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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李偉嘉 | 接受藥物治療的前列腺肥大患者，其殘存的急尿感與血清中反應C蛋白質數值有關 | 2012/10/30 上午 10:15:44 | 0 |
| 原 文 | 題 目 | Serum C-reactive protein levels are associated with residual urgency symptoms in patients with benign prostatic hyperplasia after medical treatment |
| 作 者 | 廖俊厚，鍾旭東，郭漢崇 | |
| 出 處 | Urology. 2011 Dec;78(6):1373-8. | |
| 出版日期 | 2011, Oct 2 | |
| 評 論 |
耕薪廖俊厚主任此次發表於Urology 雜誌的文章，說明C reactive protein較高的前列腺肥大患者，在經過適當的甲型阻斷劑與抗毒蕈鹼受體類藥物雙重治療後，仍有較高比率的患者持續著急尿的症狀，此一發現暗示了慢性發炎對於膀胱過動症可能扮演著不為人知的秘密角色。 在21世紀科學昌明的時代，膀胱功能失調卻仍有如一秘密花園，耐人尋味。相對於許多病因清楚，只需注重治療的學門而言，病生理機轉仍處於曖昧不明的膀胱過動症，實屬於異數。而這樣的疾病，即需要大量的流行病學調查，點出臨床上可能相關的因子，啟發基礎學者進行致病機轉的研究方向。廖俊厚主任在本次的研究中指出血清中C reactive protein大於0.3 mg/dL的前列腺肥大患者，可能隱藏著膀胱或前列腺的慢性發炎，造成臨床上症狀的表現。這個可貴的說法，引起了Urology 編輯們的興趣，在editorial comment中指出了”neuro-endocrine-immune”交互作用的重要性，其中的一些評論與本會最近幾次會議的討論不謀而合，甚為精采。建議有志於此道的同好，必讀。 對於其他科的醫師來說，膀胱功能病生理的細節變化難以類推，使得筆者在說明時，曾經說過ㄧ句話：「膀胱像ㄧ個孤僻的小房間，與其他臟器不太連動，而且常常是ㄧ個被害者。」，在透過本篇的研究之後，我們期待有一天，能夠解開膀胱與人體其他重要致病機轉的聯結，使得膀胱功能的研究不再是ㄧ個孤島。 |
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| abstract |
OBJECTIVE: Urinary urgency is a common and bothersome symptom in patients with benign prostatic hyperplasia (BPH); this symptom may persist even after medical treatment. Chronic inflammation has been reported to be associated with the pathogenesis of BPH and lower urinary tract symptoms (LUTS). We investigate the association between serum C-reactive protein (CRP) level and residual urgency symptoms in BPH patients after medical treatment. METHODS: Two-hundred-five men undergoing stable medical treatment for BPH, defined as a total prostate volume ≥40 mL, were enrolled. Patients with acute infection or those taking nonsteroid antiinflammatory drugs or aspirin were excluded. Uroflowmetry, postvoid residual volume, transrectal ultrasound parameters, serum prostate specific antigen (PSA), and CRP level were measured. A three-day void diary was recorded to identify the presence of urinary urgency. RESULTS: The mean serum CRP level was 0.24 mg/dL (range 0.01-2.84), and residual urgency was identified in 90 patients (43.9%). Patients with residual urgency were older and had significantly higher serum CRP levels (0.39 ± 0.54 mg/dL) than those without urgency (0.13 ± 0.20, P <.001). On multivariable logistic regression analysis, men with CRP levels ≥0.3 mg/dL were more likely to have urgency (odds ratio 8.08, 95% confidence interval 3.26-20.0) after adjusting for age, serum PSA level, total prostate volume, and antimuscarinic use. Patients with serum CRP levels ≥0.30 mg/dL had more urgency (82.1%) than those with serum CRP levels <0.30 mg/dL (34.9%). CONCLUSION: Serum CRP level is significantly associated with residual urgency in BPH patients after medical treatment. Chronic inflammation may play a role in the occurrence of residual urgency in BPH patients. |
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