Mitsui Yozo, Yamabe Fumito, Hori Shunsuke, Uetani Masato, Aoki Hiroshi, Sakurabayashi Kei, Okawa Mizuho, Kobayashi Hideyuki, Nagao Koichi, Nakajima Koichi
Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan.
Transl Androl Urol. 2023 Jul 31;12(7):1090-1100. doi: 10.21037/tau-23-108. Epub 2023 Jul 18.
Few investigations regarding hematospermia duration have been reported thus far. The aim of this study was to identify clinical factors associated with the duration of hematospermia.
Clinical data of 198 patients with hematospermia treated at Toho University Omori Medical Center from 2007 to 2022 were retrospectively evaluated. To identify independent predictors of hematospermia duration, uni- and multivariate Cox analyses were performed. Receiver operating characteristic analysis, Kaplan-Meier survival curves, and propensity score matching were applied for statistical evaluations.
Multivariate analysis of all 198 patients showed urine pH (UpH) level and any abnormal imaging finding of the prostate to be independent predictors of hematospermia duration. Based on the receiver-operating curve of UpH level for hematospermia improvement, the patients were divided into two groups using a threshold of 6.0 (Low-UpH 5.0-6.0, n=128; High-UpH 7.0-9.0, n=70). Kaplan-Meier curves indicated that patients in the High-UpH group or with any abnormal imaging finding had a higher rate of hematospermia persistence (both P<0.05). Even after matching between the groups classified by UpH (n=60 each), multivariate analysis showed that UpH level (hazard ratio 0.75, 95% CI: 0.61-0.92; P=0.006) and any abnormal imaging finding (hazard ratio 1.55, 95% CI: 1.04-2.31; P=0.033) were independent predictors of hematospermia duration. In Kaplan-Meier analysis findings of matched cohorts, High-UpH and presence of any abnormal imaging findings remained significantly correlated with higher rate of hematospermia persistence, while further stratification using a combination of these two factors identified a stepwise reduction in that rate (P=0.019). In addition, the proportion of patients with these two factors present simultaneously was significantly higher in the group with hematospermia for two months or more, and especially with a duration of greater than six months, than in the group with a duration of less than two months.
Although further research is needed, both UpH level and imaging findings of the prostate are considered useful biomarkers for predicting prolonged hematospermia.
迄今为止，关于血精持续时间的研究报道较少。本研究的目的是确定与血精持续时间相关的临床因素。
回顾性评估2007年至2022年在东邦大学大森医疗中心接受治疗的198例血精患者的临床资料。为了确定血精持续时间的独立预测因素，进行了单因素和多因素Cox分析。采用受试者工作特征分析、Kaplan-Meier生存曲线和倾向评分匹配进行统计评估。
对所有198例患者的多因素分析显示，尿液pH值（UpH）水平和前列腺的任何异常影像学表现是血精持续时间的独立预测因素。根据UpH水平改善血精的受试者工作曲线，以6.0为阈值将患者分为两组（低UpH组5.0 - 6.0，n = 128；高UpH组7.0 - 9.0，n = 70）。Kaplan-Meier曲线表明，高UpH组或有任何异常影像学表现的患者血精持续率更高（均P < 0.05）。即使在按UpH分类的组间进行匹配（每组n = 60）后，多因素分析显示UpH水平（风险比0.75，95% CI：0.61 - 0.92；P = 0.006）和任何异常影像学表现（风险比1.55，95% CI：1.04 - 2.31；P = 0.033）是血精持续时间的独立预测因素。在匹配队列的Kaplan-Meier分析结果中，高UpH和任何异常影像学表现的存在仍然与更高的血精持续率显著相关，而使用这两个因素的组合进行进一步分层发现该率逐步降低（P = 0.019）。此外，血精持续两个月或更长时间，尤其是持续时间超过六个月的组中，同时存在这两个因素的患者比例显著高于持续时间少于两个月的组。
尽管需要进一步研究，但UpH水平和前列腺影像学表现均被认为是预测血精持续时间延长的有用生物标志物。
