Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia
Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia
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DOI：
10.1097/01.ju.0000173072.73702.64
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发表时间：
2005-10-01
影响因子：
6.6
通讯作者：
Gann, P
中科院分区：
文献类型：
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作者：
McVary, KT;Rademaker, A;Gann, P
目的：下尿路症状（LUTS）与良性前列腺增生（BPH）客观指标（如前列腺大小和尿动力学参数）的关系已被证明难以评估。在BPH动物模型中的研究表明，自主神经系统（ANS）活动是前列腺生长的重要决定因素。我们调查了ANS活动的关系，LUTS以及BPH的男性与BPH的客观措施。材料和方法：这项研究是在3,047名男性与LUTS继发于前列腺增生在筛选入组在1个大型，多中心，双盲，安慰剂对照试验，旨在评估药物治疗对前列腺增生进展的长期影响。共有38名美国泌尿外科协会（AUA）症状评分为8或更高，最大尿流率为4至小于15 ml/s的男性根据心率，血压，通过倾斜台对循环应激的反应以及血浆和尿儿茶酚胺评估ANS活性。将这些ANS相关变量与LUTS的主观指标（AUA症状评分、生活质量评分和BPH影响指数）、总体健康指标（兰德36项健康调查）和BPH的客观临床指标（前列腺大小、排尿后残余容量和最大尿流率）进行比较。计算每个ANS变量与每个LUTS和BPH变量的Pearson相关系数。使用逐步多元回归分析进一步评估这些相关性，以确定哪些BPH和LUTS变量与ANS变量独立相关。被确定为显着的关系，然后进行最终的多元回归分析，连同控制变量，以排除已知的外来和混淆的影响ANS活动。调整对ANS活动的外在影响后，AUA症状评分（P <0.01），BPH影响指数评分（p <0.001）和生活质量评分（p <0.05）与倾斜后1分钟和5分钟收缩压和舒张压的变化独立相关。此外，前列腺移行区体积（p <0.001）和兰德36项健康调查精神子量表评分（p <0.001）与血浆去甲肾上腺素反应till.Conclusions：ANS活动过度与最常用的LUTS指标，即AUA症状评分和BPH影响指数评分显著相关。此外，倾斜后血清去甲肾上腺素增加的幅度预测前列腺大小。在控制了ANS活动的外部影响后，这些关系仍然存在。目前的研究结果可能有重要意义的病理生理机制的基础或影响LUTS以及其最佳治疗的男性BPH。
Purpose: The relationship of lower urinary tract symptoms (LUTS) to objective measures of benign prostatic hyperplasia (BPH), such as prostatic size and urodynamic parameters, has proved difficult to evaluate. Studies in animal models of BPH suggest that autonomic nervous system (ANS) activity is an important determinant of prostatic growth. We investigated the relationship of ANS activity to LUTS as well as to objective measures of BPH in men with BPH.Materials and Methods: This study was done in 3,047 men with LUTS secondary to BPH during screening for enrolment at 1 center in a large, multicenter, double-blind, placebo controlled trial designed to assess the long-term effects of medical therapy on BPH progression. A total of 38 men with an American Urological Association (AUA) symptom score of 8 or greater and a maximum urinary flow rate of 4 to less than 15 ml per second had ANS activity assessed based on heart rate, blood pressure, the response to circulatory stress via tilt table, and plasma and urinary catecholamine. These ANS related variables were compared with subjective measures of LUTS (AUA symptom score, quality of life score and BPH impact index), overall health measures (RAND 36-Item Health Survey) and objective clinical measures of BPH (prostate size, post-void residual volume and maximum urinary flow rate). Pearson correlation coefficients were calculated for each ANS variable vs each LUTS and BPH variable. These correlations were further assessed using stepwise multiple regression analysis to determine which BPH and LUTS variables were independently related to the ANS variable. Relationships that were identified as significant then underwent final multiple regression analysis together with control variables to exclude known extraneous and confounding influences on ANS activity.Results: After adjusting for extrinsic influences on ANS activity AUA symptom score (p < 0.01), BPH impact index score (p < 0.001) and quality of life score (p < 0.05) were independently associated with the change in systolic and diastolic blood pressure 1 and 5 minutes after tilt. Additionally, prostate transition zone volume (p < 0.001) and the RAND 36-Item Health Survey mental subscale score (p < 0.001) were independently associated with the plasma norepinephrine response to tilt.Conclusions: ANS hyperactivity is significantly associated with the most commonly used measures of LUTS, namely AUA symptom score and BPH impact index score. Also, the magnitude of the serum norepinephrine increase after tilt predicts prostate size. These relationships persist after controlling for extrinsic influences on ANS activity. The current findings may have important implications concerning the pathophysiological mechanisms underlying or influencing LUTS as well as its optimal treatment in men with BPH.