【作者】 李波；

【导师】 郭宏骞；

【作者基本信息】 南京大学 ， 外科学， 2012， 硕士

【摘要】 目的：比较单纯BPH组、BPH合并糖尿病及高血压组、BPH合并糖尿病组、BPH合并高血压组4组患者的生存质量、勃起功能、下尿路症状及尿流率,分析每组患者生存质量、勃起功能、下尿路症状及尿流率的相关性。方法：选取2011年10月-2012年4月就诊于南京大学医学院附属鼓楼医院泌尿外科被确诊为BPH且资料完整的110例患者为研究对象,年龄48-89岁。采用面对面交谈的方式询问患者病史,运用健康测量量表SF-36、国际勃起功能问卷表(IIEF-5)、国际前列腺症状评分(IPSS)来获取患者生存质量、勃起功能、下尿路症状评分,采用Laborie尿动力学仪检测患者最大尿流率(Qmax)、尿流时间和总尿量。计算相对排尿阻力=尿流时间/Qmax。结果：4组患者年龄比较无显著统计学差异(P=0.150)。4组患者的生存质量仅在总体健康维度上有显著差异(P=0.008),进一步分析显示BPH合并糖尿病及高血压组的总体健康显著低于单纯BPH组(χ2=10.41,0.01＜P＜0.025)及BPH合并高血压组(χ2=8.14,0.025＜P＜0.05),总体健康其他组间比较均无显著统计学差异。4组患者的IIEF-5比较处于有显著统计学差异的临界值(P=0.051)。4组患者的IPSS评分、尿流率均无显著统计学差异(P＞0.05)。单纯BPH组、BPH合并糖尿病及高血压组、BPH合并高血压组的精神健康维度均只与年龄呈正相关,而与本研究中的其他因素无关；BPH合并糖尿病组的精神健康维度则与年龄无关,而与IPSS储尿期评分及IPSS生活质量评分呈负相关。单纯BPH组、BPH合并糖尿病及高血压组的生理机能、生理职能均与ⅡEF-5呈正相关,而BPH合并糖尿病组、BPH合并高血压组生存质量各维度均与IIEF-5不相关。单纯BPH组的总体健康维度与IPSS,总分、IPSS排尿期评分、IPSS生活质量评分均呈负相关,而另外3组的总体健康维度则与本研究中的因素都没有相关性。单纯BPH组的生理机能、生理职能维度均与Qmax呈正相关,而另外3组的生理机能、生理职能维度均与Qmax不相关；BPH合并高血压组的社会功能、情感职能维度均与Qmax呈负相关,而另外3组的社会功能、情感职能均与Qmax不相关。4个疾病维度下BPH患者的躯体疼痛与年龄、IIEF-5、IPSS及尿流率均无显著相关性(P＞0.05)。单纯BPH组、BPH合并糖尿病及高血压组的年龄与IPSS均没有相关性；而BPH合并糖尿病组的年龄与IPSS总分、IPSS排尿期评分呈正相关,BPH合并高血压组的年龄则与IPSS储尿期评分呈非常显著正相关。单纯BPH组的年龄与IIEF-5、总尿量呈负相关,而在另外3组则没有发现年龄与勃起功能、尿流率的相关性。单纯BPH组IIEF-5与IPSS总分、IPSS储尿期评分、IPSS排尿期评分、IPSS生活质量评分均呈负相关,BPH合并糖尿病组的ⅡEF-5仅与IPSS生活质量评分呈负相关,BPH合并高血压组的IIEF-5则仅与IPSS生活质量评分呈正相关,BPH合并糖尿病及高血压组的IIEF-5与IPSS没有相关性。单纯BPH组的IIEF-5与总尿量、Qmax均呈正相关,与相对排尿阻力呈负相关,而另3组的IIEF-5与尿流率均无相关性。单纯BPH组的IPSS总分、IPSS储尿期评分、IPSS排尿期评分、IPSS生活质量评分均与总尿量、Qmax、尿流时间、相对排尿阻力相关,而BPH合并糖尿病及高血压组仅有IPSS生活质量评分与Qmax相关。结论：糖尿病、高血压等基础疾病对BPH患者生存质量有一定影响。BPH合并糖尿病或高血压时,患者的勃起功能进一步降低。不同疾病维度下BPH患者的年龄、生存质量、IIEF-5、IPSS及尿流率的相关性有相当大的差异。更多还原

