目的 探讨噻托溴铵喷雾剂(能倍乐)对合并有前列腺肥大(BPH)的慢性阻塞性肺疾病急性加重的影响。方法 2017年9月—2019年9月在我院呼吸与危重症医学科的AECOPD的男性患者167例,年龄51～96岁,平均(74.26±7.6)岁。分别为AECOPD组、AECOPD+噻托溴铵喷雾剂治疗组。比较AECOPD合并BPH与能倍乐的关系。结果 AECOPD患者合并有BPH的45人(52.94%),能倍乐治疗合并有BPH的AECOPD患者48人(58.53%),两组比较差异无统计学意义(P＞0.05)。其中,AECOPD患者合并有BPH患者中有10人(11.76%)出现尿频、夜尿多;尿潴留的4人(4.7%);同时口服哈乐和保列治的16人(18.82%);要置尿管导尿的5人(5.8%)。能倍乐治疗AECOPD患者合并有BPH患者中有7人(8.53%)出现尿频、夜尿多;尿潴留的1人(1.21%);同时口服哈乐和保列治的20人(24.39%);要置尿管导尿的3人(3.6%),比较差异均无统计学意义(P＞0.05)。结论 能倍乐不增加合并BPH的COPD患者的急性加重;也不增加治疗BPH的药物使用。能倍乐对于稳定期合并BPH的COPD患者治疗是安全的。

Objective To investigate the effect of Spiriva Respimat on acute exacerbation of COPD with benign prostatic hyperplasia(BPH). Methods The 167 patients who were hospitalized for acute exacerbation of chronic obstructive pulmonary disease (COPD)(aged 51～96 years) with an average age of (74.26±7.6) years and the 82 patients treated with Spiriva Respimat in the department of respiratory and critical care medicine of our hospital from September 2017 to September 2019 were reviewed. In our pilot study, 48 AECOPD patients with BPH patients were enrolled as the treatment group and another 45 similar cases as the control group. In the former group Spiriva Respimat was administered and the control group was not. Results There were 45 patients (52.94%) with BPH in AECOPD group and 48 patients (58.53%) with BPH in Spiriva Respimat group. There was no statistical significance between the two groups (P>0.05). Among them, 10 patients (11.76%) with AECOPD and BPH had frequent urination and night urination, 4 patients (4.7%) of urinary retention, 16 patients (18.82%) who had oral Harnal and Finasteride, 5 patients (5.8%) need catheterization. In the AECOPD patients with BPH treated with Spiriva Respimat, 7 patients (8.53%) had frequent urination and night urination, 1 patient (1.21%) had urinary retention, 20 patients (24.39%) had oral Harnal and Finasteride, and 3 patients (3.6%) were managed through catheterization (P>0.05). Conclusion Spiriva Respimat does not increase the acute exacerbation of COPD patients with BPH, nor does it increase the use of drugs to treat BPH. It is safe to treat COPD patients with BPH in stable stage.

目的 研究NR3C1(核受体亚科3,C组,成员1)又称糖皮质激素受体(GR)表达量对前列腺癌恶性程度的影响及其与前列腺癌生化复发的相关性。方法 通过组织芯片免疫组化染色检测的方法检验NR3C1在不同恶性程度前列腺癌组织的表达情况,结合Taylor数据库分析NR3C1表达水平与前列腺癌临床病理特征关系,再采用Kaplan-Meier法分析NR3C1对前列腺癌生化复发生存率的影响,最后用Cox回归分析临床病理特征与生化复发的相关性。结果 组织芯片免疫组化结果显示NR3C1在Gleason评分低的前列腺癌组织中表达高于Gleason评分高的前列腺癌组织(P=0.028)。结合Taylor公用数据库分析,NR3C1在前列腺癌组织中的表达低于癌旁组织(P＜0.001),NR3C1在Gleason评分低的前列腺癌组织中表达高于Gleason评分高的前列腺癌组织(P=0.005),NR3C1低表达与PSA复发(P=0.028)和转移(P=0.003)相关。Kaplan-Meier结果提示:NR3C1高表达组患者术后的生化复发生存率更高(P=0.043),总体生存率没有明显区别(P=0.872)。单因素分析结果显示:NR3C1(P=0.002),病理分期(P＜0.001),Gleason评分(P＜0.001),是否转移(P=0.012)是前列腺癌生化复发的影响因素。多因素分析结果显示:高Gleason 评分(P=0.017)和转移(P<0.001)均为生化复发危险因素。结论 NR3C1影响前列腺癌的发病进程,检验NR3C1的表达情况,能预测前列腺癌患者生化复发的概率,可协助判断前列腺癌预后。

