膀胱内前列腺突出程度对度他雄胺治疗良性前列腺增生效果的影响被引量：8

Impact of intravesical prostatic protrusion on therapeutic effects of Dutasteride in patients with benign prostatic hyperplasia

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摘要目的探讨良性前列腺增生（BPH）患者膀胱内前列腺突出（IPP）程度对5α还原酶抑制剂疗效影响。方法回顾性分析154例存在明显下尿路症状予度他雄胺0．5mg／d单药治疗的BPH患者。收集患者年龄、体重指数、治疗前后国际列腺症状评分（IPSS）、前列腺体积（TPV）、移行区体积（TZV）、最大尿流率（Qmax）、IPP、前列腺特异性抗原（PSA）变化等临床指标。采用Logistic回归分析患者发生急性尿潴留或外科手术治疗的影响因素。结果154例患者中41例（26．6％）发生急性尿潴留或者需要外科手术治疗。其中急性尿潴留或外科手术治疗1年累积发生率分别为9．1％（IPP〈10mm组）和70．5％（IPP≥10mm组）。在IPP〈10mm组患者中IPSS、TPV、TZV、Qmax、PSA较治疗前明显改善（均P〈0．001）；而在IPP≥10mm组的患者中，只有TPV、TZV较前改善（均P〈0．001），其余各项临床指标改善差别均无统计学意义。多因素分析显示IPP程度（OR=1．49；95％CI：1．07-2．11，P=0．020）和治疗前Qmax（OR=0．32；95％CI：0．11-0．93，P=0．036）可作为急性尿潴留和外科手术治疗的预测因素。结论本研究结果显示IPP可以预测度他雄胺治疗BPH的效果。IPP≥10min患者，度他雄胺疗效差，容易在治疗过程中发生急性尿潴留或转为外科手术治疗。 Objectives To evaluate the influence of intravesical protrusion of the prostate（IPP） on the response to treatment with 5α-reductase inhibitors in patients with benign prostatic hyperplasia （BPH）. Methods Data on 154 patients with lower urinary tract symptoms secondary to BPH, treated with Dutasteride 0.5 rag/day, were retrospectively analyzed. Patient age, body mass index （BMI） ,international prostate symptom score（IPSS）before and after treatment, total prostate volume （TPV）, transition zone volume （TZV）, maximum urinary flow rate （Qmax）, intravesical prostatic protrusion（IPP）, prostate specific antigen（PSA）and other clinical indicators were collected. Logistic regression was used to analyze factors leading to acute urinary retention or surgical intervention. Results Of the 154 patients, 41 （26.6%）developed acute urinary retention or required surgical intervention. The 1-year cumulative incidences of acute urinary retention or BPH-related surgery for the IPP〈10 mm group and the IPP ≥10 mm group were 9.1% and 70.5%, respectively. Significant improvement in IPPS,TPV, TZV, Qmax and PSA was found in patients in the IPP〈10 mm group after treatment（P〈0. 001） ,while only TPV and TZV showed significant improvement in the IPP ≥10 mm group. Multivariate analysis revealed that IPP （OR = 1.49 ; 95 % CI ： 1.07 - 2.11, P =0. 020 ） and preoperative Qmax（OR = 0.32 ; 95 % CI： 0.11 - 0.93, P = 0. 036） were good predictors of acute urinary retention and surgical treatment. Conclusions IPP can predict the results of Dutasteride treatment for benign prostatic hyperplasia. The efficacy of Dutasteride is poor for patients with IPP≥10 mm,who tend to develop acute urinary retention or require surgical intervention during treatment.