Kev tshawb fawb txog kev noj tshuaj tsis tu ncua ntawm cov tshuaj ib txwm muaj nyob hauv kev kho benign prostatic hyperplasia ntawm horserplasia ntawm horserplasia ntawm nws lub network portorology ⅱ

2. Txheej txheem cej luam ntawm Western tshuaj kev tshawb fawb ntawm benign prostatic hyperplasia (bpph)

2.1 Epidemiology ntawm Bph

BPH yog ib qho kev nquag ntawm cov neeg laus thiab laus thiab cov laus. Raws li Meta-tsom xam raws li cov ntawv nyeem hauv tsev, muaj kev vam meej ntawm cov txiv neej laus dua 40 xyoo yog36.6%Cov. Tus nqi sib tshooj los ntawm cov pab pawg hnub nyoog muaj raws li hauv qab no:

Hnub nyoog 40-49:29.0%

Hnub nyoog 50-59:29.0%

Hnub nyoog 60-69:44.7%

Hnub nyoog 70-79:58.1%

Hnub nyoog 80 thiab saum toj no:69.2%

Kev vam meej hauv nroog thiab cov chaw nyob deb nroog txawv, nrog41.5%Hauv cov nroog hauv nroog thiab38.6%Nyob rau hauv cov chaw nyob deb nroog [^ 47]. Zuag qhia tag nrho, bph muaj kev vam meej hauv Suav teb, thiab tus nqi nce ntxiv nrog lub hnub nyoog. Qhov kev sib cav sib ceg siab dua hauv nroog loj dua nyob hauv thaj chaw deb nroog.

Tshuaj ntsuab cistanche extract tshuaj rau kev tiv thaiv kev noj qab haus huv prostate

2.2 pathogenesis ntawm bph

2.2.1 androgens thiab lawv kev sib cuam tshuam nrog cov receptors

Androgens tam sim no tau pom zoo yog qhov tseem ceeb tshaj plaws ntawm kev tswj hwm ntawm kev loj hlob ntawm prostatic. Ob tug loj androgens yogtestosterone (t)thiabDihydrotestosterone (DHT)Cov. Ntawm lawv, DHT yog qhov muaj zog ntau metabolite, hloov los ntawm testosterone los ntawm5α-reductaseCov. Hauv tib neeg, muaj ob hom 5α-reductase:

Ntaus i: Feem ntau pom nyob hauv daim siab thiab tawv nqaij

Hom II: Feem ntau pom nyob rau hauv prostate

Cov kev tshawb fawb tau pom tiasHom II 5%-ReductaseUa si lub luag haujlwm tseem ceeb hauv kev txhim kho bph [^ 48]. DHT qib nyob rau hauv lub prostate yog qhov siab dua hauv cov ntshav dej, tshwj xeeb tshaj yog cov txiv neej laus. DHT khi nrog high affinity rauandrogen receptors (AR)Hauv cov hlwb prostate, txhawb kev mob prostatic epithelial thiab stromal cell proliferation [^ 49] [^ 50].

Xyoo 1970, JD Wilson thiab lwm tus pom tias DHT yog qhov tseem ceeb hauv kev loj hlob ntawm kev loj hlob. Txawm li cas los xij, tsis yog txhua tus txiv neej laus uas muaj cov qib siab loj dua BPH, hais txog lwm yam kev paub thiab cov micrroenor confensivity-tseem muaj koom tes [^ 51] [^ 52]. Cov kev tshawb fawb tau pom tias qhov kev qhia tsis tau txo qis nrog lub hnub nyoog, tab sis kev ua haujlwm hauv txoj kev loj hlob thiab kev loj hlob ntawm bph [^ 53].