Objective We study the role of NR3C1 (nuclear receptor subfamily 3,group C,member 1) in PCa progression,and the correlation between its expression level and the biochemical recurrence of PCa. Methods Immunohistochemistry was used to detect the expression of NR3C1 in PCa tissues of different degrees of malignancy. The associations of NR3C1 expression and clinical pathological features were analyzed using the Taylor dataset. Kaplan-Meier was used to detect the relationship between NR3C1 expression and biochemical recurrence survival rate in PCa. Cox-regressive analysis was used to detect the relationship between clinical pathological features and biochemical recurrence. Results Immunohistochemistry analysis showed the expression of NR3C1 was higher in which its Gleason Score was lower(P=0.028). Base on the Taylor dataset,the expression of NR3C1 was higher in the adjacent benign tissues than that in PCa(P＜0.001). The expression of NR3C1 was higher in which its Gleason Score was lower(P=0.005). Furthermore,low NR3C1 expression was associated with PSA failure(P=0.028) and Metastasis(P=0.003). Kaplan-Meier showed the biochemical recurrence-free time of PCa patients in low NR3C1 expression groups reduced(P=0.043). The overall survival time of PCa patients was not correlated to NR3C1 expression levels(P=0.872). Single factor analysis showed the biochemical recurrence is associated with NR3C1 expression(P=0.002),pathological stage(P＜0.001),Gleason score(P＜0.001), Metastasis status(P=0.012). Multivariate analysis by Cox regression further identified the high Gleason Score(P=0.017) and Metastasis status (P<0.001)were hazards of the biochemical recurrence. Conclusion Our study showed that the expression of NR3C1 critically connected with the process of PCa,which indicated that we can predict the probability of the biochemical recurrence and determine the prognosis of prostate cancer by detecting the expression of NR3C1 in PCa patients.

目的 探讨原发于前列腺的产黏液尿路上皮型腺癌的临床病理特征、诊断及鉴别诊断。方法 对1例极其罕见的原发于前列腺的产黏液尿路上皮型腺癌病例的临床诊治经过、病理组织学及免疫组织化学特征进行观察和总结,并复习国内外相关文献。结果 患者77岁,因排尿困难入院, B超提示前列腺增大,前列腺异常回声性质待查;CT及肠镜检查均未发现膀胱及结直肠恶性肿瘤;血清PSA未见升高。在当地医院行前列腺穿刺检查,病理诊断为前列腺黏液腺癌。遂于我院行腹腔镜下前列腺根治手术,镜下表现为黏液腺癌伴多量黏液湖形成,并见尿路上皮的腺性化生及原位腺癌与黏液腺癌的移行过渡;免疫组化示CK7及34βE12弥漫表达,CDX-2及CEA局灶表达,其余CK20、β-catenin、GATA3、PSA、PSAP、AR及P504S均阴性。结论 原发于前列腺的产黏液尿路上皮型腺癌十分罕见,其预后差,对内分泌治疗不敏感,准确诊断将有利于指导临床医生选择正确的治疗方法及评估其预后。

