2023 年第 9 期 第 18 卷

中老年良性前列腺增生患者临床进展的危险因素研究

Risk factors for clinical progression of benign prostatic hyperplasia in the middle-aged and elderly patients

作者：逄瑷博张春燕凌存保黄薇田亚平

英文作者：Pang Aibo Zhang Chunyan Ling Cunbao Huang Wei Tian Yaping

单位：中国人民解放军总医院医学创新研究部出生缺陷防控技术研究中心,北京100853

英文单位：Birth Defects Prevention and Control Technology Research Center Department of Medical Innovation Research Chinese PLA General Hospital Beijing 100853 China

关键词：良性前列腺增生；血清炎性标志物；肾功能损伤

英文关键词：Benignprostatichyperplasia;Seruminflammatorymarkers;Renalfunctiondamage

• 摘要：

• 目的  探讨中老年良性前列腺增生（BPH）临床进展的危险因素。方法 选取2021年4月至2022年2月解放军总医院医学创新研究部出生缺陷防控技术研究中心社区巡诊中的中老年BPH患者150例，以BPH临床进展主要危险因素为分组标准，年龄≥62 岁、血清总前列腺特异性抗原（PSA）≥1.6 μg/L、前列腺总体积（TPV）≥31 ml患者纳入高进展风险组（37例），其余纳入低进展风险组（113例）。比较2组患者的临床资料。采用二元Logistic回归方法分析BPH临床进展的独立危险因素。结果 低进展风险组与高进展风险组在体重指数、吸烟史、饮酒史比例、残余尿量、血清淀粉样蛋白A、C反应蛋白、降钙素原、纤维蛋白原降解产物、脂蛋白相关磷脂酶A2、尿糖、尿蛋白、尿中性粒细胞明胶酶相关脂钙素、尿视黄醇结合蛋白、尿胱抑素C水平比较，差异均无统计学意义（均P＞0.05）。高进展风险组年龄、国际前列腺症状评分（IPSS）、TPV、血清总PSA、尿微量白蛋白/尿肌酐比值均大于/高于低进展风险组［72(67,80)岁比66(61,73)岁,10(5,15)分比7(3,13)分,47.1(34.1,60.7)ml比28.4(25.1,37.0)ml,3.42(2.45,5.41)μg/L比1.01(0.67,1.48)μg/L,16.97(7.71,53.05)mg/g比8.79(4.44,18.02)mg/g］，最大尿流率低于低进展风险组［7.8(5.9,12.3)ml/s比12.7(8.0,17.7)ml/s］，差异均有统计学意义（均P＜0.05）。二元Logistic回归分析结果显示血清总PSA和TPV是 BPH临床进展的独立危险因素（均P＜0.05）。结论 年龄、IPSS、最大尿流率、TPV、血清总PSA、尿微量白蛋白/尿肌酐比值是BPH临床进展的主要预警因素；血清总PSA、TPV是BPH临床进展的独立危险因素。

• Objective To investigate the risk factors for clinical progression of benign prostatic hyperplasia (BPH) in the middle-aged and elderly patients. Methods From April 2021 to February 2022, 150 elderly patients with BPH were selected in the community visits of the Birth Defects Prevention and Control Technology Research Center, Department of Medical Innovation Research, Chinese PLA General Hospital. Based on the main risk factors for clinical progression of BPH, patients with age≥62 years, serum total prostate specific antigen (PSA)≥1.6 μg/L, and total prostate volume (TPV)≥31 ml were included in the high progression risk group (37 cases), and the rest were included in the low progression risk group (113 cases). The clinical data of the two groups were compared, and binary Logistic regression was used to analyze independent risk factors for clinical progression of BPH. Results There were no significant differences between the low progression risk group and the high progression risk group in body mass index, proportion of smoking history, alcohol consumption history, residual urine volume, levels of serum amyloid A, C-reactive protein, calcitonin, fibrinogen degradation products, lipoprotein related phospholipase A2, urine sugar, urine protein, urinary neutrophil gelatinase related lipocalcin, urinary retinol binding protein and urinary cystatin C （all P＞0.05）. The age, international prostate symptom score (IPSS), TPV, serum total PSA and the ratio of urine microalbumin/urine creatinine in the high progression risk group were higher than those in the low progression risk group ［72(67,80)years vs 66(61,73)years, 10(5,15)points vs 7(3,13)points, 47.1(34.1,60.7)ml vs 28.4(25.1,37.0)ml, 3.42(2.45,5.41)μg/L vs 1.01(0.67,1.48)μg/L, 16.97(7.71,53.05)mg/g vs 8.79(4.44,18.02)mg/g］, and the maximum urinary flow rate in the high progression risk group was lower than that in the low progression risk group ［7.8(5.9,12.3)ml/s vs 12.7(8.0,17.7)ml/s］(all P＜0.05). Binary logistic regression analysis showed that serum total PSA and TPV were independent risk factors for clinical progression of BPH(both P＜0.05). Conclusions  Age, IPSS, maximum urinary flow rate, TPV, serum total PSA, and the ratio of urine microalbumin/urine creatinine are the main warning factors for the clinical progression of BPH, and serum total PSA and TPV are independent risk factors for clinical progression of BPH.