agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-890210.17650/2070-9781-2017-18-3-10-19agx-242Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWАНДРОГЕННЫЙ ДЕФИЦИТ И ПРОГРЕССИРОВАНИЕ ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИИ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ У БОЛЬНЫХ С МЕТАБОЛИЧЕСКИМ СИНДРОМОМ: НЕТ ЛИ ПРОТИВОРЕЧИЯ? (ОБЗОР ЛИТЕРАТУРЫ)ANDROGEN DEFICIENCY AND PROGRESSION OF BENIGN PROSTATIC HYPERPLASIA IN PATIENTS WITH METABOLIC SYNDROME: IS THERE ANY CONTROVERSY? (A LITERATURE REVIEW)КирпатовскийВ. И.KirpatovskiyV. I.

105425 Москва, ул. 3-я Парковая, 51

513rd Parkovaya St., Moscow 105425

vladkirp@yandex.ruФроловаЕ. В.FrolovaE. V.

105425 Москва, ул. 3-я Парковая, 51

513rd Parkovaya St., Moscow 105425

НадточийО. Н.NadtochiyO. N.

105425 Москва, ул. 3-я Парковая, 51

513rd Parkovaya St., Moscow 105425

ЧочуевО. С.ChochuevO. S.

105425 Москва, ул. 3-я Парковая, 51

513rd Parkovaya St., Moscow 105425

КазаченкоА. В.KazachenkoA. V.

105425 Москва, ул. 3-я Парковая, 51

513rd Parkovaya St., Moscow 105425

НИИ урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияN.A.Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiology Center, Ministry of Health of RussiaRussian Federation2017101120171831019Copyright © Кирпатовский В.И., Фролова Е.В., Надточий О.Н., Чочуев О.С., Казаченко А.В., 20172017Кирпатовский В.И., Фролова Е.В., Надточий О.Н., Чочуев О.С., Казаченко А.В.Kirpatovskiy V.I., Frolova E.V., Nadtochiy O.N., Chochuev O.S., Kazachenko A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/242

В обзоре литературы рассматриваются механизмы развития доброкачественной гиперплазии предстательной железы (ДГПЖ) у больных с метаболическим синдромом (МС) и их связь с андрогенным дефицитом, который часто имеет место у этих пациентов. Приведены данные литературы, свидетельствующие, что, несмотря на сниженный уровень тестостерона в крови у больных с МС, у них чаще диагностируется ДГПЖ, выявляется более значительное увеличение предстательной железы, более быстрое прогрессирование ДГПЖ, ухудшение состояния мочеиспускания по сравнению с пациентами аналогичных возрастных групп без МС. В качестве факторов, способствующих прогрессированию ДГПЖ при наличии МС, рассматриваются изменение тканевого метаболизма половых гормонов с увеличением концентрации как андрогенов, так и эстрогенов в предстательной железе, несмотря на сниженную концентрацию андрогенов в крови, относительное преобладание эстрогенных воздействий, фактор хронической ишемии тазовых органов, стимуляция пролиферации клеток предстательной железы вследствие повышенной концентрации инсулина и усиления секреции факторов роста, а также развивающегося хронического низкоинтенсивного воспаления. Особенности патогенеза ДГПЖ при МС предполагают коррекцию подходов к лечению больных ДГПЖ при наличии МС, поскольку традиционная терапия этих больных оказывается менее эффективной, чем у пациентов с ДГПЖ без МС.

The present review describes the mechanisms of benign prostatic hyperplasia (BPH) development in patients with metabolic syndrome (MS) and its association with androgen deficiency, which is frequently observed in these patients. We cover the data indicating that despite a reduced serum level of testosterone in patients with MS, they are more likely to be diagnosed with BPH, have more significant prostate enlargement, more rapid BPH progression, as well as deterioration of urination problems compared to patients of similar age without MS. The following factors are considered to trigger BPH in patients with MS: changes in the tissue metabolism of sex hormones with increased androgens and estrogens concentrations in the prostate gland despite the reduced serum androgen levels, relative prevalence of the estrogenic effects, chronic pelvic ischemia, stimulation of prostate cells proliferation due to the elevated insulin level and the increased secretion of growth factors, and developing chronic low-intensity inflammation. Specific features of BPH pathogenesis in individuals with MS suggest a correction of therapeutic approaches to BPH in such cases, because conventional therapy in patients with BPH and MS is less effective than in patients with BPH only.

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The authors declare that there are no conflicts of interest present.