(0.70, 1.31) -4.836 ＜0.001
        HDL-C[M(P25, P75), mmol/L] 0.88(0.79, 0.99) 1.13(0.94, 1.30) 7.812 ＜0.001
    MetS：代谢综合征; BMI：体质量指数; WC：腰围; FBG：空腹血糖; TG：甘油三酯; HDL-C：高密度脂蛋白胆固醇
    下载: 导出CSV

    表  2  MetS及其诊断指标是/否异常的BPH患者前列腺临床指标比较[M(P25, P75)]

    指标 年龄(岁) TPV(mL) APV(mL/年) IPSS-S(分) IPSS-V(分)
    血压升高
      是(n=186) 73(67, 77) 66.06(43.29, 90.66) 1.32(0.73, 2.53) 9.00(8.00, 12.00) 8.00(7.00, 9.00)
      否(n=123) 71(64, 76) 62.79(34.52, 95.40) 1.35(0.58, 2.56) 9.00(8.00, 12.00) 8.00(6.00, 8.00)
    P值 0.044 0.642 0.807 0.345 0.017
    FBG升高
      是(n=114) 74(67, 76) 76.25(44.97, 105.56) 1.69(0.71, 2.84) 9.00(8.00, 12.00) 8.00(7.00, 9.00)
      否(n=195) 71(65, 76) 60.84(36.56, 85.74) 1.23(0.68, 2.28) 9.00(8.00, 12.00) 8.00(6.00, 9.00)
      P值 0.256 0.044 0.170 0.779 0.647
    HDL-C降低
      是(n=176) 72(66, 76) 65.36(40.13, 94.70) 1.31(0.65, 2.53) 9.00(8.00, 12.00) 8.00(7.00, 9.00)
      否(n=133) 71(65, 76) 64.43(36.95, 89.07) 1.46(0.73, 2.54) 9.00(8.00, 12.00) 8.00(6.00, 9.00)
      P值 0.350 0.954 0.697 0.478 0.239
    TG升高
      是(n=60) 71(64, 76) 75.27(47.90, 106.33) 1.75(0.84, 3.07) 9.00(8.00, 12.75) 8.00(6.25, 9.00)
      否(n=249) 73(66, 76) 63.14(36.56, 90.53) 1.23(0.65, 2.44) 9.00(8.00, 12.00) 8.00(7.00, 9.00)
      P值 0.216 0.193 0.160 0.783 0.773
    WC增加
      是(n=191) 72(65, 77) 65.64(39.37, 95.99) 1.32(0.67, 2.68) 9.00(8.00, 12.00) 8.00(7.00, 9.00)
      否(n=118) 72(66, 76) 63.98(37.38, 87.06) 1.32(0.70, 2.36) 9.00(8.00, 12.00) 8.00(6.00, 8.00)
      P值 0.555 0.512 0.570 0.402 0.098
    确诊MetS
      是(n=143) 73(67, 77) 66.30(44.02, 97.57) 1.55(0.70, 2.70) 9.00(8.00, 13.00) 8.00(7.00, 9.00)
      否(n=166) 71(65, 76) 61.62(36.66, 86.38) 1.26(0.68, 2.34) 9.00(8.00, 12.00) 8.00(6.75, 9.00)
      P值 0.145 0.337 0.586 0.615 0.174
    指标 IPSS-T(分) QoL(分) Qmax(mL/s) PRV(mL) PSA(ng/mL)
    血压升高
      是(n=186) 20.00(18.00, 24.00) 4.00(3.00, 5.00) 6.00(3.83, 8.00) 64.00(14.00, 149.00) 5.36(2.52, 9.01)
      否(n=123) 20.00(18.00, 22.00) 4.00(3.00, 5.00) 5.85(3.78, 7.65) 65.00(18.00, 119.50) 5.06(2.16, 8.76)
    P值 0.052 0.420 0.842 0.918 0.587
    FBG升高
      是(n=114) 20.00(18.00, 24.00) 4.00(3.00, 5.00) 6.20(4.03, 8.08) 50.00(14.50, 170.50) 4.98(1.94, 9.06)
      否(n=195) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 5.65(3.68, 7.63) 66.00(14.00, 135.00) 5.25(2.56, 8.50)
      P值 0.962 0.180 0.416 0.949 0.700
    HDL-C降低
      是(n=176) 20.00(18.25, 23.00) 4.00(3.00, 5.00) 5.90(3.70, 8.00) 64.00(18.00, 140.50) 5.16(2.73, 9.06)
      否(n=133) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 6.00(3.80, 7.80) 64.50(14.00, 152.25) 5.06(2.31, 8.50)
      P值 0.328 0.424 0.878 0.775 0.655
    TG升高
      是(n=60) 20.00(18.00, 24.00) 4.00(3.25, 5.00) 5.80(3.70, 8.80) 49.00(1.50, 133.00) 4.67(3.15, 8.20)
      否(n=249) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 6.00(3.80, 7.75) 65.00(18.50, 147.00) 5.41(2.38, 9.06)
      P值 0.644 0.337 0.781 0.234 0.308
    WC增加
      是(n=191) 20.00(18.00, 24.00) 4.00(3.00, 5.00) 6.00(3.80, 7.88) 67.00(16.50, 155.00) 5.16(2.91, 8.92)
      否(n=118) 20.00(18.00, 23.00) 4.00(3.00, 4.00) 5.90(3.83, 8.00) 53.00(13.00, 130.25) 5.06(2.18, 8.70)
      P值 0.231 0.051 0.859 0.318 0.369
    确诊MetS
      是(n=143) 20.00(18.00, 24.00) 4.00(3.00, 5.00) 6.10(4.10, 8.08) 60.00(14.50, 147.50) 5.16(2.71, 8.94)
      否(n=166) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 5.65(3.68, 7.73) 65.00(14.00, 138.00) 5.10(2.30, 8.78)
      P值 0.254 0.352 0.441 0.750 0.983
    BPH:良性前列腺增生症; TPV：前列腺体积; LUTS：下尿路症状; APV：年前列腺生长量; IPSS：国际前列腺症状评分; IPSS-S：IPSS储尿期症状; IPSS-V：IPSS排尿期症状; IPSS-T：IPSS总分; QoL：生活质量评分; Qmax：最大尿流率; PRV：残余尿量; PSA：前列腺特异性抗原; MetS、BMI、WC、FBG、TG、HDL-C：同表 1
    下载: 导出CSV

