组织炎症在良性前列腺增生症中发生机理及作用：功能性磁共振的基础研究

Benign prostatic hyperplasia (BPH) is a common disease of the middle-aged men，but its pathogenesis has not been fully elucidated. Nowadays, some studies have found chronic tissue inflammatory infiltration in 60-90% of pathological specimens of BPH, our study had also found that chronic tissue inflammatory infiltration could promote the progress of BPH. The related study of our and other scholars only limited to observation and testing of single cell line, but chronic tissue inflammation is a long-term dynamic process of change. At present, it is unknown that weather the process contributes to the pathogenesis of BPH. Traditional molecular biology technique is unable to observe the dynamic changes of this process; however, for studying that, functional magnetic resonance imaging (fMRI) can provide technical support. In this project, by fMRI technique, the changes of metabolites in vivo prostate tissue would be observed in molecular level, and then the diagnosis system of evaluation of chronic prostate tissue inflammation is established. With the occurrence and development of BPH, the diagnosis system would facilitate the understanding of the development change process of chronic inflammation in the prostate tissue, to further clarify the relationship between chronic inflammation and BPH.

良性前列腺增生（BPH）是中老年男性常见病，其发病机制尚未完全阐明。近来研究发现60-90%的BPH病理标本中有慢性组织炎症浸润；最近，我们的研究发现慢性组织炎症对BPH疾病进展有促进作用。但是，目前我们及国内外学者的相关研究均局限于对单一细胞株或病理组织标本变化终点值的观察与检测；然而，慢性组织炎症是一个长期动态变化的过程，这一动态变化过程对BPH发生、发展如何发挥作用，目前尚不可知。传统分子生物学检测方法无法实现对前列腺组织中慢性组织炎症动态变化过程的观察，而功能性磁共振为研究这一过程提供了技术支持。本项目拟应用功能性磁共振，通过在分子水平观察活体前列腺组织中代谢物的变化，建立功能性磁共振评价前列腺慢性组织炎症的诊断体系，动态了解前列腺组织中慢性组织炎症的发展变化过程，结合BPH的发生、发展，进一步阐明慢性组织炎症与BPH的关系。

前列腺组织炎症在良性前列腺增生（BPH，benign prostate hyperplasia) 的发生、发展过程中扮演着重要的角色，其相关机制一直是泌尿界研究的焦点，而寻找敏感性、特异性较好的方法来检测前列腺组织炎症更具有重要现实意义，它有可能会为BPH的治疗策略和预后信息提供科学依据和理论支持。本研究首先建立大鼠前列腺慢性组织炎症模型，并应用磁共振弥散加权成像（DWI，diffusion weighted imaging）技术在分子水平观察前列腺组织中水分子弥散运动的变化，结果发现前列腺组织炎症在T2加权成像、DWI图像上无特异性改变，而重建出表观弥散系数（ADC，apparent diffusion coefficient）值可用于预测前列腺组织炎症，并可作为反映炎症程度的参考指标，其可能机制是在前列腺炎症导致的水分子弥散障碍。在临床研究当中，BPH伴前列腺组织炎症患者的ADC、Dslow低于BPH组。不管在BPH组还是BPH伴炎症组，腺体增生组的ADC、Dslow均高于间质增生组，而且ADC、Dslow与前列腺炎症程度呈负相关。综上所述，功能性磁共振诊断前列腺组织炎症具有临床可行性，并能从一定程度上反映炎症程度。与单指数模型相比，双指数DWI诊断前列腺组织炎症的效能更高，其中Dslow值较常规ADC值具有更高的敏感性和特异性。