Estrogens thiab receptors

Tshuaj estrogensKuj tseem ua lub luag haujlwm hauv cov kab mob hauv BPP. Nyob rau hauv cov txiv neej laus, estrogen qib nyob tsis sib xws los yog tseem nce, nyob qib testosterone poob, cuam tshuam nrog androgen-estrogen tshuav nyiaj li. Estrogen tuaj yeem ua tauCov recept estrogen (ER)Hauv cov nqaij mos mos, suav nrog:

Hlob: Txhawb cov khoom muag

Eru: Inhibits kev loj hlob thiab induces apoptosis

Qhov tsis txaus ntseeg ntawm cov ERα thiab ERT qhia yuav txhawb Bph txoj kev loj hlob Bph Kev [^ 54] [^ 55]. Estrogen stimulation kuj tseem yuav nce qhov qhia tawm ntawmCov ntsiab lus estrogen tsis zoo (ere)Hauv cov hlwb prostate, activating cov noob uas cuam tshuam nrog cov khoom muaj zog thiab o ^ 56].

2.2.2 Cov Ntsiab Lus Loj Hlob

Qhov Txheej Txheem Lojyog lwm pab pawg tseem ceeb ntawm cov kev tswj hwm muaj feem cuam tshuam nrog kev loj hlob ntawm tes, kev sib txawv, thiab tsiv teb tsaws chaw. Ob peb yam kev loj hlob muaj feem nrog BPH, suav nrog:

FibRighblast Kev Loj Hlob Qhov Chaw (FGFS)

Cov tshuaj insulin zoo li kev loj hlob (iGF)

Kev Hloov Kho Kev Loj Hlob-β (tgf-β)

Epidermal Kev Loj Hlob (Egf)

Hauv tib neeg, FGF tsev neeg suav nrog 23 subtepes, ntau yam uas tau pom los txhawb epithelial thiab stromal cell proliferation nyob rau hauv prostate. Ntawm lawv:

FGF -2(Yooj yim Fiblighblast txoj kev loj hlob qhov tseem ceeb, BFGF) yog qhia heev nyob rau hauv cov stromal tivthaiv ntawm bph

Cov kev tshawb fawb tau pom tiasFGF -2 qib yog 2-3 zaug siab dua hauv BPH ntaub so ntswgPiv rau cov nqaij prostate qub [^ 65] [^ 66]

Kev tshawb fawb txuas ntxiv los ntawm roquier thiab lwm tus muaj kev paub ntxiv tias lub luag haujlwm ntawm kev loj hlob yam hauv bp athogenesis.

2.2.2 CEEB TOOM TSEEM CEEB (txuas ntxiv)

FGF -7, tseem hu uaKeratinocyte kev loj hlob kev loj hlob (kgf), yog qhia heev hauv Bph Cov Ntaub Ntawv [^ 67]. FGF -7} txhawb nqa cov lus loj ntawm epithelial cell muab tau los ntawm urogen sinus thaum muaj me ntsis rau ntawm cov kab mob hlwb. Cov kev sim tsiaj tau lees paub tias FGF -7 tseem ceeb txhawb nqa qhov loj hlob ntawm bph hlwb [^ 69]. Cov kev tshawb fawb kuj tau pom tiasFGF -7 Tshaj tawm nce ntxiv thaum lub sij hawm thaum ntxov ntawm BPH, tawm tswv yim nws lub luag haujlwm yog qhov pib loj pib. FGF {{0 {}} Thiab fgf {{} Sib piv,FGF -2Qhia ua rau muaj zog ua kom muaj zog dua hauv kev txhawb nqa tus mob epithelial cell proliferation [^ 71]. FGF -10, uas yog ze ze rau fgf {2}}}}}}}}}} epostate hyperplasia [^ 72].

Cov tshuaj insulin zoo li kev loj hlob (iGFS), suav nrogIGF-I thiab IGF-II, yog ntau yam kev loj hlob muaj ntau yam uas txhawb nqa cov kws tshaj lij cell proliferation thiab txawv. IGF tau dav faib nyob rau hauv prostate thiab yog tswj los ntawm androgens. Cov kev tshawb fawb tau pom tiasIGF-Kuv yog tsuas yog tsim nyob rau hauv prostate stroma, Thaum lub sijhawm IGF-II yog qhia hauv ob epithelium thiab stroma [^ 73]. Ntxiv rau,IGF khi cov protein (igfbps), tshwj xeebIgfbp -3 Thiab igfbp -4, tswj hwm iGF Bioavailability thiab kev ua [^ 74]. Aberrations nyob rau hauv lub igf / igfbp axis yuav txhawb Bph kev nce qib los ntawm kev txhim kho igf signaling los yog txo cov kua paug.

