对比两种中医证型前列腺增生患者的前列腺体积、尿动力学指标、炎症因子及PSA水平

Comparison of prostate volume,urinary fluid dynamics indexes,inflammatory factors,and PSA levels between two traditional Chinese medicine syndrome types of benign prostate hyperplasia patients

目的 探究两种中医证型前列腺增生(BPH)患者的前列腺体积(PV)、血清尿动力学指标、炎症因子及前列腺特异性抗原(PSA)水平差异。方法 将2021年5月至2023年9月佛山市南海区中医院(广东省中西医结合医院)泌尿外科收治的肾气亏虚型、肾阳衰惫型BPH患者纳入本次前瞻性研究,分别为肾气亏虚组(n=72)、肾阳衰惫组(n=84)。比较两组患者的PV、国际前列腺症状评分(I-PSS)、尿动力学参数[最大尿流率(Qmax)、平均尿流率(Qave)、残余尿量(RUV)、膀胱最大容量(MCC)和逼尿肌压力(Pdet)]、炎症因子[白细胞计数(WBC)、C反应蛋白(CRP)]、D-二聚体、PSA水平。结果 肾气亏虚组的PV、I-PSS评分为(105.66±46.26) mL、(27.49±3.89)分,显著高于肾阳衰惫组[(81.07±40.85)mL、(19.80±3.26)分],差异均有统计学意义(P<0.05)。肾气亏虚组的Qmax、Qave、MCC和Pdet分别为(9.22±4.70)mL/s、(5.03±2.05)mL/s、(217.81±111.45)mL和(70.93±29.12)cm/H_(2)O,均显著低于肾阳衰惫组[(10.91±5.20)mL/s、(5.95±2.01)mL/s、(282.53±98.15)mL和(85.91±29.87)cm/H_(2)O],而RUV为(80.54±30.21)mL,显著高于肾阳衰惫组[(52.33±23.15)mL],差异均有统计学意义(P<0.05)。肾气亏虚组的WBC、CRP、D-二聚体和PSA分别为(8.29±2.63)×10^(9)/L、(15.09±5.70)mg/L、(1.58±0.64)μg/mL、(1.58±0.64)μg/mL和(6.73±2.01)ng/mL,均显著高于肾阳衰惫组[(7.22±2.13)×10^(9)/L、(13.01±6.35)mg/L、(1.32±0.61)μg/mL、(1.32±0.61)μg/mL和(4.24±1.79)ng/mL],差异均有统计学意义(P<0.05)。结论 在两种中医证候患者中,肾气亏虚型BPH患者的PV最大,症状、尿动力学、炎症程度和PSA最为严重。当BPH辨证分型产生矛盾时结合临床相关数据可帮助提高BPH的分型准确性,为临床辨证提供更多依据。

Objective To explore the differences in prostate volume(PV),urinary fluid dynamics indexes,inflammatory factors,and prostate-specific antigen(PSA) levels between two traditional Chinese medicine syndrome types of benign prostate hyperplasia(BPH) patients.Methods Kidney-essence deficiency syndrome,kidney-yang deficiency syndrome of BPH patients admitted to Foshan Nanhai District Traditional Chinese Medicine Hospital(Guangdong Integrated Traditional Chinese and Western Medicine Hospital) from May 2021 to September 2023 were included in this prospective study and were classified into the kidney-essence deficiency group(n=72),kidney-yang deficiency group(n=84).The PV,International Prostate Symptom Score(I-PSS),urinary dynamic parameters[include maximum urinary flow rate(Qmax),average urinary flow rate(Qave),post-void residual volume(RUV),maximum cystometric capacity of the bladder(MCC) and detrusor pressure during voiding(Pdet)],inflammatory factors [including white blood cell count(WBC),C-reactive protein(CRP)],and D-dimer(D-D),and PSA were compared.Results The PV,I-PSS score of the kidney-essence deficiency group were(105.66±46.26) mL,(27.49±3.89) points,respectively,which were higher than those of the kidney-yang deficiency group [(81.07±40.85) mL,(19.80±3.26) points],the differences were statistically significant(P<0.05).The Qmax,Qave,MCC,and Pdet of kidney-essence deficiency group were(9.22±4.70) mL/s,(5.03±2.05) mL/s,(217.81±111.45) mL,and(70.93±29.12) cm/H_2O,respectively,which were significantly lower than those in kidney-yang deficiency group [(10.91±5.20) mL/s,(5.95±2.01) mL/s,(282.53±98.15) mL,and(85.91±29.87) cm/H_2O],RUV of kidney-essence deficiency group was(80.54±30.21) mL,which was higher than that in the kidney-yang deficiency group[(52.33±23.15) mL],the differences were statistically significant(P<0.05).The WBC,CRP,D-D,and PSA of kidney-essence deficiency group were(8.29±2.63)×10^(9)/L,(15.09±5.70) mg/L,(1.58±0.64) μg/mL,and(6.73±2.01) ng/mL,respectively,which were higher than those in kidney-yang deficiency group[(7.22±2.13)×10^(9)/L,(13.01±6.35) mg/L,(1.32±0.61) μg/mL,and(4.24±1.79) ng/mL],the differences were statistically significant(P<0.05).Conclusion Among the two types of traditional Chinese medicine syndrome patients,BPH patients with kidney-essence deficiency syndrome have the highest PV,while symptoms,urodynamics,inflammation degree,and PSA are the most severe.When there are contradictions in the differentiation and classification of BPH,combining clinical relevant data can help improve the accuracy of BPH classification and provide more basis for clinical differentiation.