本文選題：前列腺增生 + 前列腺炎　； 參考：《河北醫(yī)科大學(xué)》2014年博士論文

【摘要】：第一部分良性前列腺增生癥伴組織學(xué)炎癥相關(guān)因素分析 目的:分析比較前列腺增生患者合并組織學(xué)前列腺炎與單純前列腺增生患者的相關(guān)因素，為臨床治療提供可行的依據(jù)。 方法:將因尿潴留或LUTS而行TURP的60位住院患者，根據(jù)組織病理學(xué)診斷，分為前列腺增生合并前列腺炎組45例和單純前列腺增生組15例，術(shù)前對患者年齡、尿潴留史、合并癥、國際前列腺癥狀評分(IPSS)、生活質(zhì)量評分（QOL）、前列腺體積、殘余尿量、最大尿流率Qmax、PSA、血清C反應(yīng)蛋白(CRP)、血液中白細(xì)胞總數(shù)、尿液中白細(xì)胞計(jì)數(shù)等分別認(rèn)真檢測并詳細(xì)記錄。 結(jié)果: 1兩組患者合并癥比較：單純BPH組有尿潴留病史患者例數(shù)（2/15，13%）低于前列腺增生合并炎癥組（18/45，40%）（P 0.05）；并且單純BPH組中合并糖尿病患者例數(shù)（3/15，20%）低于炎癥組（18/45，40%）（P 0.05），合并高血壓在BPH組（7/15，47%），BPH合并炎癥組（20/45，44%），合并冠心病在BPH組（4/15，27%），BPH合并炎癥組（8/45，18%），合并高脂血癥在BPH組（6/15，40%），BPH合并炎癥組（17/45，38%），兩組之間無統(tǒng)計(jì)學(xué)差異（P0.05）。 2兩組患者一般資料比較：兩組患者平均年齡之間有統(tǒng)計(jì)學(xué)差異，其中單純BPH組年齡（69.5±5.4）高于炎癥組（63.4±3.8）（P 0.05）；炎癥組IPSS和QOL評分（28.6±5.2，5.2±0.8）高于單純BPH組（23.7±4.5，4.2±1.3）（P 0.05），BPH合并炎癥組病例殘余尿RUV（249.6±14.9ml）、最大尿流率Qmax（5.2±2.4）、前列腺體積（66.8±21.3ml）與BPH組相比(157.5±21.1ml，7.8±2.1ml/s，54.4±18.7ml)均有統(tǒng)計(jì)學(xué)差異（P0.05），其中炎癥組病例殘余尿及前列腺體積均大于單純增生組，而最大尿流率低于單純增生組。 3兩組患者血PSA.CRP及血尿白細(xì)胞計(jì)數(shù)比較：BPH合并炎癥組PSA和CRP（5.3±2.1ng/L，4.4±2.7mg/L）高于BPH組（3.1±1.2ng/L，0.2±1.30mg/L），BPH合并炎癥組血尿常規(guī)白細(xì)胞計(jì)數(shù)(5.1±2.1×109/L，2.8±1.3/HP)與BPH組（4.6±1.9×109/L，2.6±1.5/HP）比較無統(tǒng)計(jì)學(xué)差異（P0.05）。 結(jié)論: 1合并前列腺組織學(xué)炎癥的前列腺增生患者，其尿潴留發(fā)生率，前列腺體積，IPSS,QOL評分，血PSA等均明顯高于單純增生組，提示前列腺炎可能促進(jìn)前列腺增生的發(fā)展進(jìn)程。 2血C反應(yīng)蛋白（CRP）作為可選擇性的血清標(biāo)志物，術(shù)前檢測CRP可間接了解前列腺增生癥是否合并前列腺炎。 3炎癥組中糖尿病發(fā)生率升高，提示代謝性疾病可能與前列腺增生合并前列腺炎有某些相關(guān)性。 第二部分促炎癥細(xì)胞因子在前列腺增生癥伴組織學(xué)炎癥中表達(dá)的研究 目的:探討患者前列腺組織及血清中腫瘤壞死因子α(TNF-α)、白細(xì)胞介素6(IL-6)以及CD3的表達(dá)及臨床意義。 方法:60名因尿潴留或LUTS行TURP手術(shù)的BPH患者，，根據(jù)病理診斷分為單純前列腺增生組（15例）及前列腺中增生合并單純前列腺炎組（45例），分組與第一部分相同。收集患者一般資料，TURP術(shù)中取前列腺組織,立即放入液氮灌中，轉(zhuǎn)-80C°低溫冰箱中保存，兩組病例標(biāo)本分別采用蛋白印跡方法（western-blotting）測定組織中TNF-α、IL-6以及CD3的含量。術(shù)前空腹抽取靜脈血3ml，ELISA測定血清中TNF-α、IL-6的含量，并應(yīng)用免疫組織化學(xué)方法定位檢測TNF-α、IL-6以及CD3在前列腺組織中的表達(dá)定位情況。 結(jié)果:免疫組織化學(xué)染色結(jié)果顯示BPH合并炎癥組TNF-α、IL-6、CD3表達(dá)MOD值（0.0524±0.04，0.0334±0.024，0.0365±0.009）高于BPH組（0.0323±0.6，0.204±0.016，0.0223±0.003），western-blot方法檢測結(jié)果顯示BPH合并炎癥組TNF-α、IL-6、CD3表達(dá)相對量(0.24±0.04，0.07±0.04，0.33±0.09)高于BPH組(0.19±0.06，0.04±0.02，0.27±0.06)，ELISA結(jié)果亦顯示BPH合并炎癥組血清中TNF-α、IL-6濃度(34.92±5.1ng/ml，22.07±14.32ng/ml)高于BPH組(24.05±11.5ng/ml，11.05±3.45ng/ml)。