良性前列腺增生患者糖脂代谢标志物水平变化及其临床意义

doi:10.3969/j.issn.1673-8640.2025.05.005

摘要/Abstract

摘要：

目的探讨老年良性前列腺增生（BPH）患者糖脂代谢标志物水平变化及其临床意义。方法收集2023年5—12月深圳市龙岗区第二人民医院和深圳市华银康医学检验实验室125例BPH患者（BPH组）和120名健康体检者（正常对照组）血液样本。检测所有研究对象糖脂代谢标志物[空腹血糖（FBG）、糖化白蛋白（GA）、1，5-脱水葡萄糖醇（1，5-AG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、小而密低密度脂蛋白胆固醇（sd-LDL-C）、同型半胱氨酸（Hcy）、脂蛋白相关磷脂酶A2（Lp-PLA2）]和前列腺相关指标[国际前列腺症状评分（IPSS）、前列腺体积（PV）、总前列腺特异性抗原（t-PSA）、最大尿流率（Qmax）]。采用Pearson相关分析评估各项指标与IPSS评分的相关性。采用Logistic回归分析评估BPH发生的影响因素。采用受试者工作特征（ROC）曲线评价各项指标单项检测和联合检测诊断BPH的效能。结果与正常对照组比较，BPH组FBG、GA、1，5-AG、HbA1c、TC、TG、LDL-C、t-PSA水平和IPSS评分、PV均升高（P<0.05），Hcy、HDL-C水平和Qmax均降低（P<0.05），sd-LDL-C、Lp-PLA2水平2个组之间差异无统计学意义（P>0.05）。LDL-C、HDL-C、FBG、HbA1c、Qmax、t-PSA均是BPH发生的独立危险因素（P<0.05）。FBG、TC、Hcy、PV、t-PSA水平与IPSS评分呈正相关（r值分别为0.199 0、0.194 8、0.216 7、0.595 3、0.581 7，P值分别为0.028 7、0.032 2、0.017 0、<0.000 1、<0.000 1），Qmax与IPSS评分呈负相关（r=-0.366 0，P<0.000 1）。FBG、HbA1c、HDL-C、LDL-C、Qmax、t-PSA单项检测和联合检测诊断BPH的曲线下面积（AUC）分别为0.812、0.631、0.794、0.658、0.850、0.915和0.983。结论老年BPH患者部分糖脂代谢标志物会发生显著变化，或可作为BPH早期诊断和风险评估的指标。

关键词: 糖脂代谢标志物, 总前列腺特异性抗原, 国际前列腺症状评分, 良性前列腺增生

Abstract:

Objective To investigate the changes of glycolipid metabolism markers in elderly patients with benign prostatic hyperplasia（BPH）and their clinical significance．Methods Totally，125 BPH patients （BPH group） and 120 healthy subjects undergoing medical checkups（control group）were enrolled from the Second People's Hospital of Longgang District and Shenzhen Huayinkang Medical Laboratory between May 2023 and December 2023. Glycolipid metabolism marker [fasting blood glucose （FBG），glycated albumin（GA），1，5-anhydroglucitol（1，5-AG），glycated hemoglobin A1c（HbA1c），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），small and dense low-density lipoprotein cholesterol（sd-LDL-C），homocysteine（Hcy），lipoprotein-associated phospholipase A2 （Lp-PLA2）] as well as prostate-related indexes [the International Prostate Symptom Score（IPSS），prostate volume（PV），total prostate-specific antigen（t-PSA）and maximum urine flow rate （Qmax）] were determined. Pearson correlation analysis was used to assess the relationship between each index and the IPSS score. Logistic regression analysis was conducted to evaluate the factors influencing the occurrence of BPH. The diagnostic efficacy for BPH was assessed by receiver operating characteristic（ROC）curve. Results Compared to control group，the levels of FBG，GA，1，5-AG，HbA1c，TC，TG，LDL-C，t-PSA，IPSS scores and PV were elevated in BPH group（P<0.05）. Hcy，HDL-C levels and Qmax were decreased，with no statistical significance observed between the 2 groups for sd-LDL-C and Lp-PLA2 levels（P >0.05）. LDL-C，HDL-C，FBG，HbA1c，Qmax and t-PSA were identified as independent risk factors for the development of BPH（P<0.05）. FBG，TC，Hcy，PV and t-PSA levels showed positive correlations with IPSS scores（r values were 0.199 0，0.194 8，0.216 7，0.595 3 and 0.581 7，respectively；P=0.028 7，0.032 2，0.017 0，<0.000 1 and <0.000 1，respectively），while Qmax showed a negative correlation with the IPSS score（r=-0.366 0，P<0.000 1）. The areas under curves（AUC）for diagnosing BPH using FBG，HbA1c，HDL-C，LDL-C，Qmax and t-PSA were 0.812，0.631，0.794，0.658，0.850，0.915 and 0.983 for single and combined determinations，respectively. Conclusions Some glycolipid metabolism markers in elderly BPH patients exhibit changes and may be serve as valuable indicators for the early diagnosis and risk assessment of BPH．

Key words: Glycolipid metabolic marker, Total prostate-specific antigen, International Prostate Symptom Score, Benign prostatic hyperplasia

中图分类号:

R446.1

陈群, 罗奇智, 梁红梅, 吴愿如, 何达辉, 廖国强, 林丽云, 卢晓静, 杨丹丹. 良性前列腺增生患者糖脂代谢标志物水平变化及其临床意义[J]. 检验医学, 2025, 40(5): 443-449.

