血糖与良性前列腺增生症的相关性研究

发布时间：2018-05-12 16:37

本文选题：良性前列腺增生症 + 血糖　；参考：《山东大学》2017年硕士论文

【摘要】：目的:良性前列腺增生症(benign prostatic hyperplasia,BPH)是泌尿系统常见疾病,多发于中老年男性患者。糖尿病(DiabetesMellitus,DM)是一组以长期高血糖为主要特征的代谢综合征,由于胰岛素缺乏和/或胰岛素作用障碍导致以血中葡萄糖水平升高为特征的代谢紊乱疾病群。近年来,随着人们生活水平的提高,人群寿命明显延长,许多增龄性疾病,比如高血压、糖尿病、肥胖性疾病等的发病率也逐年升高,BPH发病率同样是随着年龄的增长而升高。本研究对良性前列腺增生症(BPH)患者和BPH合并糖尿病的患者进行相关性研究,已有研究表明血糖代谢紊乱是与老年男性患者的BPH发病有一定关系,但样本量较小。本研究通过回顾性分析我院查体中心BPH患者的临床情况,旨在分析各指标与BPH的相关性,为临床诊断、干预提供依据。方法:回顾性分析山东省立医院体检中心,年龄50岁的1500例男性的临床资料,检测其相关指标,研究前列腺体积与各指标的相关性,分析影响良性前列腺增生症病情进展的相关因素。采用自制的调查问卷,详细记录所有研究对象的年龄等一般资料。采用CX7型全自动生化分析仪检测空腹血糖。计算体重指数(BMI),受试者裸足,仅穿贴身内衣后测量其身高(m)、体重(kg),BMI=体重(kg)/身高2(m2)。用经腹B超测定前列腺体积(V),前列腺前后径、左右径、上下径,计算公式为:V(cm3)= 0.52*(左右径)×(前后径)×(上下径)(cm)。对入选的730例BPH患者的血糖等代谢性指标(FBG、2hPBG、HbAlc、FINS、HOMA-IR)与BPH评价指标:如前列腺体积、血清前列腺特异性抗原(Prostate Specific Antigen,PSA)、国际前列腺症状评分(International Prostate Symptom Score,IPSS)、BPH病程时间等进行统计。按照BPH和DM的诊断标准,将730例BPH患者分为单纯BPH组(n=330)与BPH合并DM组(n=400),并根据患者的FBG、2hPBG、HbAlc、FINS、HOMA-IR水平进行分组,分析血糖等指标对BPH进展的影响。统计学处理数据采用SPSS20.0进行统计分析,计量资料以(x±s)表示,采用t检验;计数资料采用χ2检验,变量之间采用多元回归分析,P0.05具有统计学意义。结果:1.前列腺体积与年龄、体重指数、收缩压、血糖水平存在显著的正相关(P0.05);与身高、体重、舒张压、血脂等无明显相关性(P0.05);良性前列腺增生患者BMI、FBG、HBAlc水平均较非良性前列腺增生患者显著升高(P0.05)。2.单纯 BPH 组 PV39.24±16.65 ml,BPH 合并 DM 组 PV53.35±14.26ml,BPH合并DM组PV显著高于单纯BPH组PV,有统计学差异(t=5.381,P0.005);BPH 合并 DM 组 PSA 3.46±1.12 ng/ml,单纯 BPH 组 PSA 1.88±0.98 ng/ml,BPH合并DM组PSA显著高于单纯BPH组PSA,有统计学差异(t=4.830,P=0.013);BPH 合并 DM 组 IPSS 13.12±4.25 分,单纯 BPH 组 IPSS 8.87±2.67 分,BPH 合并DM组IPSS显著高于单纯BPH组IPSS,有统计学差异(t=3.792,P=0.010);单纯 BPH 组 BPH 病程 12.79±3.672 年,BPH 合并 DM 组 BPH 病程 13.62±3.896年,BPH合并DM组虽然高于单纯BPH组,但无统计学差异(t=0.854,P=0.437)。3.空腹血糖的水平是按照7mmol/L进行判定。空腹血糖正常(7.0mmol/L)BPH 组 PV40.79±13.87 ml,空腹血糖异常(≥7.0mmol/L)BPH 组 PV55.27±17.69ml,空腹血糖异常BPH组PV显著高于空腹血糖正常BPH组PV,有统计学差异(t=4.465,P=0.002);空腹血糖正常 BPH 组 PSA2.04±1.65ng/ml,空腹血糖异常BPH组PSA3.35±2.87 ng/ml,空腹血糖异常BPH组PSA显著高于空腹血糖正常BPH组PSA,有统计学差异(t=3.674,P=0.006);空腹血糖正常BPH组IPSS 8.78±3.76分,空腹血糖异常BPH组IPSS 12.46±5.27分,空腹血糖异常BPH组IPSS显著高于空腹血糖正常BPH组IPSS,有统计学差异(t=5.643,P=0.010);空腹血糖正常BPH组BPH病程12.65±3.58年,空腹血糖异常BPH组BPH病程13.68±3.77年,空腹血糖异常BPH组病程虽然高于空腹血糖正常BPH组病程,但无统计学差异(t=0.867,P=0.368)。4.HbAlc的判定是根据2009年ADA指南中关于糖化血红蛋白(HbAlc)的理想水平(7%)进行的,分为正常组与异常组。HbAlc异常BPH组PV53.79±17.34 ml,HbAlc 正常 BPH 组 PV41.57±11.41 ml,有统计学差异(t=4.465,P=0.002);HbAlc异常BPH组与HbAlc正常BPH组患者的PSA、IPSS、BPH病程时间没有显著性差异(t=0.843,P=0.517)。5.高胰岛素血症(HINS)的评定是根据FINS15mU/L。HINS异常BPH组PV56.57±26.75 ml,INS 正常 BPH 组 PV44.79±17.54 ml,有统计学差异(t=3.774,P=0.017);HINS 异常 BPH 组 BPH 病程 18.12±5.76 年,INS 正常 BPH 组 BPH病程13.88±4.65年,有统计学差异(t=3.825,P=0.031),两组患者的PSA与IPSS评分无统计学差异(P0.05)。6.根据HOMA-IR2.8作为胰岛素抵抗的标准。HOMA-IR的计算公式为血糖(mmol/L)*血清胰岛素(mIU/L)/22.5。胰岛素抵抗BPH组患者的PV54.68±16.77ml,胰岛素敏感BPH组PV41.35±12.67 ml,两组有统计学差异(t=4.327,P=0.004);胰岛素抵抗BPH组患者的BPH病程16.79±4.43年,胰岛素敏感BPH组BPH病程12.78±3.76年,两组有统计学差异(t=4.367,P=0.036);两组患者的PSA及IPSS水平比较,无统计学差异(P0.05)。结论:1.年龄、体重指数、收缩压、血糖水平与前列腺体积的变化密切相关,BMI、FBG、HBA1c可能是前列腺增生患者病情发展的重要危险因素。2.对BPH病人常规筛查BG,并针对合并DM患者积极采取措施,可能会延缓BPH的发展。
