良性前列腺增生致膀胱出口梗阻的超声弹性特征研究

发布时间：2018-06-16 06:03

本文选题：良性前列腺增生 + 膀胱出口梗阻　；参考：《中国人民解放军医学院》2014年博士论文

【摘要】：目的 1、研究犬前列腺组织弹性在BPH发展过程中的变化以及其与BOO严重程度的相关性；探讨犬前列腺组织弹性在BPH发展过程中变化的组织病理学基础。 2、探讨正常人和BPH病人前列腺移行区和周围区的弹性模量差异；BPH病人前列腺移行区和周围区弹性模量与BOO严重程度的相关性。材料与方法 1、动物实验（1）雄性比格犬10只，通过去势手术、前列腺周围包绕两层尼龙网膜及雌雄激素联合应用3个月的方法建立犬BPH致BOO动物模型。在激素给予前、激素给予后1、2、3个月时，分别行经直肠前列腺超声检查和尿动力检查。比较前列腺体积、前列腺组织弹性模量及尿动力各指标在不同时间点的差异性，评价前列腺组织弹性模量与尿动力各指标的相关性。（2）雄性比格犬24只，随机分为4组，每组6只，通过去势手术及雌雄激素联合应用3个月的方法建立犬BPH动物模型。在激素给予前、激素给予后1、2、3个月时行经直肠前列腺超声检查后分别处死1组动物，取病理。行HE染色、Masson染色、网状纤维染色和平滑肌免疫组化，观察各种病理组织成分的变化，及其含量与前列腺组织弹性模量的相关性。 2、临床实验（1）对221名正常健康人和BPH病人进行TRUS和SWE检查，测量前列腺重量、移行区和周围区弹性模量，比较不同年龄和前列腺重量组移行区和周围区平均弹性模量差异，以及其与年龄、前列腺重量的相关性。（2）对52例BPH病人进行IPSS，QOL评分后，行TRUS检查，测量计算得出TPV、TZV、TZI，之后行SWE检查测量前列腺移行区和周围区弹性模量，最终以尿动力学检查作为诊断BOO金标准。对比不同BOO分组各指标的差异，评价其与BOO严重程度的相关性。通过ROC曲线下面积评估各个参数诊断BOO的诊断价值。结果 1、动物实验（1）激素给予前后前列腺体积、前列腺组织弹性模量差异均有统计学意义（P均0.01）。手术前与手术后2周激素给予前尿动力各指标均无统计学差异（P均＞0.05）。激素给予前后尿动力各指标的差异均有统计学意义（P均0.01）。前列腺组织平均弹性模量与尿动力各指标均具有相关性，其中与Qmax （r=-0.802, P0.01）和Pdet@Qmax（r=0.757, P 0.01）相关性最高。（2）前列腺体积、前列腺组织弹性模量在激素给予前后均有显著差异（P0.01）。前列腺上皮细胞高度和腺腔面积随着前列腺增生发展逐渐增加，具有统计学差异（P均0.01）。不同时间点前列腺腺体面积比、腺体/间质逐渐增加，而间质、胶原纤维、网状纤维和平滑肌组织面积比逐渐下降，均具有统计学差异（P均0.01）。而随着激素给予前列腺腺体、间质、胶原纤维、网状纤维和平滑肌组织总含量均逐渐增加（P均0.01），并与前列腺组织弹性模量具有相关性，其中腺体含量与前列腺组织弹性模量相关性最高（r=0.958, P 0.01）。 2、临床实验（1）不同年龄组、前列腺重量组前列腺移行区、周围区弹性模量之间均具有统计学差异（P均0.01）。除年轻外（P0.05），各组前列腺移行区均高于周围区，具有统计学差异（P均0.05）。前列腺移行区弹性模量与年龄（rage=0.715,P0.01）、增生程度(rweight=0.673, P0.01）具有明显相关性。（2）TPV、TZV、TZI、IPSS和前列腺移行区弹性模量在不同BOO分组均具有统计学差异（P均0.05），并且与BOO分级具有相关性。其中前列腺移行区弹性模量与BOO分级相关性最高（r=0.717, P0.01）,其诊断BOO曲线下面积最高，为0.813（95%CI0.697～0.928）。当移行区杨氏模量界值为32.41kPa时，诊断BOO的敏感性，，特异性分别为65.0%和91.7%。结论 1、随着BPH的发展，犬前列腺组织的弹性模量逐渐增高，并与BOO严重程度具有明显相关性；犬前列腺组织弹性模量增高与腺体含量相关性最高。 2、随年龄、前列腺增生程度的发展，前列腺移行区弹性模量增加明显，与年龄、前列腺增生程度具有相关性；前列腺移行区弹性模量与BOO分级相关性最高，可作为评价BPH致BOO病人的一种无创方法。
[Abstract]:Purpose

