| Objective: To explore the association between hypertension-associated sympathetic hyperactivity and benign prostatic hyperplasia(BPH) by observing the epinephrine and norepinephrine(NA) levels in serum and hyperlastic prostate tissues and the changes in m RNA expression and protein levels of the adrenergic receptors a1A, a1B and a1D in patients with hypertension associated with BPH and simple BPH.Methods: 1) BPH patients receiving TURP in the urologic surgery department with well documented post-operative pathology were collected between January 2014 and October 2015. After removal, the prostate tissues were immediately stored frozen at-80 o C. Patients were to be diagnosed for hypertension according to 2014 China Guideline on the Diagnosis Criteria for Hypertension. Inclusion criteria: age ≥50years, prostate volume≥25ml, IPSS score>8 points, QOL>2 points, Qmax<15ml/s,PVR>50ml, Pdet max in PFS≥40cm H2, association with bladder outlet obstruction(BOO), normal renal function, absence of diabetes or nervous system disease, and no history of pelvic surgery. Patients were assigned to 1) Group A including patients with simple BPH(blood pressure<140/90 mm Hg)(n=45); 2) Group B including patients who had hypertension previously untreated before admission and receiving short-term antihypertensive treatment before TURP and who had not usedα-blockers(n=43); or Group C including patients confirmed with hypertension before admission which had been controlled below the target( <140/90 mm Hg) with long-term medical treatment and who had not used α-blockers(n=47). Prostate volume and postvoid residual(PVR) were measured by B-μltrasonogaphy.Urodynamic studies including Qmax and pressure-flow study(PFS) were performed.Blood biochemistry was tested by the laboratory of our hospital. The levels of epinephrine and norepinephrine in serum, urine and prostate tissues were determined by the ELISA method. The expression levels of the norepinephrine receptors α1A,α1B and α1D in prostate tissues were determined by the IHC method. The m RNA expression levels of the norepinephrine receptors α1A, α1B and α1D in prostate tissues were determined by Real-Time PCR. The protein expression levels of the norepinephrine receptors α1A, α1B and α1D in prostate tissues were determined by Western-blotting.Resμlts: 1) Compared with Group A(simple BPH group), there were significant increases in the fasting levels of epinephrine and norepinephrine in serum, urine and hyperplastic prostate tissues in Group B(hypertension associated with BPH group)(P<0.01). Compared with Group B, there were significant decreases in the fasting levels of epinephrine and norepinephrine in serum, urine and hyperplastic prostate tissues in Group C(P<0.05); compared with Group A, there were significant increases in the m RNA expression and protein levels of the norepinephrine receptors α1A,α1B and α1D in hyperplastic prostate tissues in Group B; compared with Group B,there were significant decreases in the m RNA expression and protein levels of the norepinephrine receptors α1A, α1B and α1D in hyperplastic prostate tissues in Group C(P<0.05). Both the volume and weight of hyperplastic prostate tissues were greater in Group B than in Group A(simple BPH group)(P<0.05), and smaller in Group C than in Group B(hypertension associated with BPH group)(P<0.05). There were no significant differences across the three groups in HR, urine protein, blood glucose, blood lipids, total cholesterol, TPSA, or PFSA(P>0.05).Conclusions: 1.In hypertensive patients, there woμld be increased levels of epinephrine and norepinephrine in serum, urine and prostate tissues and increased m RNA and protein expression levels of the norepinephrine receptors α1A, α1B andα1D, and blood pressure control coμld lower the levels of norepinephrine in serum and prostate tissues and the receptor expression levels in prostate tissues. 2. There woμld be increased IPSS in hypertensive patients with BPH, and blood pressure control coμld improve IPSS. |
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