| The etiology of prostatitis is complex,and the symptoms are varied.Prostatitis can cause or aggravate lower urinary tract symptoms in elderly patients with BPH,however,prostatitis is generally neglected in elderly men,those elderly male patients who are suffering from urination disorder are often simply diagnosed as BPH,and some patients with PSA abnormalities are often suspected to be suffering from prostate cancer and go through the pain of prostate biopsy,which can lead to ineffective or excessive treatment.Therefore,for elderly patients with BPH,it is essential to make clear whether they have combined with prostatitis and what type of inflammation.PSA is produced by prostate alone,and is a sensitive indicator on diagnosing prostate disease,it is of great value in the early diagnosis,differential diagnosis,evaluation of therapeutic effect and prognosis evaluation of prostate disease.Neutrophil-to-lymphocyte ratio(NLR)in peripheral blood can reflect ebb and flow balance changes of neutrophils and lymphocytes in body tissues,and has been used in the diagnosis and treatment of inflammatory diseases andtumors.Is there a correlation between histological prostatitis and PSA,NLR in peripheral blood? Are these indicators helpful to the diagnosis and treatment of histological prostatitis? In order to improve the diagnostic level of prostatitis,this study was conducted.The classification method of Prostatitis recommended by National Institutes of Health(NIH)has played an important role on the diagnosis and treatment of prostatitis in young men,but there exist some shortcomings to elderly men.Pathological examination is recognized the gold standard technique for obtaining a definitive diagnosis.However,in actual clinical work,it is not realistic to obtain prostate tissue of each patient for pathological examination.For those elderly patients with BPH suffering from lower urinary tract symptoms,how to judge whether they are combining with histological prostatitis?In this study,we selected postoperative prostate specimen of patients with BPH for pathological analysis of inflammation characteristics,and explored the relationship between NLR and histological prostatitis,and analyzed the characteristics of serum PSA-related indexes in patients with histological acute prostatitis,further pave a way for the diagnosis and treatment of histological prostatitis.Part 1: Analysis of pathological characteristics of histological prostatitisObjective: To observe whether there exist inflammatory cells in the prostate tissue slices of patients with BPH,we classified the prostatitis according to the type of inflammatory cells,and analyzed the damage degree of glandular epithelium.Methods: The data of patients who underwent transurethral bipolar plasmakinetic prostatectomy from June 2017 to June 2018 were retrospectively collected,a total of 100 patients with BPH were selected according to inclusion criteria and exclusion criteria.These 100 patients were divided into four groups according to the results of pathological inflammation of the resected prostate tissue: Group A,there was both neutrophils infiltration and chronic inflammatory cell infiltration in pathological sections;Group B,only there was chronic inflammatory cell infiltration in pathological sections;Group C,only there was neutrophils infiltration in pathological sections;Group D,without any inflammation.At the same time,the damage degrees of glandular epithelium in prostate tissue slices were analyzed and divided into 4 levels: Level 0,there was no contact between inflammatory cells and glandular epithelium;Level 1,only there was contact between inflammatory cells and epithelium but no destroy the gland;Level 2,inflammatory cells invaded the glands and destroyed glands or glands collapsed;and Level 3,glandular destruction or collapse was more than25% in the examined materials.In these pathological sections of prostate tissue,if there existed neutrophils infiltration without chronic inflammatory cell infiltration,it could be considered as BPH with histologic acute prostatitis;if there existed chronic inflammatory cell infiltration without neutrophils infiltration,it could be considered as BPH with histologic chronic prostatitis;and if there existed both neutrophils infiltration and chronic