1 . To study the changes of canine prostate tissue elasticity in the development of BPH and its correlation with the severity of BPH ;
Objective To investigate the histopathological findings of canine prostate tissue elasticity during the development of BPH .

2 . To investigate the difference of elastic modulus between normal and BPH patients .
Correlation of elastic modulus of prostate migration area and peripheral area of BPH in patients with BPH .

Materials and Methods

1 . Animal experiment

( 1 ) Animal model of canine BPH was established in 10 male Beagle dogs by castration procedure , periprostatic wrapping around two layers of nylon mesh membrane and female androgenic hormone . At 1 , 2 and 3 months after the administration of the hormone , the prostatic volume , the elastic modulus of the prostate tissue and the difference of various indexes of the urinary dynamic indexes were compared , and the correlation between the elastic modulus of the prostate tissue and the indexes of the urinary dynamic indexes was evaluated .

( 2 ) 24 male Beagle dogs were randomly divided into 4 groups randomly divided into 4 groups ( 6 rats in each group ) . 1 group of animals were sacrificed 1 , 2 and 3 months after the hormone administration , 1 group of animals were sacrificed and pathology was taken . HE staining was performed , and the changes of various pathological tissue components were observed , and the correlation between the contents of pathological tissues and the elastic modulus of prostate tissue was observed .

2 . Clinical trials

( 1 ) TRUS and SWE examinations were performed on 221 normal healthy persons and BPH patients to measure the weight of prostate , the migration area and the elastic modulus of the surrounding area , compare the difference of the average elastic modulus between the migration area and the surrounding area of different ages and prostate weight groups , and their correlation with age and prostate weight .

( 2 ) After IPSS and QOL were scored in 52 BPH patients , TRUS examination and measurement were carried out to obtain TPV , TPV , TZI , followed by SWE examination to measure the elastic modulus of the prostate transitional zone and the surrounding area , and finally , the correlation between the indexes of different kinds of patients was evaluated .

Results

1 . Animal experiment

There was no statistical difference ( P > 0.05 ) between the two weeks before and after surgery ( P > 0.05 ) . The average elastic modulus of prostate tissue was correlated with the indexes of urinary dynamics ( r = - 0.802 , P0.01 ) and Pdet @ Qmax ( r = 0.757 , P 0.01 ) .

( 2 ) There was a significant difference between the prostate gland volume and the prostate tissue ' s modulus of elasticity before and after the administration of the hormone ( P0.01 ) . The height of the prostate epithelial cells and the area of the glandular cavity increased gradually with the development of the prostatic hyperplasia ( P0.01 ) .

2 . Clinical trials

( 1 ) There was statistical difference between the elastic modulus of the prostate and the surrounding area in different age groups ( P < 0.01 ) . There was statistical difference ( P < 0.05 ) . The elastic modulus and age of the prostate transitional zone were significantly correlated with age ( rage = 0.715 , P0.01 ) , and the degree of hyperplasia ( rweight = 0.673 , P0.01 ) .

( 2 ) The elastic modulus of TPV , TZI , IPSS and prostate transitional zone had statistical difference ( P < 0 . 05 ) .

Conclusion

1 . With the development of BPH , the elastic modulus of canine prostate tissue was gradually increased , and it had a significant correlation with the severity of BPH ;
The increase of the elastic modulus of prostate tissue was the highest in canine prostate tissue .

2 . With the development of age and prostatic hyperplasia , the elastic modulus of the prostate transitional region increased obviously , which was related to age and prostatic hyperplasia .
The highest correlation between the elastic modulus of the prostate transitional zone and the bladder ' s classification can be used as a non - invasive method to evaluate the patients with BPH .
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R697.3;R445.1

【参考文献】