良性前列腺增生/下尿路症状对心血管疾病复发的影响:一项来自中国健康与养老追踪调查数据库的队列研究

Benign prostatic hyperplasia/lower urinary tract symptoms and their impact on the recurrence of cardiovascular disease:a cohort study from the China Health and Retirement Longitudinal Study database

目的探讨良性前列腺增生(BPH)/下尿路症状(LUTS)对心血管疾病(CVD)复发风险的影响。方法本研究为基于中国健康与养老追踪调查(CHARLS)数据库的前瞻性队列研究。纳入标准为2011年通过全国基线调查的参与者,排除标准为:①女性参与者;②基线时无BPH/LUTS相关信息的参与者;③基线时未发生过CVD的参与者。比较BPH/LUTS患者与非BPH/LUTS患者一般资料的差异。采用Cox比例风险模型分析BPH/LUTS是否为CVD复发的危险因素。结果最终纳入患有脑卒中或心脏病的中老年男性患者903例,其中BPH/LUTS患者324例(36.9%),非BPH/LUTS患者579例(64.1%)。BPH/LUTS患者较非BPH/LUTS患者合并高血压病[186例(57.4%)与165例(28.5%),P=0.014]、血脂异常[100例(31.2%)与104例(18.2%),P<0.001]、糖尿病[55例(17.2%)与57例(9.8%),P=0.002]、慢性肾病[71例(22.2%)与56例(9.8%),P<0.001]、慢性肺病[87例(26.9%)与117例(20.3%),P=0.029]的比例更高。随访7年,CVD共复发341例(37.8%),其中心脏病复发319例(35.3%),脑卒中复发38例(4.2%)。在多因素调整Cox回归模型中,BPH/LUTS是CVD复发(HR=1.41,95%CI1.12~1.77,P=0.003)和心脏病复发(HR=1.40,95%CI1.10~1.77,P=0.005)的危险因素,而BPH/LUTS不是脑卒中复发的危险因素(HR=2.05,95%CI0.97~4.32,P=0.058)。对年龄进行分层分析,在年龄≤65岁的人群中BPH/LUTS是CVD复发(HR=1.43,95%CI1.07~1.91,P=0.002)和心脏病复发(HR=1.40,95%CI 1.03~1.90,P=0.006)的危险因素,而不是脑卒中复发的危险因素(HR=2.16,95%CI0.98~6.09,P=0.053)。在年龄>65岁的患者中,BPH/LUTS不是CVD复发(P=0.110)、心脏病复发(P=0.096)和脑卒中复发(P=0.830)的危险因素。结论BPH/LUTS与CVD复发风险增加密切相关,尤其对于年龄≤65岁的CVD患者。因此,对于年龄≤65岁中老年男性CVD患者,预防并积极治疗BPH/LUTS可能具有重要的意义。

Objective To explore the impact of benign prostatic hyperplasia(BPH)/lower urinary tract symptoms(LUTS)on the risk of cardiovascular diseases(CVD)recurrence.Methods sThis study is a prospective cohort study based on the China Health and Retirement Longitudinal Study(CHARLS)database.The inclusion criteria were participants who underwent the national baseline survey in 2011.The exclusion criteria were as follows:①female participants;②participants without BPH/LUTS information at baseline;③participants who had not experienced CVD at baseline.The basic characteristics of BPH/LUTS patients and non-BPH/LUTS patients was compared.The Cox proportional hazards model was used to analyze whether BPH/LUTS is a risk factor for CVD recurrence.Results A total of 903 male patients with stroke or heart disease were finally included,among which there were 324(36.9%)cases of BPH/LUTS and 579(64.1%)cases without BPH/LUTS.Patients with BPH/LUTS had a higher proportion of comorbidities such as hypertension[186 cases(57.4%)vs.165 cases(28.5%),P=0.014],dyslipidemia[100 cases(31.2%)vs.104 cases(18.2%),P<0.001],diabetes[55 cases(17.2%)vs.57 cases(9.8%),P=0.002],chronic kidney disease[71 cases(22.2%)vs.56 cases(9.8%),P<0.001],and chronic lung disease[87 cases(26.9%)vs.117 cases(20.3%),P=0.029]compared to those without BPH/LUTS.During the 7-year follow-up,there were 341(37.8%)cases of CVD recurrence,including 319(35.3%)cases of heart disease recurrence and 38(4.2%)cases of stroke recurrence.In the multifactorial adjusted Cox regression model,BPH/LUTS was a risk factor for CVD recurrence(HR=1.41,95%CI 1.12-1.77,P=0.003)and heart disease recurrence(HR=1.40,95%CI 1.10-1.77,P=0.005),while BPH/LUTS was not a risk factor for stroke recurrence(HR=2.05,95%CI 0.97-4.32,P=0.058).When stratified by age,in the population aged≤65 years,BPH/LUTS was a risk factor for CVD(HR=1.43,95%CI 1.07-1.91,P=0.002)and heart disease recurrence(HR=1.40,95%CI 1.03-1.90,P=0.006),but not for stroke recurrence(HR=2.16,95%CI 0.98-6.09,P=0.053).In patients aged>65 years,BPH/LUTS was not a risk factor for CVD(P=0.110),heart disease(P=0.096),or stroke recurrence(P=0.830).Conclusions BPH/LUTS is closely related to an increased risk of CVD recurrence,especially for CVD patients aged≤65 years old.Therefore,for elderly male CVD patients aged≤65 years,preventing and actively treating BPH/LUTS may have significant implications.