    表  3  有/无糖尿病史及FBG控制不佳的BPH患者前列腺临床指标比较[M(P25, P75)]

    指标 年龄(岁) TPV(mL) APV(mL/年) IPSS-S(分) IPSS-V(分) IPSS-T(分) QoL(分) Qmax(mL/s) PRV(mL) PSA(ng/mL)
    糖尿病史
      有(n=34) 74(68, 76) 51.43(31.70, 95.85) 0.96(0.45, 2.22) 9.00(7.00, 12.25) 8.00(6.00, 9.00) 20.00(16.00, 25.00) 4.00(4.00, 5.00) 6.20(4.20, 8.63) 50.00(15.00, 190.00) 4.23(1.70, 6.60)
      无(n=275) 72(65, 76) 66.10(41.13, 90.72) 1.44(0.71, 2.68) 9.00(8.00, 12.00) 8.00(7.00, 9.00) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 5.95(3.70, 7.93) 64.50(14.00, 138.00) 5.25(2.45, 9.01)
      P值 0.213 0.374 0.187 0.832 0.530 0.898 0.189 0.418 0.700 0.153
    FBG≥5.6 mmol/L
      是(n=101) 73(67, 76) 78.36(45.93, 109.59) 1.75(0.78, 3.07) 9.00(8.00, 12.00) 8.00(7.00, 9.00) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 6.40(3.90, 8.10) 50.00(14.25, 157.50) 5.05(1.94, 9.06)
      否(n=208) 71(65, 76) 58.95(36.31, 85.01) 1.21(0.65, 2.28) 9.00(8.00, 12.00) 8.00(6.00, 9.00) 20.00(18.00, 23.00) 4.00(3.00, 5.00) 5.60(3.80, 7.60) 67.00(14.00, 138.00) 5.15(2.53, 8.50)
      P值 0.480 0.009 0.052 0.745 0.622 0.848 0.275 0.382 0.814 0.804
    FBG≥5.6 mmol/L
      有糖尿病史(n=21) 72(68, 77) 59.20(32.21, 96.74) 1.07(0.45, 2.28) 9.00(7.50, 12.50) 8.00(6.50, 8.50) 20.00(17.50, 25.00) 4.00(4.00, 5.00) 7.00(4.10, 8.90) 42.50(12.75, 187.00) 4.40(1.57, 6.53)
      无糖尿病史(n=80) 74(64, 76) 80.25(52.56, 121.53) 1.83(0.90, 3.38) 9.00(8.00, 12.00) 8.00(7.00, 9.00) 20.00(18.00, 22.75) 4.00(3.00, 5.00) 6.20(3.75, 8.08) 52.00(14.00, 150.50) 5.23(2.29, 9.39)
      P值 0.718 0.264 0.143 0.833 0.296 0.987 0.477 0.514 0.951 0.141
    TPV、LUTS、APV、IPSS、IPSS-S、IPSS-V、IPSS-T、QoL、Qmax、PRV、PSA：同表 2; FBG：同表 1
    下载: 导出CSV
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  • 收稿日期:  2019-05-17
  • 录用日期:  2020-06-22
  • 刊出日期:  2020-11-30

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