锦州地区男性吸烟、体质量指数与临床良性前列腺增生的危险性研究(英文)

Cigarette smoking, body mass index associated with the risks of clinical benign prostatic hyperplasia in male patients from Jinzhou area

背景:良性前列腺增生是一种老年男性常见的疾病,尽管发病的危险因素仍不清楚,但是诸多生活方式因素对此病具有一定的影响作用。目的:观察锦州地区男性吸烟、体质量指数与临床良性前列腺增生危险性之间的关系。设计:病例对照观察。单位:华中科技大学同济医学院流行病与统计学系;辽宁医学院预防医学教研室。对象:选择2004-05/2006-05在辽宁医学院附属第一及第三医院、锦州中心医院和锦州市第二人民医院泌尿外科收治的343例良性前列腺增生行外科手术患者为病例组,年龄50￣82岁。纳入标准:①年龄>50岁,I-PSS症状分>7。②排尿后直肠指检前列腺Ⅰ度以上(横径>3cm)。③B超检查示前列腺体积≥30g。④最大尿流率<15mL/s;选择同期入住于上述医院,因患各种与良性前列腺增生、前列腺癌以及前列腺炎危险因素无关疾病的361例患者为对照组,年龄50￣82岁,平均65岁。所有患者均对调查内容知情并同意。方法:采用标准调查表对病例组和对照组患者进行调查,定义一生总吸烟量≥20包为吸烟者,反之为不吸烟者。根据吸烟量分成不吸烟、吸烟量1￣19支/d、吸烟量20￣29支/d和吸烟量≥30支/d,并按吸烟的时间分为不吸烟、1￣19年、20￣29年和≥30年。通过询问法,获得受试对象体质量指数,分为体质量指数<18.4、正常(体质量指数18.5￣23.9)、超重(体质量指数24.0￣27.9)和肥胖(体质量指数≥28);调查患者文化程度分为文化程度<7年,7￣11年和≥12年,患者的职业分为工人、农民、知识分子及其他。将调查结果输入计算机、建立数据库,应用多元Logistic模型分析患者吸烟量、吸烟时间、体质量指数、文化程度、职业与临床良性前列腺增生的比值比(OR)和95%可信限(CI)。主要观察指标:患者吸烟量、吸烟时间、体质量指数、文化程度、职业与临床良性前列腺增生的关系。结果:纳入病例组患者343例,对照组361例均进入结果分析。①吸烟量≥30支/d患者与不吸烟者相比,发生临床良性前列腺增生的危险性增加(OR=1.32,95%CI为0.92￣2.58,P<0.01)。②超重及肥胖吸烟者发生临床良性前列腺增生的危险性较不吸烟者显著增高(OR=1.68,2.35,95%CI分别为1.32￣3.67,1.83￣4.16,P<0.01)。③体力劳动者(农民)与发生良性前列腺增生的危险性呈负相关(P<0.05)。脑力劳动者(知识分子)发生临床良性前列腺增生的危险性高于对照组(χ2=6.62,P<0.01)。结论:吸烟≥30支/d的男性与临床良性前列腺增生呈正相关,超重(体质量指数24.0￣27.9)和肥胖(体质量指数≥28.0)的男性吸烟发生临床良性前列腺增生的危险性显著地升高。

BACKGROUND： Benign prostatic hyperplasia is a common disease of older males. Although the etiology remains unclear the factors of life style and habits may have an effect on the disease. OBJECTIVE： To examine the association of cigarette smoking and body mass index with the risk of clinical benign prostatic hyperplasia. DESIGN ： A hospital-based case-control study SETTINGS： Department of Epidemiology and Statistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology; Department of Preventive Medicine, Liaoning Medical College. PARTICIPANTS： Totally 343 males with benign prostatic hyperptasia of 50-82 years old （patient group）, who were surgically treated between May 2004 and May 2006, were selected from the Department of Urinary Surgery of the First Affiliated Hospital and Third Affiliated Hospital of Liaoning Medical College （former Jinzhou Railway Central Hospital）, Jinzhou Central Hospital and Jinzhou Second People＇s Hospital. Inclusive criteria： （1） males above 50 years old; international prostatic symptom score （IPSS） 〉 7; （2） Digital recta examination （DRE） after miction indicated prostate grade Ⅰ （transverse diameter 〉 3 cm）; （3） prostatic volume ≥ 30 g; （4） maximum urinary flow rate 〈 15 mL/s; Meanwhile, 361 inpatients with diseases irrelative to the risk factors of benign prostatic hyperplasia, prostatic cancer and prostatitis were selected from the above hospitals as the control group, they were 50-82 years of age with an average of 65 years old. Informed contents were obtained from all the enrolled subjects. METHODS ： All the patients and controls were interviewed using an anonymous questionnaire. All participants were asked to report whether they had smoked 20 packs of cigarettes or more in their lifetimes and, if yes, they were smokers, on the contrary they were non-smokers. Based on usual number of cigarettes reported in the questionnaire, men were categorized as 1-10, 11-20, 21-30 and 〉 30 cigarettes per day. Based on duration of smoking, the participants were further classified as never smoke, 1-19, 20-29 and ≥ 30 years. Body mass index （BMI） was assessed from measured body mass and body height, and the standards of BMI in adults in China was 18.5-23.9 for normal, 24.0-27.9 for overweight and ≥ 28.0 for obesity）, then the participants were further classified as BMI 〈 18.4, 18.5-23.9, 24.0-27.9 and /〉 28.0 subgroups respectively. Years of education （〈 7, 7 -11, and ≥ 12） and occupation （worker, peasant, intellectual and others） were also investigated. The results of the investigation were input into computer to establish database, the odds ratios （OR） and the 95% confidence interval （C/） in relation to the various measures were estimated using unconditional multiple logistic regression models, including number of cigarettes smoked per day, BMI, years smoked, years of education, occupation. MAIN OUTCOME MEASURES： Relationships of number of cigarettes smoked per day, years smoked, BMI, years of education and occupation with benign prostatic hyperplasia. RESULTS： Totally 343 cases in the patient group and 361 cases in the control group were involved in the analysis of results. （1） Patients smoked /〉 30 cigarettes per day had an elevated risk of benign prostatic hypertrophy as compared with the non-smokers （OR =1.32, 95% Ct 0.92-2.58, P 〈 0.01）. （2） The risks of benign prostatic hypertrophy in overweight and obesity were significantly increased as compared with non-smokers （OR = 1.68, 95%Ct 1.32-3.67; OR = 2.35, 95%Ck 1.83-4.16）. （3） Manual worker （peasant） was negatively correlated with the risk of benign prostatic hyperplasia （X^2=6.62, P 〈 0.01）. CONCLUSION ： Smoking 30 cigarettes per day was positively related to benign prostatic hyperplasia. For male who were both overweight （BMI 24.0-27.9） and obesity （BMI ≥ 28.0）, smoking,was significantly associated the increased risk of surgically treated benign prostatic hyperplasia.