Objective To investigate clinicopathological characteristics, diagnosis and differential diagnosis of primary mucin-producing urothelial-type adenocarcinoma of prostate. Methods We reported a rare case of mucin-producing urothelial-type adenocarcinoma of prostate and reviewed relevant literatures to discuss the clinicopathological features, diagnosis and differential diagnosis. Results In this case, the patient was a 77-year-old male with the history of dysuria. B-ultrasound indicated benign prostatic enlargement and abnormal echogenicity remained to be determined. CT scan and gastrointestinal endoscopy didn't show any evidence of bladder and colorectal tumor. No serum prostate-specific antigen (PSA) increased. The patient underwent laparoscopic radical resection of prostate cancer. Microscopically, the tumor presented as mucinous carcinoma, similar to colorectal mucinous carcinoma, but the migration from the normal prostatic urethra was observed and the urethral epithelium at the transitional site was characterized by adenoepithelial metaplasia and adenocarcinoma in situ. Immunohistochemical staining showed neoplastic cells were diffuse and strongly positive for CK7 and 34βE12, focally positive for CDX-2 and CEA and negative for CK20, β-catenin, GATA3, PSA, PSAP, AR and P504S. Conclusion Mucin-producing urothelial-type adenocarcinoma of prostate is an extremely rare tumor. It has a poor prognosis and it is not sensitive to endocrine therapy.

目的 探讨肝硬化失代偿期患者前列素E2(PGE2)水平对患者感染发生预测价值。方法 选取2016年3月—2017年6月我院收治肝硬化失代偿期患者64例为研究对象,根据患者是否合并有感染分为A组(合并感染,23例)和B组(未合并感染,41例),采用酶联免疫吸附(ELISA)法检测患者PGE2水平,比较两组患者血清PGE2水平,并用ROC曲线预测PGE2在肝硬化失代偿期合并感染价值。结果 A、B两组患者在性别、年龄、白蛋白水平、WBC计数、Child分级、肝硬化病因方面比较均无统计学意义(P＞0.05)。A组患者PGE2水平高于B组[(3 894.6±368.4)pg/mL vs(2 541.8±318.6)pg/mL,P＜0.05]。ROC曲线在肝硬化失代偿期患者合并感染风险曲线下面积为0.86(95%CI为0.75～0.91),有统计学意义(P=0.000 0),当肝硬化失代偿期患者血清PGE2浓度为2 845 pg/mL时,预测肝硬化失代偿期患者合并感染灵敏度和特异度最高,分别为0.831和0.794。结论 肝硬化失代偿期患者PGE2水平显著升高,检测PGE2水平对肝硬化失代偿期患者发生感染有一定预测价值。

目的 探讨不同分化程度前列腺癌患者的直肠超声图像特征,为前列腺癌分化程度的诊断提供依据。方法 纳入我院收治的前列腺癌患者120例,均接受直肠超声检查,根据Gleason评分评估分化程度分成低分化组(n=41)、中分化组(n=39)与高分化组(n=40)。分析不同分化程度患者的结节大小、血流分级、回声、边界是否清晰以及包膜完整性,并对血流频谱进行观察。结果 低分化组的结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、边界欠清晰、包膜欠完整、高回声占比高于高分化组,且低分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于中分化组,中分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于低分化组,差异有统计学意义(P<0.05)。结论 不同分化程度前列腺癌患者的直肠超声表现存在差异,随着分化程度越低,肿瘤边界清晰度、包膜完整性越差,血流越丰富。

目的 观察⁹⁹锝-亚甲基二膦酸盐对前列腺癌骨转移患者骨痛、骨质疏松的治疗效果。方法 对76例前列腺癌骨转移患者给予⁹⁹锝-亚甲基二膦酸盐治疗1年(每疗程15 d,每天静滴22 mg,15 d为一个疗程,共12个疗程),比较治疗前及治疗1年后患者骨密度(BMD)值及血清钙、磷、碱性磷酸酶、骨钙素、I型胶原交联羧基末端肽、1,25二羟维生素D3等指标的变化。结果 云克治疗后腰椎(L1-4)及左股骨颈、大转子及小转子骨密度(BMD)值均较治疗前增加(P＜0.05);云克治疗后AKP、ICTP均较治疗前明显下降(P＜0.01)。OC云克治疗后较治疗前增加(P＜0.05)。血钙、血磷、1,25-二羟维生素D3云克治疗后与云克治疗前相比无明显变化,P<0.05。前列腺癌骨转移轻度骨痛组及中度骨痛组治疗1年后骨痛VAS评分明显降低,差异有统计学意义,P＜0.05。重度骨痛组云克治疗前、治疗后VAS评分比较,差异无统计学意义,P<0.05。结论 ⁹⁹锝-亚甲基二膦酸盐在治疗前列腺癌骨转移的骨痛、骨质疏松方面,具有缓解骨痛,促进骨增殖,抑制骨吸收,提高骨密度,防治骨质疏松的作用。

