老年人良性前列腺增生症与胰岛素抵抗

Relationship between benign prostatic hyperplasia and insulin resistance in elderly men

目的 观察胰岛素抵抗和空腹胰岛素（FINS）水平与老年良性前列腺增生（BPH）的关系. 方法 以2008年2月在湘雅二医院老年病科门诊就诊的BPH患者68例为观察对象,分析FINS、血清前列腺特异性抗原（PSA）、糖化血红蛋白、空腹血糖、餐后2 h血糖,计算胰岛素抵抗指数（HOMA-IR）.测量血压、体质量、身高、腹围,计算体质指数.测定前列腺体积,评估下尿路症状（LUTS）,并询问LUTS出现的时间. 结果 （1）按照HOMA-IR＞2.8为胰岛素抵抗,将患者分为敏感组48例和抗组20例,结果显示抵抗组患者的前列腺体积高于敏感组,分别为（61.1±32.9）ml和（40.4±16.5）ml,差异有统计学意义（P＜0.05）;两组PSA分别为（3.3±2.3）μg/L与（2.9±1.3）μg/L,差异无统计学意义（P＞0.05）;LUTS出现时间（13.4±6.6）年和（8.7±6.0）年,差异无统计学意义（P＞0.05）;国际前列腺症状评分（IPSS）分别为（16.4±6.7）分和（13.3±7.1）分,差异无统计学意义（P＞0.05）.（2）以前列腺症状药物治疗（MTOPS）研究的进展性评价指标为标准,将患者分为低进展组与高进展组,分别为30例和38例,两组FINS、HOMA-IR比较,差异有统计学意义（均P＜0.01）.（3）前列腺体积与HOMA-IR、FINS呈正相关（r值分别为0.431和0.492,均P＜0.01）.结论老年BPH患者存在胰岛素抵抗,胰岛素抵抗程度、高FINS水平与前列腺体积的增大及疾病进展有关.

Objective To explore the relationship between insulin resistance （IR） and benign prostatic hyperplasia （BPH） in elderly men. Methods All BPH outpatients in Geriatric department of the second Xiang Ya Hospital in Feb 2008 were recruited in this study. Bioche assays including insulin （FINS）, prostate specific antigen （PSA）, HbAlc, fasting plasma glucose, 2 hours postprandial blood glucose were performed and HOMA-IR were calculated. The blood pressure, body weight, height and waist circumference were measured, and the body mass index （BMI） was calculated. Prostate volume （PV） was measured by abdominal ultrasound, lower urinary tract symptoms （LUTS） was evaluated by International Prostate Symptom Score （IPSS） and inquired about the history of LUTS in detail. Results （1） HOMA-IR〉 2.8 was diagnosed as insulin resistance （IR）. The patients were divided into two groups： insulin sensitivity （IS） group （n=48） and IR group （n=20）. The PV level was higher in IR group than in IS group [（61.1-32. 9） ml vs. （40.4±16.5）ml, P〈0. 05], there were no statistical differences in PSA [（3.3±2.3） μg/L vs. （2.91±1.3） μg/L, P〉0.05], the history of LUTS [（13.4±6.6）years vs. （8.7±6.0）years, P〉0.05], IPSS [（16.42±6.67）scores vs. （13. 29±7.09）scores, P〉0. 05] between the two groups. （2）According to BPH progressivity evaluation provided by MTOPS study （age≥62 years, PSA≥1. 6 μg/L, PV≥31 ml）, the patients were divided into two groups： low progressive risk group （n= 30） and high progressive risk group （n= 38）. The FINS and HOMA-IR levels were significantly higher in highprogressive risk group than in low progressive risk group （all P〈0. 01）. （3）The PV was positively correlated with HOMA-IR level and FINS level （r= 0. 431, 0. 492, P〈0. 01）. Conclusions IR exists in majority of elderly BPH patients, the degree of IR and relative high level of FINS are related to the enlargement of PV and the development of BPH.