本文選題：良性前列腺增生癥 + 血糖��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:良性前列腺增生癥(benign prostatic hyperplasia,BPH)是泌尿系統(tǒng)常見(jiàn)疾病,多發(fā)于中老年男性患者。糖尿病(DiabetesMellitus,DM)是一組以長(zhǎng)期高血糖為主要特征的代謝綜合征,由于胰島素缺乏和/或胰島素作用障礙導(dǎo)致以血中葡萄糖水平升高為特征的代謝紊亂疾病群。近年來(lái),隨著人們生活水平的提高,人群壽命明顯延長(zhǎng),許多增齡性疾病,比如高血壓、糖尿病、肥胖性疾病等的發(fā)病率也逐年升高,BPH發(fā)病率同樣是隨著年齡的增長(zhǎng)而升高。本研究對(duì)良性前列腺增生癥(BPH)患者和BPH合并糖尿病的患者進(jìn)行相關(guān)性研究,已有研究表明血糖代謝紊亂是與老年男性患者的BPH發(fā)病有一定關(guān)系,但樣本量較小。本研究通過(guò)回顧性分析我院查體中心BPH患者的臨床情況,旨在分析各指標(biāo)與BPH的相關(guān)性,為臨床診斷、干預(yù)提供依據(jù)。方法:回顧性分析山東省立醫(yī)院體檢中心,年齡50歲的1500例男性的臨床資料,檢測(cè)其相關(guān)指標(biāo),研究前列腺體積與各指標(biāo)的相關(guān)性,分析影響良性前列腺增生癥病情進(jìn)展的相關(guān)因素。采用自制的調(diào)查問(wèn)卷,詳細(xì)記錄所有研究對(duì)象的年齡等一般資料。采用CX7型全自動(dòng)生化分析儀檢測(cè)空腹血糖。計(jì)算體重指數(shù)(BMI),受試者裸足,僅穿貼身內(nèi)衣后測(cè)量其身高(m)、體重(kg),BMI=體重(kg)/身高2(m2)。用經(jīng)腹B超測(cè)定前列腺體積(V),前列腺前后徑、左右徑、上下徑,計(jì)算公式為:V(cm3)= 0.52*(左右徑)×(前后徑)×(上下徑)(cm)。對(duì)入選的730例BPH患者的血糖等代謝性指標(biāo)(FBG、2hPBG、HbAlc、FINS、HOMA-IR)與BPH評(píng)價(jià)指標(biāo):如前列腺體積、血清前列腺特異性抗原(Prostate Specific Antigen,PSA)、國(guó)際前列腺癥狀評(píng)分(International Prostate Symptom Score,IPSS)、BPH病程時(shí)間等進(jìn)行統(tǒng)計(jì)。按照BPH和DM的診斷標(biāo)準(zhǔn),將730例BPH患者分為單純BPH組(n=330)與BPH合并DM組(n=400),并根據(jù)患者的FBG、2hPBG、HbAlc、FINS、HOMA-IR水平進(jìn)行分組,分析血糖等指標(biāo)對(duì)BPH進(jìn)展的影響。統(tǒng)計(jì)學(xué)處理數(shù)據(jù)采用SPSS20.0進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料以(x±s)表示,采用t檢驗(yàn);計(jì)數(shù)資料采用χ2檢驗(yàn),變量之間采用多元回歸分析,P0.05具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.前列腺體積與年齡、體重指數(shù)、收縮壓、血糖水平存在顯著的正相關(guān)(P0.05);與身高、體重、舒張壓、血脂等無(wú)明顯相關(guān)性(P0.05);良性前列腺增生患者BMI、FBG、HBAlc水平均較非良性前列腺增生患者顯著升高(P0.05)。2.單純 BPH 組 PV39.24±16.65 ml,BPH 合并 DM 組 PV53.35±14.26ml,BPH合并DM組PV顯著高于單純BPH組PV,有統(tǒng)計(jì)學(xué)差異(t=5.381,P0.005);BPH 合并 DM 組 PSA 3.46±1.12 ng/ml,單純 BPH 組 PSA 1.88±0.98 ng/ml,BPH合并DM組PSA顯著高于單純BPH組PSA,有統(tǒng)計(jì)學(xué)差異(t=4.830,P=0.013);BPH 合并 DM 組 IPSS 13.12±4.25 分,單純 BPH 組 IPSS 8.87±2.67 分,BPH 合并DM組IPSS顯著高于單純BPH組IPSS,有統(tǒng)計(jì)學(xué)差異(t=3.792,P=0.010);單純 BPH 組 BPH 病程 12.79±3.672 年,BPH 合并 DM 組 BPH 病程 13.62±3.896年,BPH合并DM組雖然高于單純BPH組,但無(wú)統(tǒng)計(jì)學(xué)差異(t=0.854,P=0.437)。