中老年男性体检人群良性前列腺增生关联因素研究

逄瑷博; 徐国纲; 赵鑫; 凌存保; 田亚平; 张春燕

doi:10.12435/j.issn.2095-5227.2023.121

中老年男性体检人群良性前列腺增生关联因素研究

Factors associated with benign prostatic hyperplasia in middle-aged and elderly men undergoing physical examination

摘要

摘要:
背景寻找良性前列腺增生(benign prostatic hyperplasia，BPH)发生的影响因素有助于对BPH进行早期预防。
目的探讨中老年男性体检人群临床指标与前列腺体积的相关性，寻找BPH的关联因素。
方法回顾性分析2021年6月—2023年6月某三甲医院体检中心行健康检查的中老年男性的资料，以前列腺总体积(total prostate volume ，TPV)为分组标准，TPV＞25 cm³为BPH组，TPV≤25 cm³为健康对照组，采用Spearman相关性分析和多因素Logistic回归分析与TPV相关的因素。
结果共纳入6 732例45 ~ 89岁中老年男性，其中BPH组3 972例，健康对照组2 760例。与健康对照组相比，BPH组年龄M(IQR)：56(51 ~ 60)岁 vs 53(49 ~ 58)岁，P＜0.001、体质量指数(body mass index，BMI)M(IQR)：26.41(24.64 ~ 28.36) kg/m² vs 25.76(24.06 ~ 27.80) kg/m²，P＜0.001、空腹胰岛素(insulin，INS)M(IQR)：10.67(7.27 ~ 15.53) mmol/L vs 10.25(6.90 ~ 14.93) mmol/L，P=0.005、总前列腺特异性抗原(total prostate specific antigen，tPSA)M(IQR)：1.01(0.66 ~ 1.63) ng/L vs 0.75(0.51 ~ 1.10) ng/L，P＜0.001较高，高密度脂蛋白胆固醇(high density lipoprotein-cholesterol，HDL-C)M(IQR)：1.18(1.00 ~ 1.37) mmol/L vs 1.19(1.01 ~ 1.40) mmol/L，P=0.004、游离前列腺特异性抗原(free prostate specific antigen，fPSA)/tPSA M(IQR)：0.31(0.23 ~ 0.41) vs 0.32(0.24 ~ 0.42)，P=0.016较低。相关性分析显示，TPV与年龄(r=0.24，P＜0.001)、tPSA(r=0.33，P＜0.001)、fPSA(r=0.36，P＜0.001)均呈显著正相关。多因素Logistic回归分析结果显示，随着年龄(OR=1.051，95% CI ：1.042 ~ 1.060， P＜0.001)、BMI(OR=1.095，95% CI ：1.076 ~ 1.116， P＜0.001)和tPSA(OR=1.775，95% CI：1.647 ~ 1.913，P＜0.001)的增长或升高，BPH的发病风险升高，但高HDL-C男性发生BPH的概率较低(OR=0.790，95% CI：0.665 ~ 0.945，P=0.009)。
结论 tPSA、年龄、BMI、HDL-C与前列腺增生发生有关。

Abstract:
Background Finding factors that associated with the development of benign prostatic hyperplasia (BPH) will be helpful in the early prevention of BPH.
Objective To investigate the correlation between clinical indicators and prostate volume in middle-aged and elderly men undergoing physical examination, and find factors associated with the occurrence of BPH.
Methods Clinical data about middle-aged and elderly men aged from 45 to 89 years who underwent health checkups in a health check center of a tertiary hospital from June 2021 to June 2023 were retrospectively analyzed, and total prostate volume (TPV) was used as a grouping criterion, with TPV>25 cm³ as the BPH group, and TPV≤25 cm³ as the healthy control group. Correlation analysis and multifactorial Logistic regression were used to analyze the risk factors and protective factors associated with the total volume of benign prostatic hyperplasia.
Results Totally 6 732 cases were included, with 3 972 cases in the BPH group, and 2 760 cases in the healthy control group. Compared with the healthy control group, the BPH group had higher age (MIQR: 5651 - 60 years vs 5349 - 58 years, P＜0.001), body mass index (BMI) (MIQR: 26.4124.64 - 28.36 kg/m² vs 25.7624.06 - 27.80 kg/m², P＜0.001), fasting insulin (INS) (MIQR: 10.677.27 - 15.53 mmol/L vs 10.256.90 - 14.93 mmol/L, P=0.005), total prostate specific antigen (tPSA) (MIQR: 1.010.66 - 1.63 ng/L vs 0.750.51 - 1.10 ng/L, P<0.001), while the high-density lipoprotein-cholesterol (HDL-C) (MIQR: 1.181.00 - 1.37 mmol/L vs 1.191.01 - 1.40 mmol/L, P=0.004) and fPSA/tPSA (MIQR: 0.310.23 - 0.41 vs 0.320.24 - 0.42, P=0.016) were lower. Correlation analysis showed significant positive correlation between TPV and age (r=0.24, P<0.001), tPSA (r=0.33, P<0.001), fPSA (r=0.36, P<0.001); Multivariate Logistic regression analysis showed that the increase of age (OR=1.051, 95% CI: 1.042 - 1.060, P<0.001), BMI (OR=1.095, 95% CI: 1.076 - 1.116, P<0.001) and tPSA (OR=1.775, 95% CI: 1.647 - 1.973, P<0.001) were associated with higher risk of BPH, and men with higher HDL-C (OR=0.790, 95% CI: 0.665 - 0.945, P=0.009) had lower risk of BPH.
Conclusion Age, BMI, tPSA and HDL-C are independently associated with occurrence of benign prostatic hyperplasia.

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