尿潴留組各促炎癥細(xì)胞因子含量明顯高于LUTS組，高IPSS評分組各促炎癥細(xì)胞因子含量高于低IPSS評分組。前列腺增生癥合并不同程度炎癥之間各促炎癥細(xì)胞因子亦存在統(tǒng)計(jì)學(xué)差異，以重度炎癥升高最為顯著。 結(jié)論: 前列腺增生合并前列腺炎時(shí)，局部前列腺組織中TNF-α、IL-6、CD3含量均升高，血清中TNF-α及IL-6亦升高，尿潴留及高IPSS評分時(shí)前列腺局部組織及血清中TNF-α及IL-6均升高，提示炎癥刺激下促炎因子表達(dá)明顯增多，使前列腺上皮及間質(zhì)細(xì)胞增殖，導(dǎo)致前列腺體積增大，促進(jìn)臨床癥狀進(jìn)展。TNF-α、IL-6、CD3可作為評價(jià)下尿路癥狀病情程度的分子生物學(xué)指標(biāo)。 第三部分熱休克蛋白27在前列腺增生伴組織學(xué)炎癥中的表達(dá)研究 目的:討前列腺增生癥合并炎癥患者前列腺組織及血清中熱休克蛋白27表達(dá)及臨床意義。 方法:60名TURP手術(shù)的BPH患者，分為單純前列腺增生組（15例）及前列腺中增生合并單純前列腺炎組（45例），分組同第一部分，收集患者一般資料，TURP術(shù)中取前列腺組織，立即放入液氮灌中，后轉(zhuǎn)入-80C°低溫冰箱中保存，采用western-blotting測定組織中HSP27的含量，ELISA測定血清中HSP27的含量，并應(yīng)用免疫組織化學(xué)方法定位檢測HSP27在前列腺組織中的表達(dá)定位情況。比較HSP27的表達(dá)在前列腺增生合并炎癥組與單純前列腺增生組，尿潴留組和LUTS組，高IPSS和低IPSS組的差異，不同程度炎癥組之間差異，并與TNF-α、IL-6、CD3表達(dá)進(jìn)行相關(guān)性分析。 結(jié)果: 1免疫組織化學(xué)染色方法顯示，前列腺增生合并組織學(xué)炎癥組中HSP27MOD值（0.0574±0.13）高于單純增生組（0.0427±0.062），在尿潴留組中MOD值（0.0596±0.012）高于LUTS組（0.0236±0.04），在高IPSS組中（0.0545±0.014）高于低LUTS組（0.0321±0.12）。統(tǒng)計(jì)學(xué)有顯著性差異。（P 0.01）。前列腺增生合并不同程度炎癥之間亦存在統(tǒng)計(jì)學(xué)差異，以重度炎癥升高最為顯著。HSF27表達(dá)升高與TNF-α、IL-6表達(dá)有關(guān)。 2western-blotting方法結(jié)果顯示，HSP27在炎癥組中測定值（0.41±0.13）高于單純增生組（0.27±0.06），在尿潴留組中測定值為（0.44±0.12）高于LUTS組（0.23±0.04），HSP27在高IPSS組（0.45±0.14）高于低LUTS組（0.21±0.12）。 3ELISA測定血清中HSP27濃度，在炎癥組（156.86±64.4ng/ml）高于單純增生組（97.10±48.19ng/ml），在尿潴留組（144.65±45.28ng/ml）高于LUTS組（102.28±50.37ng/ml），在高IPSS組（146.23±38.57ng/ml）高于低LUTS組（103.48±53.82ng/ml）。差異有統(tǒng)計(jì)學(xué)意義。（P0.05）。 結(jié)論: 1前列腺增生合并前列腺炎組前列腺組織及血清中HSP27含量高于單純增生組,尿潴留組及高IPSS組亦高于LUTS組及低IPSS組，說明小分子HSP27可能作為分子伴侶在炎癥反應(yīng)刺激下促使前列腺增生癥病程進(jìn)展，并出現(xiàn)相應(yīng)的臨床癥狀。 2前列腺增生合并組織學(xué)炎癥時(shí)HSP27的升高與促炎癥因子TNF-α及IL-6的升高有明顯相關(guān)性，并且尿潴留時(shí)，HSP27升高與TNF-α、IL-6升高亦有明顯相關(guān)性，說明在前列腺增生合并慢性炎癥的發(fā)病機(jī)制中，HSP27與促炎癥細(xì)胞因子可能存在相互誘導(dǎo)的關(guān)系，其分子學(xué)信號傳導(dǎo)途徑有待進(jìn)一步研究。
[Abstract]:Analysis of factors associated with histological inflammation in the first part of benign prostatic hyperplasia


