本文選題：良性前列腺增生 + 膀胱出口梗阻��； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2014年博士論文

【摘要】：目的 1、研究犬前列腺組織彈性在BPH發(fā)展過程中的變化以及其與BOO嚴(yán)重程度的相關(guān)性；探討犬前列腺組織彈性在BPH發(fā)展過程中變化的組織病理學(xué)基礎(chǔ)。 2、探討正常人和BPH病人前列腺移行區(qū)和周圍區(qū)的彈性模量差異；BPH病人前列腺移行區(qū)和周圍區(qū)彈性模量與BOO嚴(yán)重程度的相關(guān)性。 材料與方法 1、動(dòng)物實(shí)驗(yàn) （1）雄性比格犬10只，通過去勢(shì)手術(shù)、前列腺周圍包繞兩層尼龍網(wǎng)膜及雌雄激素聯(lián)合應(yīng)用3個(gè)月的方法建立犬BPH致BOO動(dòng)物模型。在激素給予前、激素給予后1、2、3個(gè)月時(shí)，分別行經(jīng)直腸前列腺超聲檢查和尿動(dòng)力檢查。比較前列腺體積、前列腺組織彈性模量及尿動(dòng)力各指標(biāo)在不同時(shí)間點(diǎn)的差異性，評(píng)價(jià)前列腺組織彈性模量與尿動(dòng)力各指標(biāo)的相關(guān)性。 （2）雄性比格犬24只，隨機(jī)分為4組，每組6只，通過去勢(shì)手術(shù)及雌雄激素聯(lián)合應(yīng)用3個(gè)月的方法建立犬BPH動(dòng)物模型。在激素給予前、激素給予后1、2、3個(gè)月時(shí)行經(jīng)直腸前列腺超聲檢查后分別處死1組動(dòng)物，取病理。行HE染色、Masson染色、網(wǎng)狀纖維染色和平滑肌免疫組化，觀察各種病理組織成分的變化，及其含量與前列腺組織彈性模量的相關(guān)性。 2、臨床實(shí)驗(yàn) （1）對(duì)221名正常健康人和BPH病人進(jìn)行TRUS和SWE檢查，測(cè)量前列腺重量、移行區(qū)和周圍區(qū)彈性模量，比較不同年齡和前列腺重量組移行區(qū)和周圍區(qū)平均彈性模量差異，以及其與年齡、前列腺重量的相關(guān)性。 （2）對(duì)52例BPH病人進(jìn)行IPSS，QOL評(píng)分后，行TRUS檢查，測(cè)量計(jì)算得出TPV、TZV、TZI，之后行SWE檢查測(cè)量前列腺移行區(qū)和周圍區(qū)彈性模量，最終以尿動(dòng)力學(xué)檢查作為診斷BOO金標(biāo)準(zhǔn)。對(duì)比不同BOO分組各指標(biāo)的差異，評(píng)價(jià)其與BOO嚴(yán)重程度的相關(guān)性。通過ROC曲線下面積評(píng)估各個(gè)參數(shù)診斷BOO的診斷價(jià)值。 結(jié)果 1、動(dòng)物實(shí)驗(yàn) （1）激素給予前后前列腺體積、前列腺組織彈性模量差異均有統(tǒng)計(jì)學(xué)意義（P均0.01）。手術(shù)前與手術(shù)后2周激素給予前尿動(dòng)力各指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異（P均＞0.05）。激素給予前后尿動(dòng)力各指標(biāo)的差異均有統(tǒng)計(jì)學(xué)意義（P均0.01）。前列腺組織平均彈性模量與尿動(dòng)力各指標(biāo)均具有相關(guān)性，其中與Qmax （r=-0.802, P0.01）和Pdet@Qmax（r=0.757, P 0.01）相關(guān)性最高。 （2）前列腺體積、前列腺組織彈性模量在激素給予前后均有顯著差異（P0.01）。前列腺上皮細(xì)胞高度和腺腔面積隨著前列腺增生發(fā)展逐漸增加，具有統(tǒng)計(jì)學(xué)差異（P均0.01）。不同時(shí)間點(diǎn)前列腺腺體面積比、腺體/間質(zhì)逐漸增加，而間質(zhì)、膠原纖維、網(wǎng)狀纖維和平滑肌組織面積比逐漸下降，均具有統(tǒng)計(jì)學(xué)差異（P均0.01）。而隨著激素給予前列腺腺體、間質(zhì)、膠原纖維、網(wǎng)狀纖維和平滑肌組織總含量均逐漸增加（P均0.01），并與前列腺組織彈性模量具有相關(guān)性，其中腺體含量與前列腺組織彈性模量相關(guān)性最高（r=0.958, P 0.01）。 2、臨床實(shí)驗(yàn) （1）不同年齡組、前列腺重量組前列腺移行區(qū)、周圍區(qū)彈性模量之間均具有統(tǒng)計(jì)學(xué)差異（P均0.01）。除年輕外（P0.05），各組前列腺移行區(qū)均高于周圍區(qū)，具有統(tǒng)計(jì)學(xué)差異（P均0.05）。前列腺移行區(qū)彈性模量與年齡（rage=0.715,P0.01）、增生程度(rweight=0.673, P0.01）具有明顯相關(guān)性。 （2）TPV、TZV、TZI、IPSS和前列腺移行區(qū)彈性模量在不同BOO分組均具有統(tǒng)計(jì)學(xué)差異（P均0.05），并且與BOO分級(jí)具有相關(guān)性。其中前列腺移行區(qū)彈性模量與BOO分級(jí)相關(guān)性最高（r=0.717, P0.01）,其診斷BOO曲線下面積最高，為0.813（95%CI0.697～0.928）。當(dāng)移行區(qū)楊氏模量界值為32.41kPa時(shí)，診斷BOO的敏感性，，特異性分別為65.0%和91.7%。 結(jié)論 1、隨著BPH的發(fā)展，犬前列腺組織的彈性模量逐漸增高，并與BOO嚴(yán)重程度具有明顯相關(guān)性；犬前列腺組織彈性模量增高與腺體含量相關(guān)性最高。 2、隨年齡、前列腺增生程度的發(fā)展，前列腺移行區(qū)彈性模量增加明顯，與年齡、前列腺增生程度具有相關(guān)性；前列腺移行區(qū)彈性模量與BOO分級(jí)相關(guān)性最高，可作為評(píng)價(jià)BPH致BOO病人的一種無(wú)創(chuàng)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 .
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R697.3;R445.1

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本文編號(hào)：2025640