影响BPH/LUTS患者α受体阻滞剂和5-α还原酶抑制剂治疗效果的因素分析  

Analysis of the impact factor for the therapeutic effects of α-blocker and 5-ARI in BPH/LUTS patients

作　　者：金露 全晶[2] 代光成 朱进[1] 薛波新[1] JIN Lu;QUAN Jing;DAI Guangcheng;ZHU Jin;XUE Boxin(Department of Urology,Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215000,China;Department of Urology,Peking University Shenzhen Hospital)

机构地区：[1]苏州大学附属第二医院泌尿外科,江苏苏州215000 [2]北京大学深圳医院泌尿外科

出　　处：《临床泌尿外科杂志》2019年第12期973-976,共4页Journal of Clinical Urology

摘　　要：目的:探讨可用于预测具有下尿路症状(LUTS)的良性前列腺增生(BPH)患者α受体阻滞剂和5-α还原酶抑制剂治疗效果的相关指标。方法:通过设计前瞻性研究,对患者进行为期6个月的随访,收集患者年龄、治疗前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、前列腺体积(PV)、前列腺移行带体积(TZV)、前列腺突入膀胱内程度(IPP)、残余尿量(PVR)、PSA水平等指标,比较患者治疗前后相关指标的差异;按IPSS下降程度将患者分为三组,比较三组患者治疗前各临床指标的差异;选取临床指标,绘制ROC曲线,确定具有预测价值的指标。结果:本研究最终纳入92例患者,患者在接受6个月的坦索罗辛联合非那雄胺治疗后,除IPP外其余指标均有明显变化(P<0.05)。将患者根据IPSS降低程度将患者分为治疗效果优、良、差组,其中40例患者IPSS下降程度≥50%为治疗效果优组;38例患者IPSS下降>25%且<50%为治疗效果良组,14例患者IPSS下降≤25%为治疗效果差组。三组患者IPP值比较差异有统计学意义(P<0.05),其余临床指标无明显差异。根据IPP和治疗效果绘制ROC曲线,曲线下面积(AUC)为0.825,最佳临界值为13.65 mm,敏感性为0.929,特异性为0.654。结论:坦索罗辛联合非那雄胺治疗BPH/LUTS患者有效,IPP可用于坦索罗辛联合非那雄胺治疗效果的预测。Objective:To find a predicting indicator for the therapeutic effects in benign prostatic hyperplasia(BPH)patients with lower urinary tract symptoms(LUTS)treated with alpha blockers and 5α-reductase inhibitors.Method:A prospective study was designed and patients were followed up for six months.Patients’clinical characteristics,including age,IPSS,QOL score,maximum flow rate,postvoid residual urine volume,intravesical prostatic protrusion(IPP),PSA level and prostate volume were collected.The change of these characteristics before and after the treatment for 6 months was assessed.Patients were divided into 3 groups based on the change of IPSS,and these characteristics before the treatment among the 3 groups were compared.The specific characteristic would be used to generate the ROC curve and a valuable factor would be chosen.Result:A total of 92 patients were collected at last.After 6 months of treatment,the clinical characteristics all changed significantly(P<0.05),except IPP.Patients were divided into 3 groups.Forty patients showed an excellent IPSS decrease of 50%or greater and 14 patients showed an IPSS decrease of<25%.Thirty-eight patients were in the middle group.There was a significant difference among the 3 groups for IPP,while not other characteristics(P<0.05).The ROC curve was generated based on IPP and AUC was 0.825.The cut-off value was 13.65 mm,with sensitivity of 0.929 and specificity of 0.654.Conclusion:Tamsulosin and finasteride are effective for BPH/LUTS patients,and IPP is considered a useful predictor of the therapeutic effects of tamsulosin and finasteride.

关 键 词：前列腺增生 下尿路症状 膀胱内前列腺突出度 Α受体阻滞剂 5-Α还原酶抑制剂 

分 类 号：R697.32[医药卫生—泌尿科学]