Objective : To analyze the factors associated with histological prostatitis and benign prostatic hyperplasia in patients with benign prostatic hyperplasia ( BPH ) and to provide a feasible basis for clinical treatment .


Methods : Sixty - six patients who were hospitalized for the treatment of urinary retention or LUTS were randomly divided into four groups : prostate hyperplasia combined with prostatitis group ( 45 cases ) and simple benign prostatic hyperplasia group ( 15 cases ) , the age of the patient , the history of urinary retention , complications , international prostate symptom score ( IPSS ) , quality of life ( QOL ) , prostate volume , residual urine volume , maximum urine flow rate Qmax , PSA , serum C - reactive protein ( CRP ) , total white blood cell count , white blood cell count , etc . were carefully detected and recorded in detail .


Results :


The number of patients with simple BPH ( 2 / 15 , 13 % ) was lower than that in patients with benign prostatic hyperplasia ( 18 / 45 , 40 % ) ( P 0.05 ) .
The number of patients with diabetes mellitus ( 3 / 15 , 20 % ) was lower than that in the group of BPH ( 18 / 45 , 40 % ) ( P 0.05 ) . The combination of hypertension in BPH group ( 7 / 15 , 47 % ) , BPH combined with inflammation group ( 20 / 45 , 44 % ) , combined with coronary heart disease in BPH group ( 4 / 15 , 27 % ) , BPH combined inflammation group ( 8 / 45 , 38 % ) , and BPH combined inflammation group ( 17 / 45 , 38 % ) , there was no statistical difference between the two groups ( P0.05 ) .


The average age ( 69.5 鹵 5.4 ) of the simple BPH group was higher than that in the inflammatory group ( 63.4 鹵 3.8 ) ( P 0.05 ) .
The IPSS and QOL scores ( 28.6 鹵 5.2 , 5.2 鹵 0.8 ) in the inflammatory group were higher than those in the simple BPH group ( 23.7 鹵 4.5 , 4.2 鹵 1.3 ) ( P 0.05 ) , the residual urine RUV ( 249.6 鹵 14.9 ml ) , the maximum urinary flow rate Qmax ( 5.2 鹵 2.4 ) , the prostate volume ( 66.8 鹵 21.3 ml ) and the BPH group ( 157.5 鹵 21.1 ml , 7.8 鹵 2.1 ml / s , 54.4 鹵 18.7 ml ) were significantly higher than those in the BPH group ( 157.5 鹵 21.1 ml , 7.8 鹵 2.1 ml / s , 54.4 鹵 18.7 ml ) .


The serum levels of PSA and CRP ( 5.3 鹵 2.1 ng / L , 4.4 鹵 2.7 mg / L ) in BPH combined with inflammatory group were higher than those in BPH group ( 3.1 鹵 1.2 ng / L , 0.2 鹵 1.30 mg / L ) . There was no statistical difference between the two groups ( 5.1 鹵 2.1 脳 109 / L , 2.8 鹵 1.3 / HP ) and BPH ( 4.6 鹵 1.9 脳 109 / L , 2.6 鹵 1.5 / HP ) ( P0.05 ) .


Conclusion :


1 . The incidence of urinary retention , prostate volume , IPSS , QOL and blood PSA were significantly higher in patients with benign prostatic hyperplasia combined with prostate histological inflammation than that in simple hyperplasia group , which suggested that prostatitis might promote the development of prostate hyperplasia .