inflammatory cell infiltration,it could be considered that at the same time the patient combined with histologic acute and chronic prostatitis.Results: All prostate pathological tissue slices showed different degrees of chronic inflammatory cell infiltration and hyperplasia changes.Groups A,B,C,and D comprised 59,41,0,and 0 cases,respectively.In Group A,7 cases presented no glandular epithelial disruption,26 cases presented mild disruption,23 cases presented moderate disruption,and 3 cases presented severe disruption.In Group B,25 cases presented no glandular epithelial disruption,15 cases presented mild disruption,1 case presented moderate disruption,and no case presented severe disruption.The differences between the two groups were significant(P< 0.05).Conclusions: In this study,patients with BPH are all complicated with histologic chronic prostatitis,which shows that chronic prostatitis plays a catalytic role in the progression of benign prostatic hyperplasia;More than half of BPH patients combined with histologic acute prostatitis,and this type of inflammation has a greater degree of damage to the prostate gland.Part 2: Analysis of neutrophil-to-lymphocyte ratio in blood of patients with BPH and histological prostatitisObjective: To analyze the correlation between histological prostatitis and neutrophil to lymphocyte ratio in blood,we can further provide new ideas for the diagnosis of prostatitis.Methods: The neutrophil counts and lymphocyte counts in blood of patients were collected,further neutrophil-to-lymphocyte ratio was calculated.The neutrophil counts and lymphocyte counts were detected by Heze Municipal Hospital Center Laboratory.These neutrophil-to-lymphocyte ratios werecompared and analyzed respectively by student’ t test between group A and group B.Results: In group A,the neutrophil-to-lymphocyte ratio was 3.97±2.82.In group B,the neutrophil-to-lymphocyte ratio was 2.73 ± 2.21.The value of neutrophil-to-lymphocyte ratio was higher in group A than B,the difference were significant(P<0.05).Conclusions: Histological acute prostatitis can elevate neutrophil-to-lymphocyte ratio in peripheral blood,the ratio can be used as an index to predict whether patients with BPH are complicating histological acute prostatitis,which has potential application value.Part 3: Analysis of serum PSA-related indexes in patients with benign prostatic hyperplasia and prostatitisObjective: To provide new ideas for the diagnosis of prostatitis,this study was performed to explore the characteristics of serum t PSA,f PSA,f PSA/t PSA,t PSAD,f PSAD in patients with concurrent benign prostatic hyperplasia and prostatitis.Methods: The quantitative determination kit(chemiluminescence immunoassay)of PSA was used by the central laboratory of Heze Municipal Hospital to test the patients’ serum values of t PSA,f PSA,f PSA/t PSA,and three diameters of prostate measured by color Doppler ultrasound were collected.Then calculated: prostate volume(PV)= length × width × thickness × 0.52;t PSAD = t PSA/PV;f PSAD = f PSA/PV.these values of t PSA,f PSA,f PSA/t PSA,t PSAD,f PSAD were compared and analyzed respectively by rank sum test between group A and group B.Results: In group A,the concentration of serum t PSA was 7.68(3.12,14.63)ng/ml,the concentration of serum f PSA was 1.09(0.56,2.04)ng/ml,the value of f PSA/t PSA was 0.16(0.1,0.23),the value of t PSAD was 0.13(0.07,0.25)ng/ml~2,the value of f PSAD was 0.02(0.01,0.03)ng/ml~2.In group B,the concentration of serum t PSA was 3.6(1.24,10.15)ng/ml,the concentration of serum f PSA was 0.76(0.25,1.51)ng/ml,the value of f PSA/t PSA was 0.2(0.15,0.31),the value of t PSAD was 0.08(0.04,0.21)ng/ml~2,the value of f PSAD was0.02(0.01,0.03)ng/ml~2.The values of t PSA,t PSAD were all higher in group A than group B,and the values of f PSA/t PSA were lower in group A than group B;these differences were significant(P<0.05).There was no statistically significant difference for the values of serum f PSA,f PSAD between the two groups(P>0.05).Conclusions: Histological acute prostatitis can elevate level of serum t PSA,t PSAD and cut down f PSA/t PSA value in patients with BPH,while the effect of histological chronic prostatitis on serum PSA-related indexes is small. |
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