Cetinkaya M, Cetinkaya H, Ulusoy E, Baz S, Memiş A, Yaşa H, Yanik B, Oztürk B, Uzunalimoğlu O
Department of Urology, Ankara Numune Hospital, Turkey.
Prostate. 1998 Jul 1;36(2):80-4. doi: 10.1002/(sici)1097-0045(19980701)36:2<80::aid-pros2>3.0.co;2-i.
The object of this study was to investigate the effects of hepatic cirrhosis on the development of benign prostatic hyperplasia and consequent effects on prostatic volume, serum prostate-specific antigen (PSA), and prostatism symptoms.
Sixty patients with postnecrotic cirrhosis and alcoholic cirrhosis at age 40 and over, and 20 voluntary subjects in the same age group with normal hepatic functions, were evaluated with prostatic volume calculation by transrectal ultrasound, symptom scoring according to American Urology Association (AUA) criteria, measurement of serum prostate-specific antigen (PSA), serum total testosterone (TT), free testosterone (FT), estradiol (E2), and calculation of E2/FT ratios, and the results were analyzed statistically by the Mann-Whitney U-test.
Serum FT and TT levels were significantly lower in the hepatic cirrhosis group compared to the control group (P = 0.0000 and P = 0000, respectively). Though mean serum E2 level was a little higher in cirrhotic patients compared to controls, the difference was not significant; however, the higher E2/FT ratio in the cirrhotic group was statistically significant (P = 0.27 and P = 0.0002, respectively). In the cirrhotic group, the decrease in FT and TT levels was greater, as the disease advanced. While E2 and E2/FT ratio increase, correlate with poor prognosis, no statistically significant differences were found. Mean prostatic volume, serum PSA level, and total symptom score were significantly higher in the control group, compared to the cirrhotic group (P = 0.0001, P = 0.0006, and P = 0.002, respectively). Prostatic volume decreased parallel to severity of disease in cirrhotic patients.
The main reason for the decrease in mean prostatic volume in cirrhotic patients compared to subjects in the same age group with normal hepatic functions was the decrease in serum FT and TT levels, and the secondary cause was the increase in E2/FT ratio, indicating estrogenic predominance.
本研究旨在调查肝硬化对良性前列腺增生发展的影响以及对前列腺体积、血清前列腺特异性抗原（PSA）和前列腺增生症状的后续影响。
对60例年龄在40岁及以上的坏死性肝硬化和酒精性肝硬化患者，以及20例同年龄组肝功能正常的志愿者进行经直肠超声计算前列腺体积、根据美国泌尿外科学会（AUA）标准进行症状评分、测量血清前列腺特异性抗原（PSA）、血清总睾酮（TT）、游离睾酮（FT）、雌二醇（E2）并计算E2/FT比值，结果采用Mann-Whitney U检验进行统计学分析。
肝硬化组血清FT和TT水平显著低于对照组（分别为P = 0.0000和P = 0.0000）。虽然肝硬化患者的平均血清E2水平略高于对照组，但差异不显著；然而，肝硬化组较高的E2/FT比值具有统计学意义（分别为P = 0.27和P = 0.0002）。在肝硬化组中，随着疾病进展，FT和TT水平下降幅度更大。虽然E2和E2/FT比值升高与预后不良相关，但未发现统计学显著差异。对照组的平均前列腺体积、血清PSA水平和总症状评分显著高于肝硬化组（分别为P = 0.0001、P = 0.0006和P = 0.002）。肝硬化患者的前列腺体积与疾病严重程度平行下降。
与同年龄组肝功能正常的受试者相比，肝硬化患者平均前列腺体积减小的主要原因是血清FT和TT水平降低，次要原因是E2/FT比值升高，表明雌激素占优势。