目的 探讨我院17年间前列腺癌患者的临床特征如发病年龄、前列腺特异性抗原(PSA)、Gleason评分、分期及穿刺阳性率等的变化。方法 采用回顾性分析,对广州市第一人民医院2000—2016年泌尿外科1 231例穿刺活检的患者及564例前列腺癌患者资料进行分析,按患者的诊断时间分为A组(2000—2005年)、B组(2006—2009年)、C组(2010—2012年)、D组(2013—2014年)、E组(2015—2016年),对各组的年龄、PSA、Gleason评分、分期及穿刺活检阳性率进行统计学分析,看各组间的各项指标差异是否有统计学意义。结果 5组年龄均值(73.36,73.74,72.05,73.40,72.96岁)、PSA均值(208.95,190.25,173.19,283.54,148.69 μg/L)及穿刺活检阳性率均值(48%,43%,37%,44%,39%)差异均无统计学意义(P均>0.05)。5组Gleason均值为6.80,6.73,7.12,6.93,7.32,A、B组和E组Gleason评分差异有统计学意义(P均<0.05),其余各组Gleason评分差异均无统计学意义(P均>0.05)。TNM分期转化得分5组均值为5.96,6.80,7.05,7.31,6.83, A和C组、D组、E组差异均有统计学意义(P均<0.05),其余各组TNM分期转化得分差异均无统计学意义(P均>0.05)。结论 17年间前列腺癌患者诊断时的年龄、PSA水平及穿刺活检阳性率没有显著变化。

Objective To investigate changes of inpatients with prostate cancer in the last 17 years such as age of onset, prostate specific antigen (PSA), Gleason score, prostate cancer staging and positive rate of prostate biopsy. Methods A retrospective analysis was conducted in 1 231 cases of biopsy patients of urology and 564 patients with prostate cancer who were hospitalized in the First People's Hospital of Guangzhou from 2000 to 2016. According to the time of diagnose. All the patients were divided into five groups: group A(2000-2005),group B(2006-2009),group C(2010-2012), group D(2013-2014)and group E(2015-2016). The age, PSA, Gleason score, staging and positive rate of prostate biopsy were compared to realize whether the indicators of the differences between groups was statistically significant. Results In five groups, means of age, PSA, Gleason score and prostate biopsy positive rate are respectively 73.36,73.74,72.05,73.40,72.96 years; 208.95,190.25,173.19,283.54,148.69 μg/L;6.80,6.73,7.12,6.93,7.32; 5.96,6.80,7.05,7.31,6.83 and 48%,43%,37%,44%,39%. There was no significant difference in age, PSA and positive rate of prostate biopsy (P>0.05). The Gleason scores of group A and group E, group B and group E were statistically significant (P<0.05), while the other groups had no significant differences in Gleason score (P>0.05). There werestatistical significancein TNM staging score between group A and group C,group D, group E(P <0.05),while the other groups had nostatistical significance (P>0.05). Conclusion There are no change of prostate cancer patients in diagnosis of age, PSA levels and positive rate of prostate biopsy in the past 17 years.

