不同血糖代谢状态的良性前列腺增生患者胰岛β细胞功能及相关危险因素的研究

摘要

目的：分析不同血糖代谢状态的良性前列腺增生（ BPH）患者胰岛β细胞功能及相关生化等指标情况，探讨前列腺体积与各指标的相关性。方法选取144例住院的BPH患者，根据口服葡萄糖耐量试验（ OGTT）结果分为正常血糖（NGR）组（n＝63）、糖调节受损（IGR）组（n＝53）及糖尿病（DM）组（n＝28）。测量各组人群血压、身高、体重，计算体重指数（ BMI），测量空腹血糖（ FPG）、空腹胰岛素（ FINS）、空腹血脂、糖化血红蛋白（ HbA1c）、前列腺特异抗原（PSA）、游离前列腺特异性抗原（fPSA）、糖负荷后2 h血糖（2h PG），2 h胰岛素（2 h Ins）。采用国际前列腺症状评分（ IPSS）评价患者临床症状，超声测量前列腺大小并计算前列腺体积。结果 DM组BMI、甘油三酯（ TG）均高于NGR组、IGR组（ P ﹤0.05），DM组的FPG、2 h PG、HbA1c均高于IGR组、NGR组（α"﹤0.017）；IGR组FPG、2 h PG均高于NGR组（α"﹤0.017）。从NGR 组至IGR、DM组，胰岛素抵抗指数（ HOMA-IR）呈逐渐增高的趋势；DM组HOMA-IR高于IGR组、NGR组（α"﹤0.017）。DM组及IGR组2 h Ins均高于NGR组（α"﹤0.017）。从NGR组到IGR组、DM组，患者PV呈逐渐增高的趋势，且DM组PV高于NGR组（α"﹤0.017）。多元线性回归分析显示PV与年龄、FINS、2h Ins呈正相关。结论随着BPH患者糖耐量的恶化，胰岛素抵抗逐渐加重，前列腺体积逐渐增加；年龄、高胰岛素血症是前列腺增生发生及进展的高危因素。%Objective To analyze pancreatic beta cell function and related biochemical indexes in benign prostatic hyperplasia( BPH)pa-tients in different state of glucose metabolism,to explore the correlation between prostate volume( PV)and the indexes. Methods The subjects consisted of 144 hospital patients with BPH. According to oral glucose tolerance test( OGTT)results,the patients were divided into three groups, including 63 normal blood glucose regulation patients( NGR group),53 impaired glucose regulation patients( IGR group),28 diabetes mellitus pa-tients(DM group). Blood pressure,height,weight,fasting plasma glucose(FPG),fasting insulin(FINS),blood fat,HBA1c,2 h plasma glu-cose(2 hPG),2 h insulin(2 h Ins),serum prostate specific antigen( PSA)and free prostate-specific antigen( fPSA)were examined. The body mass index( BMI),prostate volume( PV),homeostasis model assessment of insulin resistance( HOMA-IR)and basic insulin secretion in-dex( HOMA-%β)were measured. Clinical symptoms of patients were evaluated by International Prostate Symptom Score( IPSS). Results In DM group,the BMI,triglycerides(TG)were statistically higher than thsoe in IGR group and NGR group( P ﹤0. 05). The FPG、2 h PG、HbA1c were higher in DM group than those in IGR group and NGR group(α﹤0. 017). The FPG,2 h PG were higher in IGR group than those in NGR group(α﹤0. 017). From NGR group to IGR,DM group,HOMA-IR and PV showed a trend of increased gradually,the PV,HOMA-IR were higher in DM group than those in NGR group(α"﹤0. 017),the HOMA-IR was higher in DM group than that in IGR group(α"﹤0. 017). The 2 h Ins were higher in both DM group and IGR group than NGR group(α"﹤0. 017). The results showed that PV was positive correlated with age,FINS,2 h Ins by multiple linear regression analysis. Conclusion With the deterioration of glucose tolerance in BPH patients,insulin resistance increases gradually,and prostate volume increases gradually. Age,hyperinsulinism are risk factors in the development of prostatic hy-perplasia.