加入會員｜ 會員登入 ｜聯絡我們 ｜English

學術論壇

學術論壇可提供瀏覽者及一般會員閱讀瀏覽學術文章。
您必須為協會會員或專科醫師才可擁有發表文章及討論之權限。
發表人 討論主題 發表時間 討論數
彭崇信 慢性發炎和良性攝護腺腫大的嚴重度及疾病進展有關 2017/7/3 上午 03:11:12 0
原 文 題　　目 Chronic Prostate Inflammation is Associated with Severity and Progression of Benign Prostatic Hyperplasia, Lower Urinary Tract Symptoms and Risk of Acute Urinary Retention
作　　者 Nickel JC, Roehrborn CG, Castro-Santamaria R, Freedland SJ, Moreira DM
出　　處 The Journal of Urology, 2016 Nov;196(5):1493-1498
出版日期 November, 2016
評 論 本研究是從一個為期四年的縱貫性研究REDUCE (Reduction by Dutasteride of Prostate Cancer Events)中，分析發炎(inflammation)和良性攝護腺腫大及下尿路症狀的相關性。受試者在研究起始點都接受攝護腺病理切片檢查。在4109位無攝護腺癌的男性中，急性和慢性攝護腺發炎的比例為15.6 %及78.3 %。慢性攝護腺發炎的人，有較高的IPSS (0.6, p = 0.001)及較大的攝護腺體積(3.2 cc, p <0.001)。其發生急性尿滯留的危險性也較高(HR 1.6-1.8, p = 0.001)。而急性發炎和良性攝護腺腫大的發生和疾病進展，無明顯相關性。近年來研究顯示，慢性發炎在良性攝護腺腫大的發生和進展上，有重要的角色。可能的機制為，慢性發炎造成組織持續性受傷及癒合，進而導致腫大形成。目前攝護腺發炎的診斷，主要是依據組織學研究腺體內浸潤性淋巴球表現，其他如相關症狀、理學指診、攝護腺鈣化、尿液及其他生物指標等，也有助於臨床診斷。從臨床角度來看，良性攝護腺腫大常合併慢性發炎現象。這些病患的下尿路症狀往往較為嚴重，而藥物治療的效果也較差。現今攝護腺腫大及下尿路症狀的常用藥物，並無明顯的抗發炎作用。針對此標的研發的藥物，如hexanic lipidosterolic extract of Serenoa repens, nonsteroidal anti-inflammatory drugs, 和vitamin D receptor agonists等，是未來治療的展望，甚至可能預防良性攝護腺腫大。
abstract

Purpose
We evaluated associations between histological prostate inflammation, and the development and progression of benign prostatic hyperplasia/lower urinary tract symptoms in men randomized to placebo in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study in a 4-year period.

Materials and Methods
The association of acute and chronic inflammation detected on baseline biopsies and benign prostatic hyperplasia related parameters, including I-PSS (International Prostate Symptom Score) and prostate volume, at multiple time points during 4 years in men randomized to placebo enrolled in the REDUCE prostate cancer prevention study was analyzed with the Student t-test. The association of inflammation with newly developed benign prostatic hyperplasia/lower urinary tract symptoms and benign prostatic hyperplasia progression in patients with existing benign prostatic hyperplasia/lower urinary tract symptoms was analyzed with univariable and multivariable Cox models.

Results
Acute and chronic inflammation was seen in baseline negative biopsies of 641 (15.6%) and 3,216 (78.3%) of the 4,109 men in the study. Chronic but not acute inflammation was associated with slightly higher baseline I-PSS (0.6 difference, p = 0.001) and larger prostate volume (3.2 cc difference, p <0.001), a difference noted throughout the study interval. The presence of acute and chronic inflammation was not associated with the incidence of benign prostatic hyperplasia/lower urinary tract symptoms in men without those conditions at baseline or the progression of symptomatic benign prostatic hyperplasia in men with benign prostatic hyperplasia/lower urinary tract symptoms at baseline. However, an association was observed with more severe inflammation. Chronic inflammation at baseline was associated with an increased risk of acute urinary retention (HR 1.6–1.8, p = 0.001).

Conclusions
Our longitudinal evaluation of REDUCE patients randomized to placebo for 4 years confirmed that chronic inflammation is associated with severity and the progression of benign prostatic hyperplasia and benign prostatic hyperplasia/lower urinary tract symptom outcomes.
回覆發表 回覆討論主題內容 最後發表
目前尚無任何相關的回覆資料