[Abstract]:Objective: benign prostatic hyperplasia (BPH) is a common disease of the urinary system and frequently occurs in middle-aged and old male patients. Diabetes (DiabetesMellitus, DM) is a group of metabolic syndrome characterized by long-term hyperglycemia, which is caused by insulin deficiency and / or insulin resistance to the level of glucose in the blood. In recent years, with the improvement of people's living standards, the life expectancy of the population has been obviously prolonged, and the incidence of many aging diseases, such as hypertension, diabetes, and obesity, is also increasing year by year. The incidence of BPH is also increased with the increase of age. This study has been applied to patients with benign prostatic hyperplasia (BPH). The correlation study between the patients with BPH and diabetes has been studied. The study shows that the disorder of blood glucose metabolism is related to the incidence of BPH in the elderly male patients, but the sample size is small. This study aims to analyze the clinical situation of the BPH patients in the center of our hospital, and to analyze the correlation between the indexes and the BPH. Methods: a retrospective analysis of the clinical data of 1500 men aged 50 years in the medical center of Shangdong Province-owned Hospital, the correlation of the prostate volume and the indexes, and the related factors affecting the progression of benign prostatic hyperplasia were analyzed. The questionnaire was used to record all the subjects in detail. General data of age and so on. A CX7 automatic biochemical analyzer was used to measure the fasting blood glucose. The body weight index (BMI) was calculated. The subjects were bare feet, and the body height (m), weight (kg), BMI= weight (kg) / height 2 (M2) were measured after wearing only body underwear. The prostate gland accumulation (V) was measured by abdominal B-ultrasound, the diameter of the prostate, the left and right diameter, and the upper and lower diameters were calculated as V (cm3) = 0.5. 2* (left and right diameter) * (anteroposterior diameter) * (CM). Metabolic indices such as blood glucose, such as FBG, 2hPBG, HbAlc, FINS, HOMA-IR, and BPH in 730 patients with BPH were evaluated, such as the volume of the prostate, the serum prostate specific antigen (Prostate Specific Antigen), and the international prostate symptom score, According to the diagnostic criteria of BPH and DM, 730 cases of BPH patients were divided into simple BPH group (n=330) and BPH combined DM group (n=400). According to the patients' FBG, 2hPBG, HbAlc, and the levels were grouped to analyze the effect of blood sugar and other indexes on the progress. Statistical analysis and measurement data were used for statistical analysis and measurement. The data were indicated by (x + s), using t test, the count data were tested by chi 2, multivariate regression analysis was used between variables, and P0.05 had statistical significance. Results: 1. the volume of prostate had significant positive correlation with age, body mass index, systolic blood pressure and blood glucose level (P0.05); there was no significant correlation with height, weight, diastolic pressure and blood lipid (P0.05); BMI, FBG and HBAlc water in patients with benign prostatic hyperplasia were significantly higher than those of non benign prostatic hyperplasia (P0.05).2. simple BPH group PV39.24 + 16.65 ml, BPH combined DM group PV53.35 14.26ml. SA 1.88 + 