Transition Zone Index of the Prostate as an Indicator of Bladder Outlet Obstruction and a Predictor of Response to Medical Treatment in Symptomatic Benign Prostatic Hyperplasia

使用前列腺過渡區指數在有症狀之良性前列腺肥大評估膀胱外阻塞及藥物治療效果

10.6440/TZUCMJ.199712.0249

郭漢崇(Hann-Chorng Kuo)

良性前列腺肥大 ； 前列腺過渡區 ； 過渡區指數 ； 藥物治療 ； benign prostatic hyperplasia ； transition zone ； transitional zone index ； finasteride ； deibenyline

慈濟醫學雜誌

9卷4期（1997 / 12 / 01）

249 - 258

英文

TZI與前列腺容積及過渡區容積有很好的相關性(P=0.000)，且與病人年齡(P=0.017)，症狀積分IPSS(P=0.02)，Qmax(P=0.02)均有很好的相關性。過渡區容積則僅與年齡有相關性(P=0.021)，在全部病人中平均全前列腺容積僅有27.9 ± 15.4Ml，過渡區容積為10.4 ± 8.5Ml，而TZI則為0.34 ± 0.11，顯示本研究群的病人為具有小的前列腺但症狀嚴重者。 當我們比較在藥物治療效果良好的病人之前列腺容積參數，可以發現較高的TZI與病人的IPSS良好改差(IPSS減少10以上)有關，尤其在病人單獨以finasteride 治療(p=0.05) 及病人以finasteride加dibenyline同時治療(p=0.007)兩組最為明顯。而在使用finasteride的病人中，Qmax有良好改善(Qmax增1.5Ml/sec)的病人中其TZI亦較高。全前列腺容積及過渡區容積則僅有同時使用finasteride及dibenyline病人組中有較好的IPSS改善病人中有意義的差別。在所有的前列腺容積參數中，TZI是較為可信賴的指標以評估有症狀的前列腺肥大。一個較高的TZI不僅意味病人有較嚴重的前列腺阻塞，也可用來預測病人在使用finasteride 或共同使用finasteride及dibenyline時有較良好的治療效果。(慈濟醫學1997;9:249-258)

The purpose of this study was to assess the correlation between the transition zone index (TZI) of the prostate and lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH), and the value of the TZI in predicting treatment outcome. Two hundreds and twenty-five men(mean ± SD age, 66.9 ± 7.7years) received treatment for 6 months with dibenyline (10 mg bid), finasteride (5 mg gd), or dibenyline and finasteride. Parameters of durinary flow obstruction and prostatic volume were evaluated before and at the end of treatment. The pretreatment symptom score (IPSS), maximal flow rate (Qmax), and total prostatic volume were used as parameters of obstruction. Total prostatic volume, Transition zone volume, and TZI were used as prostatic volume parameters in transrecastal sonography. Correlations between obstructive and prostatic volume parameters were analyzed using multiple regression. TZI showed significant correlations with age(P=0.017), IPSS(P=0.02), Qmax(P=0.02), total prostatic volume (P=0.00), and transtition zone volume (P=0.00). Transition zone volume was correlated with age (P=0.019) and IPSS(P=0.02), whereas total prostatic volume correlated only with age(P=0.021). The mean total prostatic volume was 27.9 ± 15.4 mL, the transition zone volume was 10.4 ± 85mL, and the TZI was 0.34 ± 0.11, indicating patients had, on average, small prostates despite their severe symptoms. High TZI values were associated with improvement of IPSS in patients treated with finasteride alone (P＜0.05), and in those treated with combined drugs (P=0.007). A higher TZI was also noted in patients with increased Qmax values who were treated with finasteride alone (P＜0.05). Total prostatic volume and transition zone volume were significantly higher only in patients with IPSS improvement who were treated with combined drugs. TZI was the most reliable parameter among all prostatic volume parameters for assessing symptomatic BPH. A higher TZI not only indicated a severe bladder outlet obstruction caused by BPH, but also predicted a favorable response to finasteride and combination treatment. (Tzu Chi Med J 1997;9:249-258)