Kev Hloov Kho Kev Loj Hlob-β (tgf-β)yog tsev neeg loj ntawm cytokines koom tes nrog kev txhim kho ntawm tes. Ntawm lawv,Tgf-β1inhibits epithelial prove thiab txhawb kev nruj sib zog [^ 78]. TGF-β1 kuj tseem ceebepithelial-rau-mesenchymal hloov (EMT), ua rau muaj kev nkag mus rau cov nqaij mos rau cov ntaub so ntswg kho [^ 79]. Hauv kev sib piv,Tgf-β2yog ntau cuam tshuam nrog cov lus teb mob qog thiab tuaj yeem pab txhawb rau Bph txoj kev nce qib [^ 84].

Hauv cov ntsiab lus, muaj ntau yam kev loj hlob ntawm cov kab ke thiab cov phiajcim kev sib koom tes hauv cov papogenesis ntawm bph, txawm hais tias lawv cov kev tswj hwm kev cai tshwj xeeb.

2.2.3 Inflammatory yam ntxwv

Bph yog cuam tshuam ze nrog cov mob o. Hauv kev kawm txog 167 bph tus neeg mob,75-90%ntawm postate cov ntaub so ntswg pom cov cim ntawm o. Inflammatory cytokines pab ua kom pob khaus khaus thiab stromal hyperplasia, suav nrog kev ua haujlwm ntawmFGF -2 Thiab fgf -21, uas ua rau muaj kev nce siab ntawm cellular thiab txo tus ntxhiab [^ 85] [{{1} {1}}].

Cov kev tshawb fawb tau txheeb xyuas cov theem ntawmIpt -2}, is -4},}}, thiab iTn-γ-γNyob rau hauv bph ntaub [^ 88-90]. Il -2 Thiab Il -7} promote promote promote promote promote promote promote {4}} tuaj yeem ua rau mob cell proliferation.Macrophage inibitory cytokine -1 (M -1)Kuj tseem muaj ntau ntxiv hauv BPH cov ntaub thiab tuaj yeem txhawb cov lus teb mob. Tsis tas li ntawd,Cox -2, tus tseem ceeb enzyme hauv Prostaglandin synthesis, yog upregulated hauv Bph cov ntaub [^ 91] [^ 92]. Txawm li cas los xij, kev sib raug zoo ntawm kev sib raug zoo ntawm kev ua pa thiab bph kev nce zuj zus.

2.3 Kev Kho Mob ntawm benign prostatic hyperplasia

2.3.1 Saib Xyuas Tos

Saib xyuas tos yog qhov tsis paub txog kev tswj hwm kev tswj hwm feem ntau siv rau cov neeg mob nrogCov tsos mob me me qis qis dua (Luts), txhais liIps ≤ 7, lossis rau cov neeg mob laus nrogmob rau cov tsos mob hnyav(Ipss> 8) Leej twg tsis haum rau kev nquag vim yog tsis zoo txoj kev noj qab haus huv lossis tus kheej nyiam [^ 93].

2.3.2 Kev Kho Mob Tshuaj

Kev Kho Mobileologological yog qhov kev kho mob tseem ceeb rau cov neeg mob uas muaj mob hnyav. Lub hom phiaj yog txhawm rau txhim kho cov tsos mob, ncua kev kis mob, thiab txo qhov xav tau kev phais mob, thaum tswj hwm lub neej zoo thiab txo kev tsis zoo.

2.3.2.1 α {{{}} adrenergic receptor blockers

α {1- blockersUa los ntawm kev so cov leeg du cov leeg hauv prostate thiab zais zis thiab lub zais zis, yog li tshem tawm cov zis. Lawv pab kom cov kev tso zis ntau tshaj plaws thiab txo cov zis seem. Cov tshuaj muaj xws liTamsulosin, Alfuzosin, Terazosin, Dozazosin, thiabSilodosinCov. Cov tshuaj no yog thawj-kab kho rau BPP, tshwj xeeb tshaj yog rau cov neeg mob nrog kev sib cais dynamication [^ 94].