0.98 ng/ml, BPH combined with DM group PSA was significantly higher than pure BPH group PSA, statistically significant (t=4.830, P=0.013), BPH combined DM group IPSS 13.12 + 4.25, simple group 8.87 + 2.67 points, statistically significant difference (3.792, 12.79). The course of BPH in BPH combined with DM group was 13.62 + 3.896 years, while the BPH combined DM group was higher than that of the simple BPH group, but there was no statistical difference (t=0.854, P=0.437) the level of.3. fasting blood glucose was determined according to 7mmol/L. The blood glucose abnormal BPH group PV was significantly higher than the normal BPH group PV in the fasting blood glucose (t=4.465, P=0.002); the normal BPH group of the fasting blood glucose was PSA2.04 + 1.65ng/ml, the fasting blood glucose abnormal BPH group PSA3.35 + 2.87 ng/ml, the fasting blood glucose abnormal group was significantly higher than that of the fasting blood glucose group. The IPSS in the normal BPH group was 8.78 + 3.76, the abnormal BPH group of fasting blood glucose was IPSS 12.46 + 5.27, and the IPSS in the fasting glucose abnormal BPH group was significantly higher than the normal BPH group IPSS in the fasting blood glucose (t=5.643, P=0.010), and the BPH course of the fasting glucose normal BPH group was 12.65 + 3.58 years, the fasting blood glucose abnormal course was 13.68 + 3.77 years, and the fasting blood glucose was abnormal Although the course of disease in group H was higher than that of the normal BPH group, there was no statistical difference (t=0.867, P=0.368).4.HbAlc was determined according to the ideal level of glycosylated hemoglobin (HbAlc) in the 2009 ADA Guide (7%), divided into PV53.79 + 17.34 ml in the normal group and the abnormal group of.HbAlc abnormal BPH group, and 11.41 of the HbAlc normal groups. There were statistical differences (t=4.465, P=0.002), and there was no significant difference in PSA, IPSS, and BPH course time between the abnormal BPH group of HbAlc and the normal HbAlc group (t=0.843, P=0.517). =0.017); the course of BPH in abnormal group BPH was 18.12 + 5.76 years, and the course of BPH in normal BPH group was 13.88 + 4.65 years. There was a statistical difference (t=3.825, P=0.031). The PSA and IPSS score of the two groups had no statistical difference (P0.05) /L) /22.5. insulin resistance to BPH group was PV54.68 + 16.77ml, and insulin sensitive BPH group PV41.35 + 12.67 ml. The two groups were statistically different (t=4.327, P=0.004); the course of insulin resistance to BPH group was 16.79 + 4.43 years, and the course of insulin sensitivity was 12.78 + 3.76 years. The two groups were statistically different. IPSS level comparison, no statistical difference (P0.05). Conclusion: 1. age, body mass index, systolic blood pressure, blood sugar level and prostate volume change closely related, BMI, FBG, HBA1c may be an important risk factor for the development of the patients with benign prostatic hyperplasia.2. screening BG for BPH patients, and taking active measures for patients with DM may delay BP. The development of H.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R697.3;R587.1

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