改善高龄中重度良性前列腺增生症患者下尿路症状对肾功能的影响  

The effect of improving moderate and severe benign prostatic hyperplasia with lower urinary tract symptoms on renal function in elderly patients aged 80 years and over

作　　者：王倩[1] 张斌[1] 杨胜楠[1] 赵向娅[1] 杨轶[1] 董玲 李淑莹 田蕊[1] Wang Qian;Zhang Bin;Yang Shengnan;Zhao Xiangya;Yang Yi;Dong Ling;Li Shuying;Tian Rui(The Second Department of General Geriatrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院老年综合二科,450052

出　　处：《中华老年医学杂志》2022年第12期1494-1497,共4页Chinese Journal of Geriatrics

基　　金：河南省科技攻关项目 (222102310435)。

摘　　要：目的探讨改善高龄良性前列腺增生症(BPH)患者下尿路症状(LUTS)对肾功能的影响。方法病例对照研究,选取2018年7月至2020年7月在郑州大学第一附属医院老年科住院的患者,肾功能正常或慢性肾脏病(CKD)3a期,接受坦索罗辛联合非那雄胺药物治疗,完成6个月门诊随访的中重度BPH/LUTS患者129例,年龄80~97(84.3±3.5)岁。根据是否患高血压和CKD3a期,进一步分为血压正常组(51例)和高血压组(78例)、肾功能正常组(77例)和CKD3a期组(52例),比较患者治疗前及治疗1、3、6个月后血肌酐、估算肾小球滤过率(eGFR)、前列腺体积(PV)、残余尿量(PVR)及国际前列腺症状评分(IPSS)等指标差异,采用多元线性回归分析影响高龄老年BPH/LUTS患者肾功能的相关危险因素。结果经坦索罗辛联合非那雄胺治疗1、3、6个月后,高龄BPH/LUTS患者下尿路症状得到改善,IPSS评分、PVR均下降,差异有统计学意义(均P<0.01),治疗6个月后PV、血肌酐及eGFR无变化(均P>0.05);但进一步分别进行亚组分析结果显示,高血压组和CKD3a期组患者治疗前血肌酐增加,CKD3a期组治疗前eGFR降低(均P<0.05);与治疗前比较,高血压组患者血肌酐及eGFR在治疗3个月后改善,CKD3a期组患者治疗1个月即改善,差异均有统计学意义(均P<0.05),血压正常组和肾功能正常组患者治疗6个月后血肌酐及eGFR均无明显变化(均P>0.05)。多元线性回归分析结果显示,高血压(β=2.06,P<0.05)及CKD3a期(β=17.16,P<0.01)是影响治疗前后肌酐变化的独立危险因素,高血压(β=-2.27,P<0.01)、CKD3a期(β=-11.93,P<0.01)、治疗前PV(β=-0.11,P<0.05)是治疗前后eGFR变化值的独立危险因素。结论在合并高血压或CKD3a期的高龄患者中,改善中重度BPH/LUTS可改善其肾功能。Objective To investigate the effect of improving moderate and severe benign prostatic hyperplasia(BPH)with lower urinary tract symptoms(LUTS)on renal function in elderly patients aged 80 years and over.Methods A total of 129 inpatients with moderate and severe BPH and its associated LUTS(BPH/LUTS)who took tamsulosin combined with finasteride aged 80 years old and over in Geriatric Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the retrospective study from July 2018 to July 2020.Patients were divided into normal blood pressure group(n=51)and hypertension group(n=78)and divided into normal renal function group(n=77)and CKD3a stage group(n=52).Serum creatinine,estimated glomerular filtration rate(eGFR),prostate volume(PV)and post-void residual urine volume(PVR),and International Prostate Symptom Score(IPSS)were compared before versus after 1,3 and 6 months of treatment.Multivariable linear regression analysis was performed to evaluate the influence of the most relevant factors on renal function in patients with BPH/LUTS.Results After 1,3 and 6 months of tamsulosin combined with finastide treatment,the lower urinary tract symptoms of elderly patients with BPH/LUTS were improved,IPSS score and PVR were decreased,and the differences were statistically significant(all P<0.01).PV,serum creatinine and eGFR were not changed after 6 months of treatment(all P>0.05).However,further subgroup analysis showed that serum creatinine level in hypertension group and CKD3a stage group was increased compared with that before treatment,while eGFR in CKD3a stage group was decreased before treatment,and the difference was statistically significant(all P<0.05).Compared with before treatment,serum creatinine and eGFR in hypertensive group improved after 3 months of treatment,and CKD3a group improved after 1 month of treatment,and the differences were statistically significant(all P<0.05).There were no significant changes in serum creatinine and eGFR in normal blood pressure group and normal renal funct

关 键 词：前列腺增生 下尿路症状 肾功能不全 老年人 80以上 

分 类 号：R697.3[医药卫生—泌尿科学]