Kev tsis zoo yuav suav nrogKiv taub hau, hypotension, qaug zog, lossis rov ua dua tshiab EjaculationCov. Lawv tsis raug pom zoo rau cov neeg mob uas muaj prostatic prostatic txhim kho lossis cov uas muaj hypotension.

2.3.2. {{{2 5 α-reductase inibitors (5- aris)

5-} arisinhibit qhov hloov dua siab tshiab ntawm testosterone rauDHT, ua rau txo cov kua roj thiab hnoos-epithelial cell Apoptosis. Muaj ob hom tseem ceeb:

Tus tav dhau(Xaiv tau cov khoom lag luam II 5%-reductase)

Dutasteride(inhibits ob hom I thiab II)

Cov tshuaj no tau tshwj xeeb rau cov neeg mob nrogenlarged prostate volume (>30 ml)thiab HIGH qib siab. Lawv pab txhim kho cov tsos mob thiab txo qhov kev pheej hmoo ntawm kev tso zis thiab qhov xav tau kev phais mob. Txawm li cas los xij, cov tsos mob nyem yuav siv3-6 hlis[^ 95]. Cov kev mob tshwm sim muaj xws liTxo libido, erectile kawg, thiabGynecomastia.

2.3.2.3 m receptor antagards

M RECORTOR antubsinistsInhibit cov tshuaj tiv thaiv kab mob muscarinic, feem ntau m2 thiab m3 subtypes, yog li txo cov zais zis qis qis tso zis tawm (Luts) hauv BPH cov neeg mob. Tam sim no, tshuaj nrog xaiv rau M2 thiab M3 receptors, xws liOxybutyninthiabtolterodine, yog siv ntau. Cov tshuaj no feem ntau yog thov hauv BPH cov neeg mob nrogCov tsos mob uas ciaZoo li kev tso zis, Nocturia, thiab nquag tso zis, tshwj xeeb tshaj yog thaum seem zis yog tsawg dua 50 ml. Txawm li cas los xij, lawv tuaj yeem ua rau phiv xws liLub qhov ncauj qhuav, kiv taub hau, cem quav, plooj plooj, thiab tso zis cia. Yog li ntawd, m redeptor antagists yogtsis pom zoo rau cov neeg mob uas muaj cov zis tseem ceeb lossis tso zis tawm[^95].

2.3.2.4 PDE5 Inhibitors

Phosphodiesterase Hom 5 Inhibitors (PDE5I)Ua kom nce cov leeg cgmp, coj mus rau cov leeg nqaij du, uas tuaj yeem txo qis qis tso zis tawm thiab txhim kho kev nyab xeeb. Txawm hais tias Ameslikas siv rau kev kho erectile kawg, cov pov thawj los ntawm Meta-Analyzes qhia tiasPde5I tuaj yeem txo IPSs thiab txhim kho erectile muaj nuj nqi (inyas)hauv BPH cov neeg mob. Txawm li cas los xij, lawv cov nyhuv ntawmsiab tshaj plaws tso dej ntws (qmax)yog txwv. PDE5I yog feem ntau zoo siab zam, nrog cov kev cuam tshuam me me xws liNasal congestion thiab yaug[^96].

2.3.2.5 β 3- adrenergic receptor agonists

{3- adrenergic receptor agonistsUa rau detrusor cov leeg du cov leeg β3 receptors los txhawb kev so thiab yoog ua kom tsis tu ncua lub zais zis (OAB) cov tsos mob. Txawm hais tias feem ntau siv rau OAB, lawv kuj tuaj yeem muaj txiaj ntsig BPH cov neeg mob nrog cov tsos mob tsis sib xws. Cov kev mob tshwm sim muaj xws liTawg siab, mob taub hau, thiab qhov ncauj qhuavCov. Ceev faj tau qhia thaum siv hauv cov neeg mob hypertiveensive [^ 98].