目的 探索锌剂治疗大鼠慢性细菌性前列腺炎(CBP)的机理及影响。方法 健康成年雄性大鼠100只,随机分为正常对照组(n=20)、CBP模型对照组(n=20)、CBP锌剂治疗组(n=20)、CBP左氧氟沙星治疗组(n=20)及CBP锌剂与左氧氟沙星混合治疗组(n=20)。采用消痔灵及大肠埃希菌制备CBP大鼠模型。CBP锌剂治疗组、CBP左氧氟沙星治疗组及CBP混合治疗组给予相应药物灌胃治疗,正常对照组及CBP模型对照组给予无菌生理盐水灌胃。疗程10 d,分别于2 d、4 d、6 d、8 d、11 d取各组大鼠前列腺,检测细菌数量并分离鉴定细菌性质。于4 d、9 d、14 d、20 d、28 d取各组大鼠前列腺,进行组织病理学检测。结果 CBP各治疗组大鼠前列腺组织的细菌数量与模型对照组相比均明显降低(P﹤0.05)。CBP混合治疗组大鼠前列腺内细菌在治疗8 d后不能检出。4～6 d CBP混合治疗组大鼠前列腺组织的细菌数量与CBP锌剂治疗组相比明显降低(P﹤0.05)。正常对照组大鼠前列腺病理学检查未见明显病理变化;模型对照组大鼠前列腺组织表现为慢性炎症的病理变化;各治疗组大鼠前列腺慢性炎症改变均有不同程度缓解,其中混合治疗组的慢性炎症明显减轻。结论 锌剂具有活化提高前列腺组织细胞抗菌能力的作用,有利于前列腺组织炎性病理损害的缓解以及损伤组织的修复,与敏感抗生素结合治疗CBP具有更显著的治疗效果。

Objective To explore the zinc agent in the treatment of chronic bacterial prostatitis (CBP) rats and the effect. Methods 100 healthy adult male rats, were randomly divided into normal control group (n=20), CBP model group (n=20), CBP zinc treatment group (n=20), CBP levofloxacin treatment group (n=20) and mixed treatment group of CBP zinc and levofloxacin (n=20). Preparation of the CBP rat model was made by Xiaozhiling and E.coli system. CBP zinc treatment group, CBP levofloxacin treatment group and CBP mixed treatment group were given the appropriate drugs for treatment,besides,the normal control group, CBP model control group were given sterile saline. It took 10d. Rats in each group at 2d, 4d, 6d, 8d, 11d were detected, including the number of bacteria and the bacteria isolation and identification properties. The pathological study in 4d, 9d, 14d, 20d, 28d and prostate of rats in each group were detected. Results The prostate tissue of the CBP group rats in the treatment of bacterial number compared with the model control group decreased significantly (P<0.05). CBP mixed treatment of prostate were not detected in bacteria after 8d treatment.4 - 6 days of CBP treatment of prostate tissue in rats of the treatment group compared with the quantity of bacteria and CBP zinc decreased significantly (P<0.05). Normal control group rats pathological prostate pathology examination showed no significant pathological prostate tissue; The model control group rats showed chronic inflammatory pathological changes; The treatment group rat prostate inflammatory changes were alleviated chronic inflammation, which mixed treatment group were significantly reduced. Conclusion Zinc enhances prostate tissue antibacterial ability, is conducive to the inflammation in prostate tissue response and the repair of damaged tissue. Sensitive antibiotics combined with treatment of CBP have a significant therapeutic effect.

目的 研究NEK2(中心体相关激酶2)在前列腺癌和良性组织中的表达情况及其与前列腺癌预后的相关性。方法 运用qRT-PCR检测NEK2在前列腺癌和癌旁组织的表达差异,通过组织芯片免疫组化染色检测的方法检验NEK2在前列腺癌和癌旁组织的表达情况,最后使用Taylor的数据对NEK2进行生物信息学分析。结果 qRT-PCR检测NEK2在前列腺癌组织的表达显著高于癌旁组织(6.93±0.15 vs 5.38±0.4,t=6.25,P=0.003),组织芯片免疫组化结果显示NEK2在前列腺癌组织的表达显著高于癌旁组织(5.84±0.56 vs 4.27±0.49,t=5.38, P<0.001),结合Taylor公用数据库分析,NEK2高表达组患者术后的生化复发生存率减少( χ²=4.33,P=0.037),NEK2高表达组和低表达组在前列腺癌总体生存率上没有明显区别( χ²=0.27,P=0.605)。结论 NEK2参与前列腺癌的发生、发展进程,同前列腺癌发病进程密切相关,通过检测前列腺癌患者NEK2的表达情况,可早期预测生化复发的概率,能够作为判断前列腺癌预后的潜在生物学标志物。