【Abstract】 Objective:To compare the quality of life, erectile function, lower urinary tract symptoms’and uroflowmetry in four groups such as benign prostatic hyperplasia simplex(BPH simplex), BPH with diabetes mellitus (DM) and hypertension, BPH with DM and BPH with hypertension. And to evaluate the relation between quality of life, erectile function, lower urinary tract symptoms and uroflowmetry in each group.Methods:110patients (range48-89years), diagnosed as BPH and having complete data, were included in the study from October2011to April2012in Department of Urology, Affiliated Drum Tower Hospital, Medical College of Nanjing University. History-taking was carried out face to face, and quality of life, erectile function and lower urinary tract symptoms were estimated by The Medical Outcomes Study36-ltem Short-Form Health Survey(SF-36), International Index of Erectile Function(IIEF-5), International Prostate Symptom Score (IPSS) respectively. The maximum flow rate(Qmax), flow time and total volume of urine were measured by Laborie urodynamic apparatus. Relative voiding resistance=flow time/Qmax.Results:No statistical difference was found in age in the four groups(P=0.150).In8domains of SF-36, only general health was observed with significant difference among four groups (P=0.008), and further analysis revealed that the general health in BPH with DM and hypertension group was inferior to BPH simplex group (x2=10.41,0.01<P<0.025) and BPH with hypertension group (x2=8.14,0.025<P<0.05), but the rest were not significant difference each other. IIEF-5was on the border of significant difference among four groups (P=0.051) There were no significant difference in IPSS or uroflowmetry among four groups (P>0.05)Mental health was positively correlated with age only, not correlated with any other factor in the study, in the BPH simplex group, BPH with DM and hypertension group and BPH with hypertension group. Mental health was not correlated with age, but correlated negatively with IPSS storage score and IPSS quality of life score(IPSS-QoL) in BPH with DM group. IIEF-5was positively correlated with both physical functioning and role-physical in the BPH simplex group and BPH with DM and hypertension group, but not correlated with any domain of SF-36in BPH with DM group or BPH with hypertension group. General health was negatively correlated with IPSS total score, IPSS voiding score and IPSS-QoL in BPH simplex group, but not correlated with any factor in the study in the other three groups. Qmax was positively correlated with both physical functioning and role-physical in the BPH simplex group, but not correlated with physical functioning or role-physical in the other three groups. Qmax was negatively correlated with both social functioning and role-emotional in the BPH with hypertension group, but not correlated with social functioning or role-emotional in the other three groups. Bodily pain was not correlated with any factor in the study in any group(P>0.05).Age was not correlated with any IPSS score in the BPH simplex group or BPH with DM and hypertension group, but correlated positively with both IPSS total score and IPSS voiding score in BPH with DM group, and correlated extremely positively with IPSS storage score in BPH with hypertension group. Age was negatively correlated with both IIEF-5and total volume of urine in the BPH simplex group, but not correlated with IIEF-5or any uroflowmetry parameter in the other three groups. IIEF-5" was negatively correlated with IPSS total score, IPSS storage score, IPSS voiding score and IPSS-QoL in the BPH simplex group, but correlated negatively with IPSS-QoL only in BPH with DM group, and correlated positively with IPSS-QoL only in BPH with hypertension group. There was no significant correlation between IIEF-5and any IPSS score in BPH with DM and hypertension group. IIEF-5was positively correlated with both total volume of urine and Qmax and correlated negatively with relative voiding resistance in the BPH simplex group, but not correlated with any uroflowmetry parameter in the other three groups. Any IPSS score was correlated significantly with any uroflowmetry parameter in the BPH simplex group, but only IPSS-QoL was correlated significantly with Qmax in the BPH with DM and hypertension group.Conclusion:Basal disease such as DM or hypertension has certain impact on the quality of life of patients with BPH. When merged with DM or hypertension, the patients’erectile function decreases further. The relation between age, quality of life, IIEF-5, IPSS and uroflowmetry varies greatly due to the patients’different dimensions of disease.更多还原