摘要:良性前列腺增生是当前中老年男性发病率最高的良性疾病之一,传统认为雄激素和年龄在其形成过程中发 挥着最主要的作用。目前临床上的主要治疗药物是 2型 5-α还原酶抑制剂 (5α- reductase inhibitors, 5-ARIs), 但是部分患者治疗无效或逐渐出现药物抵抗,机制不明。大量研究表明,其他性激素如雌激素、孕激素、缩宫素 等,通过作用于其相对应的受体在影响前列腺上皮细胞和间质细胞增殖中也发挥着重要作用。
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刘占良,牛亦农. 性激素与良性前列腺增生关系的研究进展[J]. 泌尿外科杂志(电子版),2021,13(2):96-99. DOI:10.3969/j.issn.1674-7410.2021.02.021.
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良性前列腺增生 (benign prostatic hyperplasia, BPH) 是影响中老年男性生活质量最常见的疾病之一, 会导致良性前列腺增大 (benign prostatic enlargement, BPE)、良性前列腺梗阻(benign prostatic obstruction, BPO) 和 下 尿 路 梗 阻 症 状 (lower urinary tract symptoms, LUTS) [1] 。BPH的发病率随 着年龄的增长不断升高,其患病率在40岁的男性中约 为5%~10%,而在70~80岁的男性中则达到80%[2] 。
前列腺是激素敏感的器官[1] ,传统认为雄激素在 BPH形成过程中发挥着最主要的作用,2型5α还原酶 抑制剂 (5 α- reductase inhibitors, 5-ARIs) 通过阻 断体内的睾酮 (testosterone, T) 向双氢睾酮 (dihydrotestosterone, DHT) 转化,削弱雄激素相关信 号通路,诱导前列腺上皮细胞凋亡,缩小前列腺体 积,缓解下尿路症状,是目前临床上治疗 BPH 的一 线用药[3] 。但是在接受 5- ARIs治疗的 BPH 患者中, 至少有 30%的患者临床症状没有改善,甚至出现疾 病进展[4] 。因此探索BPH形成原因及部分BPH患者5- ARIs治疗失败和疾病进展的机制具有重要意义。
BPH 的具体发生机制目前仍不明确,除了雄激 素外,多种性激素如雌激素、孕激素、缩宫素等都 可能在 BPH 的发生发展中起到重要的作用,本文就 BPH与性激素的关系及其相关研究进展综述如下。
1 雄激素与前列腺增生
2 雌激素与前列腺增生
3 孕激素与前列腺增生
4 缩宫素与前列腺增生
5 结语与展望
5 结语与展望
前列腺是一个激素敏感的器官,除雄激素是 BPH 形成、发展的必要激素外,多种性激素如雌激 素、孕激素、缩宫素等在 BPH 的形成和发展中也都 起到了重要的作用。如前所述,对 5-ARIs发生抵抗 的 BPH 患者,可能由于 SRD5A2基因的启动子发生 甲基化,前列腺内 DHT 合成减少、T 堆积,T 在芳 香化酶的催化下转化成雌激素,雌激素通过作用于 雌激素受体促进 BPH 进展,与此同时孕激素、缩宫 素可能协同雌激素发挥作用。虽然部分研究已经描 述了这些激素对 BPH 的影响,但还没有得出关于它 们在疾病进展中如何作用以及激素之间相互作用的 结论,未来还需要更多相关研究进一步探讨性激素 与 BPH的关系,完善 BPH的临床治疗方案。
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