Objective To investigate the expression of NEK2(NIMA-related kinase 2)in prostate cancer as well as benign prostatic hyperplasia,and the involvement of NEK2 in the prognosis of prostate caner(PCa). Methods The different expression of NEK2 in the tissue of prostate cancer and the adjacent benign tissues of prostate were measured by real-time quantitative reverse transcriptase-polymerase chain reaction (QRT-PCR) analysis and immunohositochemistry analysis,and then bioinformatically analyzed using the Taylor dataset. Results QRT-PCR showed that NEK2 was highly expressed in PCa than in the adjacent benign tissues (6.93±0.15 vs 5.38±0.4,t=6.25,P=0.003). Immunohositochemistry analysis showed the expression of NEK2 was higher in PCa than in the adjacent benign tissues(5.84±0.56 vs 4.27±0.49,t=5.38, P<0.001). Furthermore, the biochemical recurrence-free time of PCa patients in high NEK2 expression groups significantly reduced( χ²=4.33,P=0.037). The overall survival time of PCa patients was not correlated to NEK2 expression levels( χ²=0.27,P=0.605). Conclusion The above findings suggest that NEK2 is associated with production and development of PCa, and also critically connected with the process of PCa,which indicate that we can predict the probability of the biochemical recurrence-free time by detecting the expression of NEK2 in PCa patients,and NEK2 can also become a potential biomarker for PCa prognosis.

目的 分析PBK在前列腺癌中的表达及临床意义。方法 利用前列腺癌的组织芯片,包含98例前列腺癌及81例对照癌旁组织作为研究对象,免疫组化方法检测PBK的表达情况,并运用统计学方法分析免疫组化芯片及Taylor数据库中PBK表达与前列腺癌临床病理特征之间的关系。结果 PBK在前列腺癌中表达明显升高(P=0.001);且在Gleason高评分组的表达比低评分组表达升高(P=0.001)。Taylor数据库得到相似结果,且运用Kaplan-Meier分析发现PBK与无生化复发生存率显著相关(P=0.007),最后采用Cox回归模型进行多因素综合分析发现在影响前列腺癌预后的队列中,PBK高表达(P=0.041)与Gleason评分、病理分期都是前列腺癌生化复发的独立预测指标。结论 PBK的表达与前列腺癌密切相关,可作为临床诊断及治疗的分子标志物。

Objective To investigate the expression and clinical significance of PBK in prostate cancer. Methods Using tissue microarrays of prostate cancer, which including 98 cases of prostate cancer and 81 cases of normal tissue adjacent to cancer as the research object, the expression of PBK was detected by immunohistochemistry, and statistical analysis was used to analyze the relationship between the expression of PBK and the clinicopathological features of prostate cancer in the microarray and Taylor database. Results The expression of PBK in prostate cancer was significantly higher (P=0.001), and the expression increased in the group of high Gleason score (P=0.001). The Taylor database obtained similar results, and Kaplan-Meier analysis showed that PBK was significantly correlated with the biochemical recurrence free survival (P=0.007). Finally, Cox regression model was used to analyze the prognostic factors of prostate cancer. Result shows that, the high expression of PBK (P=0.041), Gleason score and pathological stage were independent predictors of biochemical recurrence of prostate cancer. Conclusion The expression of PBK is closely related to prostate cancer, and can be used as a molecular marker for clinical diagnosis and treatment.