2.3.2.2.6 phytotherapy

Tam sim no sivKev Kho Tsob NrojyuavSerenoa repens (pom Palmetto), Pygeeum African, Cucurbita Peplo (taub dag noob Extract),thiabTadenan (African Plum Extract)Cov. Cov tshuaj ntsuab yuav daws cov kab mob caj dab, txo qhov prostate o, thiab txhim kho Qol rau qee yam [^ 99]. Vim lawv cov teebmeem me me thiab cov khoom siv qis, lawv tsim nyog rau kev siv ntev thiab rau cov neeg mob uas muaj cov tsos mob me. Txawm li cas los xij, cov kev sim hauv chaw kuaj mob ntxiv yog qhov xav tau kom paub meej tias lawv cov kev ua tau zoo ua ntej kev siv hauv BPH.

2.3.3 Kev Kho Mob Kho Mob

Kev phais mob tseem yog cov kev kho mob zoo tshaj plaws raunqig rau bph, tshwj xeeb tshaj yog hauv cov neeg mob nrog cov teeb meem xws lilub pob zeb pob zeb, cov tso zis kom rov pom kev cia siab, lossis cov zis lojCov. Kev tsim kho cov kev xaiv muaj xws li:

Hloov pauv ntawm prostate (turp)

Kev phais mob siab ntawm prostate (tuip)

Holmium laser ua rau lub prostate (Holep)

Turp suav hais tias yog tus qauv kub rau Bph kev phais.Cov txheej txheem tsis zooxws liLaser Vaporization, microwave ablation, thiab koob ablationyog siv zuj zus. Rau cov neeg mob nrogprostate volume >80 ML, Qhib lossis Laparoscopic yuav tau siv.

3. Xaus

Kev phais mob tau ntev tau pom tias yog kev kho mob hauv BPH, tshwj xeeb tshaj yog nyob rau hauv mederate rau mob hnyav. Txawm hais tias phais cov txiaj ntsig yog qhov zoo, txaus ntshai xws liLos ntshav, tso zis tso zis, txo qis kev ua haujlwm, rov ua haujlwm ejaculation, kis tau tus mob, thiab qhov rov tshwm sim tuaj yeem tshwm sim. Cov Neeg MobCov teeb meem plawv lossis pulmonary comorbiditiestej zaum yuav tsis zam kev phais kom zoo.

Yog li ntawd, hauv me me mus rau qhov mob me,Cov tshuaj them yog thawj-kab kev khoCov. Cov tshuaj tam sim no xws liα {1- cov blockers, 5α-reductase inhibitors, thiab kev kho kev kho mob tau qhia qhov txiaj ntsig zoo, kev ncua kab mob kev ua tiav, thiab txo qhov kev xav tau kev phais mob. Txawm li cas los xij, qee cov tshuaj tuaj yeem ua rau muaj kev cuam tshuam zoo xws lihypotension, txo libido, thiab gynecomastia, uas tsis tuaj yeem tsis quav ntsej.

Tshuaj ntsuab tshuajtau siv dav hauv Suav teb vim lawvCov teebmeem me me thiab tsawg dua kev phiv, tab sis lawv qhov kev ua tau zoo tseem yog qhov tsis sib haum vim tsis muajCov ntawv pov thawj zooCov. Tsoos suav tshuaj (TCM) yog cov khoom muaj txiaj ntsig zoo, thiab ntau tus mob TCM-raws li kev kho mob yog cov hauv paus ntsiab lus hauv Holistic thiab tus kheej kev kho mob. Txawm li cas los xij,Cov chaw kuaj mob sim ntawm TCM rau Bph yog txwv, thiab kev siv tshuab ntawm kev ua yog tseem tsis nkag siab zoo.

Nws yog ib qho tsim nyog rauQauv thiab tshiab TCM kev tshawb fawb, TsimCov ntaub ntawv ua pov thawj raws li kev kho mob, thiab sib sau ua keSCINICAL PARPETIC THIAB NOJ NOJTxhawm rau tshawb txog cov tshuaj ntsiav tshuaj ntawm cov tshuaj ntsuab thiab cov khoom xyaw nquag. Qhov no yuav txhawb txoj kev loj hlob ntawmMuaj kev nyab xeeb, siv tau zoo, thiab pheej yig Bph kho.