CHEN Qun, LUO Qizhi, LIANG Hongmei, WU Yuanru, HE Dahui, LIAO Guoqiang, LIN Liyun, LU Xiaojing, YANG Dandan. Change and role of glycolipid metabolism markers in patients with benign prostatic hyperplasia[J]. Laboratory Medicine, 2025, 40(5): 443-449.

图/表 4

参考文献 28

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因素	β值	标准误	Wald值	P值	OR值①（95%CI②）
TC	0.154	0.496	0.096	0.756	1.166（0.441~3.083）
LDL-C	2.162	0.729	8.789	0.003	8.690（2.081~36.295）
HDL-C	-9.456	2.554	13.712	<0.001	1.008（1.001~1.012）
1，5-AG	0.007	0.004	2.342	0.126	1.007（0.998~1.015）
FBG	2.179	0.692	9.927	0.002	8.839（2.279~34.287）
TG	0.731	0.817	0.802	0.370	2.078（0.419~10.297）
Hcy	0.158	0.178	0.792	0.374	0.854（0.603~1.209）
GA	0.323	0.247	1.706	0.191	1.381（0.851~2.243）
HbA1c	2.067	0.912	5.138	0.023	7.903（1.323~47.213）
PV	-0.015	0.037	0.163	0.687	0.985（0.915~1.060）
IPSS评分	0.045	0.129	0.119	0.730	1.046（0.812~1.347）
Qmax	-0.396	0.144	7.557	0.006	0.673（0.507~0.892）
t-PSA	2.232	0.659	11.466	0.001	9.316（2.560~33.902）

因素	β值	标准误	Wald值	P值	OR值①（95%CI②）
TC	0.154	0.496	0.096	0.756	1.166（0.441~3.083）
LDL-C	2.162	0.729	8.789	0.003	8.690（2.081~36.295）
HDL-C	-9.456	2.554	13.712	<0.001	1.008（1.001~1.012）
1，5-AG	0.007	0.004	2.342	0.126	1.007（0.998~1.015）
FBG	2.179	0.692	9.927	0.002	8.839（2.279~34.287）
TG	0.731	0.817	0.802	0.370	2.078（0.419~10.297）
Hcy	0.158	0.178	0.792	0.374	0.854（0.603~1.209）
GA	0.323	0.247	1.706	0.191	1.381（0.851~2.243）
HbA1c	2.067	0.912	5.138	0.023	7.903（1.323~47.213）
PV	-0.015	0.037	0.163	0.687	0.985（0.915~1.060）
IPSS评分	0.045	0.129	0.119	0.730	1.046（0.812~1.347）
Qmax	-0.396	0.144	7.557	0.006	0.673（0.507~0.892）
t-PSA	2.232	0.659	11.466	0.001	9.316（2.560~33.902）

变量	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	Youden指数
FBG	0.812（0.755~0.868）	5.800 mmol·L^-1	87.83	68.03	0.559
HbA1c	0.631（0.560~0.702）	5.990%	80.67	50.00	0.307
HDL-C	0.794（0.737~0.852）	1.255 mmol·L^-1	63.56	85.00	0.486
LDL-C	0.658（0.589~0.726）	3.365 mmol·L^-1	74.79	52.00	0.268
Qmax	0.850（0.804~0.897）	13.860 mL·s^-1	81.51	74.19	0.557
t-PSA	0.915（0.874~0.956）	3.155 ng·mL^-1	100.00	80.65	0.807
联合检测	0.983（0.970~0.996）	0.799	88.33	100.00	0.883

变量	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	Youden指数
FBG	0.812（0.755~0.868）	5.800 mmol·L^-1	87.83	68.03	0.559
HbA1c	0.631（0.560~0.702）	5.990%	80.67	50.00	0.307
HDL-C	0.794（0.737~0.852）	1.255 mmol·L^-1	63.56	85.00	0.486
LDL-C	0.658（0.589~0.726）	3.365 mmol·L^-1	74.79	52.00	0.268
Qmax	0.850（0.804~0.897）	13.860 mL·s^-1	81.51	74.19	0.557
t-PSA	0.915（0.874~0.956）	3.155 ng·mL^-1	100.00	80.65	0.807
联合检测	0.983（0.970~0.996）	0.799	88.33	100.00	0.883