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青年肥胖男性人群中下尿路症状的流行病学特点及相关危险因素分析
作者:

李炫昊1  胡德超1  刘洋2  沈宏亮1  王文营1   宋健1   王今2  张忠涛2  田野1

Authors: Li Xuanhao1, Hu Dechao1, Liu Yang2, Shen Hongliang1, Wang Wenying1, Song Jian1, Wang Jin2, Zhang Zhongtao2, Tian Ye1
单位: 1首都医科大学附属北京友谊医院泌尿外科 北京市卫健委泌尿外科研究所 100050;2首都医科大学附属北京友谊医院普通外科 国家消化系统疾病临床医学研究中心 100050
Units: 1Department of Urology, Beijing Friendship Hospital, Capital Medical University, Institute of Urology, Beijing Municipal Health Commission, Beijing 100050, China; 2Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
关键词: 肥胖症;前列腺增生;男性;下尿路症状
Keywords: Obesity;Prostatic hyperplasia;Males;Lower urinary tract symptoms
分类号:
出版年,卷(期):页码:2020,47(1):17-23
摘要:

 目的  分析青年肥胖男性人群中下尿路症状(LUTS)的流行病学特点及相关危险因素。方法 选取2018年10月—2019年6月首都医科大学附属北京友谊医院收治的年龄为20~40岁的126例青年男性,其中就诊于代谢减重门诊的肥胖患者74例,纳入试验组;于体检中心进行正常体检的健康人群52例,纳入对照组。对比两组研究对象的血压(收缩压、舒张压),胰岛素抵抗水平(空腹血糖、胰岛素、C肽),血脂代谢(甘油三酯、高密度脂蛋白胆固醇),性激素(雌二醇、血清睾酮),C反应蛋白(CRP),国际前列腺症状评分(IPSS)及生活质量评分(QOL)等方面的差异。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ2检验;体重指数和LUTS的相关性采用Spearman等级相关分析,LUTS与各临床变量的危险因素采用单因素logistic回归分析,并对差异变量进行多因素logistic回归分析。结果

试验组和对照组研究对象在收缩压[(144.30±15.78) mmHg 比 (125.96±6.11) mmHg,P<0.001)]、舒张压[(89.46±12.76) mmHg 比 (81.35±4.58) mmHg,P=0.001]、空腹血糖[(6.73±3.15) mmol/L 比 (5.26±1.47) mmol/L,P=0.016]、胰岛素[(26.60±19.09) mg/dL 比 (13.43±7.68) mg/dL,P<0.001]、C肽[(4.20±1.73) ng/mL 比 (1.59±0.52) ng/mL,P=0.001]、甘油三酯[(2.42±1.88) mg/dL 比 (1.45±0.79) mg/dL,P=0.007]、雌二醇[(52.32±21.77) ng/L比 (42.11±12.19) ng/L,P=0.023]和CRP[(6.49±4.96) mg/L 比 (1.62±1.53) mg/L,P=0.037]方面差异均具有统计学意义。而高密度脂蛋白胆固醇[(1.10±0.55) mg/dL 比 (1.06±0.26) mg/dL,P=0.669]和血清睾酮[(275.00±100.68) ng/dL 比 (280.28±85.52) ng/dL,P=0.823]在两组间差异无统计学意义。此外,试验组相比对照组具有更高的IPSS[(3.81±1.88)分比 (0.69±0.30)分,P<0.001]和QOL评分[(2.76±0.68)分 比 (0.12±0.08)分,P<0.001],以及更高的LUTS风险[86.49%比42.31%,P<0.001],尤其是中度LUTS风险(21.62%比0,P=0.011)。Spearman等级相关分析显示,肥胖(体重指数≥30 kg/m2)与中度LUTS风险显著相关(r=0.407,P<0.001);单因素logistic回归分析显示,收缩压、空腹胰岛素水平以及C肽是青年肥胖男性人群出现中度LUTS症状的重要危险因素(P=0.009、0.029、0.002);而多因素logistic回归分析显示,收缩压和空腹C肽是其独立危险因素(P=0.011、0.003)。结论  青年肥胖男性人群中中度LUTS风险明显增加,收缩压和空腹C肽是其独立危险因素。

 Objective  To investigate the epidemiological characteristics and its associated risk factors of lower urinary tract symptoms  in young Chinese obese males. Methods  A total of 126 young males aged 2040 years admitted to Beijing Friendship Hospital, Capital Medical University were enrolled into two different groups in this study, including 74 obese patients visited metabolic weight loss clinic were included in the experimental group, and 52 conditionally healthy persons were included in the control group. Blood pressure (systolic blood pressure, diastolic blood pressure), insulin resistance (fasting blood glucose, insulin, C\|peptide), blood lipid metabolism (triglycerides, highdensity lipoprotein cholesterol), and sex hormones (estrogen) of the two groups of subjects. Hormones, serum testosterone), Creactive protein (CRP), International prostate symptom score (IPSS) and quality of life score (QOL). were compared between the  two groups of subjects. Comparisons of measurement data between groups were statistically analyze by t test, expressed by mean ± standard deviation (Mean±SD); the correlation between body mass index and LUTS was analyzed by Spearman rank correlation, and the risk factors of LUTS and clinical variables were analyzed by univariate logistic regression. The significant variables were analyzed by multivariate logistic regression. Results  There were significant statistical differences between experimental group and control group in terms of systolic blood pressure [(144.30±15.78) mmHg vs (125.9±66.11) mmHg, P<0.001], diastolic blood pressure [(89.46±12.76) mmHg vs (81.35±4.58) mmHg, P=0.001], and fasting blood glucose [(6.73±3.15) mmol/L vs (5.26±1.47) mmol/L, P=0.016], insulin [(26.60±19.09) mg/dL vs (13.43±7.68) mg/dL, P<0.001], Cpeptide [(4.20±1.73) ng/mL vs (1.59±0.52) ng/mL, P=0.001], triglycerides [(2.42±1.88) mg/dL vs (1.45±0.79) mg/dL, P=0.007), estrogen [(52.32±21.77) ng/L vs (42.11±12.19) ng/L, P=0.023] and CRP [(6.49±4.96) mg/L vs (1.62±1.53) mg/L, P=0.037], but no statistical difference regarding highdensity lipoprotein [(1.10±0.55) mg/dL vs (1.06±0.26) mg/dL, P=0.669] and serum testosterone [(275.00±100.68) ng/dL vs (280.28±85.52) ng/dL, P=0.823]. In addition, the experimental group had higher IPSS[(3.81±1.88) scores vs (0.69±0.30) scores, P<0.001]  and QOL scores [(2.76±0.68) scores vs (0.12±0.08) scores, P<0.001]  than the control group, and higher risk of LUTS [86.49% vs 42.31%, P<0.001], especially moderate LUTS ( 21.62% vs  0, P=0.011). Spearman rank correlation analysis showed that obesity (body mass index≥30 kg/m2) was significantly associated with moderate LUTS risk (r=0.407, P<0.001); Univariate logistic regression analysis showed that systolic blood pressure, insulin, and Cpeptide were important  risk factors of moderate LUTS in young obese patients (P=0.009, 0.029, 0.002). Systolic blood pressure and fasting Cpeptide were independent risk factors by multivariate logistic regression analysis (P=0.011, 0.003). Conclusions  The middle severity of LUTS was prevalent in young obese males, and systolic blood pressure and C\|peptide were its significant independent risk factors.

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