α受体阻滞剂治疗Ⅲ型前列腺炎的效果分析

Analyses of fourα-adrenergic receptor antagonists in the treatment of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)

目的探讨α肾上腺素能受体(α-AR)阻滞剂治疗Ⅲ型前列腺炎(慢性非细菌性前列腺炎/慢性骨盆疼痛综合征,CP/CPPS)的疗效和药物副作用。方法CP/CPPS患者325例,平均年龄33.2岁,平均病程2.4年,分为盐酸哌唑嗪组95例、盐酸特拉唑嗪组78例、盐酸酚苄明组27例和甲磺酸多沙唑嗪控释片组72例,根据病情选用抗生素及其他对症支持治疗。采用NIH慢性前列腺炎症状指数(CPSI)评分作为疗效评价指标,分析评定比较各组患者疗效及副作用。未使用α-AR阻滞剂的53例作为对照组。结果对照组患者治疗有效(CPSI减少≥5分)22例(41.5%),无效(CPSI减少＜5分)31例(58.5%)；治疗组有效199例(73.2%),无效73例(26.8%),2组比较差异有统计学意义(P＜0.01)。盐酸酚苄明组有效率55.6%,盐酸特拉唑嗪组78.2%,甲磺酸多沙唑嗪控释片组76.4%,盐酸哌唑嗪组71.6%。α-AR阻滞剂药物副作用主要有体位性低血压(盐酸哌唑嗪组23.2%、盐酸特拉唑嗪组17.9%、盐酸酚苄明组22.2%和甲磺酸多沙唑嗪控释片组8.3%)和射精障碍(仅盐酸酚苄明组51.9%)。因不良事件停止治疗的发生率依次为盐酸酚苄明(18.5%)、盐酸哌唑嗪(7.4%)、盐酸特拉唑嗪(5.1%)和甲磺酸多沙唑嗪控释片组(0)。结论α-AR阻滞剂是治疗CP/CPPS的基础用药之一,可以显著改善患者的NIH-CPSI评分,但在选择药物时应考虑某些制剂的副作用。

Objective To investigate the efficacy and side effects of 4 α-adrenergic receptor （α- AR） antagonists in the treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods Totally,325 patients （mean age,33.2 year;disease history,2.4 years） with CP/CPPS were randomly divided into Prazosin （ n = 95 ）, Terazosin （ n = 78 ）, Phenoxybenzamine （ n = 27 ） , and Doxazosin mesylate controlled release tablets （n = 72） groups. Some antibiotics and medications were used for allopathy. In addition,53 cases with no α-AR antagonist treatment served as control group. The efficacy and side effects in all the patients were observed and recorded. The chronic prostatitis symptom index （CPSI） was used to evaluate the efficacy. Results In control group,22 （41.5%） patients responded well to the treatment （CPSI mark drop ≥5） and 31 （58.5%） failed to respond to the treatment （CPSI mark drop 〈 5）. In study group, 199 （73.2%） patients responded well to the treatment, and 73 （26.8%） failed. The difference in efficacy between α-AR antagonists and placebo treatment was significant （ P 〈 0.01 ）. In study group, specifically, the effective rate was 55.6% in Phenoxybenzamine,78.2% in Terazosin,76.4% in Doxazosin mesylate controlled release tablets, and 71.6% in Prazosin groups. The main side effects of α-AR antagonists were postural hypotension （ a rate of 23.2% for Prazosin, 17.9% for Terazosin, 22.2% for Phenoxybenzamine, and 8.3% for Doxazosin mesylate controlled release tablets） and dysfunction of ejaculation （only in Phenoxy- benzamine group with a rate of 51.9% ）. The rates of withdrawing treatment due to side effects were in turn 18.5% of Phenoxybenzamine,7.4% of Prazosin,5.1% of Terazosin, and 0% of Doxazosin mesylate controlled release tablets. Conclusions As essential medications for the treatment of CP/CPPS,α-AR antagonists can relieve the clinical symptoms （dropping NIH-CPSI mark significantly）, but some side effects should be considered when some medications are selected.