3.空腹血糖的水平是按照7mmol/L進(jìn)行判定�？崭寡钦�(7.0mmol/L)BPH 組 PV40.79±13.87 ml,空腹血糖異常(≥7.0mmol/L)BPH 組 PV55.27±17.69ml,空腹血糖異常BPH組PV顯著高于空腹血糖正常BPH組PV,有統(tǒng)計(jì)學(xué)差異(t=4.465,P=0.002);空腹血糖正常 BPH 組 PSA2.04±1.65ng/ml,空腹血糖異常BPH組PSA3.35±2.87 ng/ml,空腹血糖異常BPH組PSA顯著高于空腹血糖正常BPH組PSA,有統(tǒng)計(jì)學(xué)差異(t=3.674,P=0.006);空腹血糖正常BPH組IPSS 8.78±3.76分,空腹血糖異常BPH組IPSS 12.46±5.27分,空腹血糖異常BPH組IPSS顯著高于空腹血糖正常BPH組IPSS,有統(tǒng)計(jì)學(xué)差異(t=5.643,P=0.010);空腹血糖正常BPH組BPH病程12.65±3.58年,空腹血糖異常BPH組BPH病程13.68±3.77年,空腹血糖異常BPH組病程雖然高于空腹血糖正常BPH組病程,但無(wú)統(tǒng)計(jì)學(xué)差異(t=0.867,P=0.368)。4.HbAlc的判定是根據(jù)2009年ADA指南中關(guān)于糖化血紅蛋白(HbAlc)的理想水平(7%)進(jìn)行的,分為正常組與異常組。HbAlc異常BPH組PV53.79±17.34 ml,HbAlc 正常 BPH 組 PV41.57±11.41 ml,有統(tǒng)計(jì)學(xué)差異(t=4.465,P=0.002);HbAlc異常BPH組與HbAlc正常BPH組患者的PSA、IPSS、BPH病程時(shí)間沒(méi)有顯著性差異(t=0.843,P=0.517)。5.高胰島素血癥(HINS)的評(píng)定是根據(jù)FINS15mU/L。HINS異常BPH組PV56.57±26.75 ml,INS 正常 BPH 組 PV44.79±17.54 ml,有統(tǒng)計(jì)學(xué)差異(t=3.774,P=0.017);HINS 異常 BPH 組 BPH 病程 18.12±5.76 年,INS 正常 BPH 組 BPH病程13.88±4.65年,有統(tǒng)計(jì)學(xué)差異(t=3.825,P=0.031),兩組患者的PSA與IPSS評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。6.根據(jù)HOMA-IR2.8作為胰島素抵抗的標(biāo)準(zhǔn)。HOMA-IR的計(jì)算公式為血糖(mmol/L)*血清胰島素(mIU/L)/22.5。胰島素抵抗BPH組患者的PV54.68±16.77ml,胰島素敏感BPH組PV41.35±12.67 ml,兩組有統(tǒng)計(jì)學(xué)差異(t=4.327,P=0.004);胰島素抵抗BPH組患者的BPH病程16.79±4.43年,胰島素敏感BPH組BPH病程12.78±3.76年,兩組有統(tǒng)計(jì)學(xué)差異(t=4.367,P=0.036);兩組患者的PSA及IPSS水平比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1.年齡、體重指數(shù)、收縮壓、血糖水平與前列腺體積的變化密切相關(guān),BMI、FBG、HBA1c可能是前列腺增生患者病情發(fā)展的重要危險(xiǎn)因素。2.對(duì)BPH病人常規(guī)篩查BG,并針對(duì)合并DM患者積極采取措施,可能會(huì)延緩BPH的發(fā)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R697.3;R587.1

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