Serum C - reactive protein ( CRP ) is used as a selectable serum marker , and CRP can be used to indirectly understand whether benign prostatic hyperplasia is combined with prostatitis .


The incidence of diabetes in the inflammatory group increased , suggesting that metabolic diseases may be associated with prostatic hyperplasia and prostatitis .


Expression of second partial pro - inflammatory cytokines in benign prostatic hyperplasia with histological inflammation


Objective : To investigate the expression and clinical significance of tumor necrosis factor 偽 ( TNF - 偽 ) , interleukin 6 ( IL - 6 ) and CD3 in patients with prostate tissue and serum .


Methods : 60 patients with BPH treated with uroschesis or LUTS were divided into simple benign prostatic hyperplasia group ( 15 cases ) and benign prostatic hyperplasia ( 45 cases ) according to the pathological diagnosis , and the contents of TNF - 偽 , IL - 6 and CD3 in the tissues were measured by western - blotting . The levels of TNF - 偽 , IL - 6 and CD3 in serum were measured by Western - blotting .


Results : The levels of TNF - 偽 , IL - 6 , CD3 in the patients with BPH were significantly higher than those in BPH group ( 0 . 0323 鹵 0 . 6 , 0 . 204 鹵 0 . 016 , 0 . 0223 鹵 0 . 003 ) . The results showed that the levels of TNF - 偽 , IL - 6 , CD3 in the patients with BPH were significantly higher than those in BPH group ( 0 . 19 鹵 0 . 06 , 0 . 04 鹵 0 . 02 , 0 . 27 鹵 0 . 06 ) .


Conclusion :


The levels of TNF - 偽 , IL - 6 and CD3 in local prostatic tissues increased , TNF - 偽 and IL - 6 in the serum increased , and TNF - 偽 and IL - 6 increased in the local prostate tissues , suggesting that the expression of TNF - 偽 , IL - 6 and TNF - 偽 and IL - 6 in the prostatic tissues and serum increased significantly , which led to the increase of prostate volume and the progression of clinical symptoms .


Expression of the third partial heat shock protein 27 in benign prostatic hyperplasia with histological inflammation


Objective : To investigate the expression and clinical significance of heat shock protein 27 in prostate tissue and serum of patients with benign prostatic hyperplasia complicated with inflammation .


Methods : 60 patients with BPH were divided into simple benign prostatic hyperplasia group ( 15 cases ) and benign prostatic hyperplasia combined with simple prostatitis group ( 45 cases ) .


Results :


The expression of HSP27MOD ( 0.074 鹵 0.13 ) in benign prostatic hyperplasia combined with histological inflammation group was higher than that in simple hyperplasia group ( 0.0524 鹵 0.062 ) , and the MOD value ( 0.0524 鹵 0.012 ) was higher in the urinary retention group than in LUTS group ( 0.0236 鹵 0.04 ) , which was higher in the high IPSS group than in the low LUTS group ( 0.0321 鹵 0.12 ) . The expression of HSF27 was related to the expression of TNF - 偽 and IL - 6 .


The results showed that HSP27 was higher in the inflammatory group ( 0.41 鹵 0.13 ) than in the simple hyperplasia group ( 0.27 鹵 0.06 ) . The value of HSP27 in the urine retention group was ( 0.44 鹵 0.12 ) higher than that in LUTS group ( 0.23 鹵 0.04 ) , HSP27 was higher in the high IPSS group ( 0.45 鹵 0.14 ) than in the low LUTS group ( 0.21 鹵 0.12 ) .


The level of HSP27 in serum was higher than that in LUTS group ( 97.10 鹵 48.19 ng / ml ) , and in the group of urinary retention ( 144.65 鹵 45.28ng / ml ) was higher than that in LUTS group ( 102.28 鹵 50.37 ng / ml ) , and in the high IPSS group ( 146.23 鹵 38.57ng / ml ) was higher than that in the low LUTS group ( 106.23 鹵 38.57ng / ml ) .


Conclusion :


The levels of HSP27 in prostate tissue and serum were higher than those in simple hyperplasia group , urinary retention group and high IPSS group than in LUTS group and low IPSS group .


There was a significant correlation between the increase of HSP27 and the increase of TNF - 偽 and IL - 6 in patients with benign prostatic hyperplasia complicated by histological inflammation , and the increase of HSP27 and TNF - 偽 and IL - 6 in the pathogenesis of benign prostatic hyperplasia combined with chronic inflammation indicated that there might be mutual induction between HSP27 and pro - inflammatory cytokines .
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R697.3

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 丁蓉;黃青枝;;前列腺增生手術(shù)43例預(yù)見性護(hù)理效果觀察[J];長江大學(xué)學(xué)報(bào)(自科版);2015年12期

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