老年科良性前列腺增生的诊治现状  

Current status of diagnosis and treatment for benign prostatic hyperplasia in geriatrics outpatient

作　　者：周哲[1] 张祥华[1] 于普林[2] 董碧蓉[4] 蹇在金 鲁翔[6] 钱芸娟[7] 方宁远 高海青[9] 祝世法[10] 王建业[3] 

机构地区：[1]北京大学吴阶平泌尿外科医学中心 北京大学首钢医院泌尿外科,100144 [2]卫生部北京医院老年医学研究所 [3]卫生部北京医院泌尿外科 [4]华西医院老年病科 [5]湘雅二医院老年病科 [6]南京医科大学附属第二医院心血管内科 [7]广东省人民医院肾内科 [8]上海仁济医院老年病科 [9]山东大学齐鲁医院老年病科 [10]浙江医院心血管内科

出　　处：《中华老年医学杂志》2011年第11期965-967,共3页Chinese Journal of Geriatrics

摘　　要：目的了解良性前列腺增生（benign prostate hyperplasia，BPH）在老年科的诊断和治疗现状，促进BPH诊断和治疗的规范化。方法抽取我国23个城市的老年科门诊BPH患者，完成老年科BPH门诊登记调查表。问卷内容包括患者的基本情况、诊疗情况和治疗效果。结果对4001份调查问卷的分析显示，患者平均国际前列腺症状评分（IPSS）（18．8±5．9）分，中、重度症状患者分别占53．8％和42．0%。并存疾病的患病率依次为高血压（63．9％）、冠心病（40．4％）、糖尿病（32．4％）和高脂血症（25．7％）。BPH相关并发症的发生率依次为尿路感染（21．0％）、尿路结石（8．3％）、反复血尿（1．8％）、肾积水（1．7％）和疝气（0．6％）。医师采用的诊疗手段中，未进行直肠指诊的占27．2％，未进行血清前列腺特异性抗原（PSA）检查的占89．5％。在药物治疗的患者中，68．1％的患者处方中有α受体阻滞剂，92．9％的处方中有5α还原酶抑制剂，11．8％的处方中有中药和植物制剂，0．4％的处方中有M受体阻滞剂。首次处方中，单药治疗的占51．1％，2种药物联合治疗的占46．6％。在中重度症状患者中，遵医嘱规律服药的占60．6％，已停药的占13．9％。需要调整处方的原因依次为药物疗效差（23．4％）、不良反应多（5．4％）、价格昂贵（3．5％）、服用不方便（2．9％）等。结论老年科门诊BPH患者以中重度症状为主，BPH治疗的同时还需考虑并存的疾病和BPH相关并发症；医师需进一步认识直肠指诊和PSA检查的重要性，联合治疗对于改善患者下尿路症状效果显著，长期治疗效果更好。Objective To evaluate the current status of diagnosis and treatment for benign prostatic hyperplasia （BPH） in geriatrics department, and to promote the standardization of diagnosis and treatment. Methods The BPH patients in geriatrics outpatients from 23 cities were included. General conditions, diagnosis and treatment, and the effect of treatment were recorded in registry questionnaire. Results The analysis of 4001 questionnaires showed that the mean international prostate symptom score （IPSS） was （18.8 ± 5.9）, and the percent of the moderate and severe symptom was 53.8% and 42.0%, respectively. The morbidities of coexist diseases were 63.9%（hypertension）, 40.4 % （coronary disease）, 32.4 % （diabetes mellitus） and 25.7 % （hyperlipidemia）. BPH-related complications were urinary infection （ 21.0%）, urinary stone （ 8.3%）, recurrent hematuria （1.8 % ）, hydronephrosis （1.7 % ）, and hernia （0.6 %）. In the initial evaluation of BPH, 27.2% of doctors didn＇t finish digital rectal examination, and 89.5% of doctors didn＇t complete PSA test. Among patients with medical therapy, α receptor blocker was used in 68. 1%, 5α-reductase inhibitor in 92.9%, Chinese medicine and plant drugs in 11.8%, and M receptor blocker in 0.4% of the prescriptions. During the first prescription, monotherapy was recorded in 51.1%, and combination therapy with two drugs was recorded in 46.6%. In the patients with moderate and severe symptoms, 60.6% of patients took the drugs regularly, 13.9% of patients withdrew the drugs. The reasons for drug adjustment were poor efficacy （23.4%）, serious side effects （5.4%）, high cost （3.5%）, taking inconveniently （ 2.9%）, etc. Conclusions Most BPH patients in geriatrics department have moderate and severe symptoms. Coexist diseases and BPH related complications should be considered during treatment of BPH. Doctors should realize the importance of digital rectal examination and PSA test. Combination therapy has more efficacy for improving lower

关 键 词：前列腺增生 诊疗准则 

分 类 号：R697.3[医药卫生—泌尿科学]