特异性COX-2抑制剂在慢性盆底疼痛综合征治疗中的应用

The study of selective COX-2 inhibitor in the treatment of chronic pelvic pain syndrome

目的应用特异性COX-2抑制剂及特拉唑嗪分组治疗ⅢB型CPPS,探讨其可能发生机制及选择合理的治疗方案。方法以两杯法及尿常规、前列腺液常规检查及NIH-CPSI评分筛选ⅢB型CPPS患者87例,并随机分为特拉唑嗪治疗组27例,塞来昔布治疗组29例及两者联合用药组31例,分别连续药物治疗4周。治疗前后分别进行NIH-CPSI评分,并对正常对照组及入组患者治疗前后的前列腺液标本应用westernblot方法进行COX-2表达水平测定及应用ELISA方法进行PGE2浓度测定。结果(1)治疗前各治疗组COX-2表达及PGE2浓度测定结果均明显高于正常对照组,有显著性差异(P<0.05),各治疗组间无显著性差异(P>0.05)。(2)治疗后各治疗组COX-2表达及PGE2浓度测定结果比较治疗前有显著性差异(P<0.05),但组间比较无显著性差异。(3)CPSI评分各治疗组治疗后每个变量与治疗前比较均有显著性差异(P<0.05);且组间比较有显著性差异(P<0.05)。结论本研究表明CPPS患者前列腺液中COX-2和PGE2的表达水平与CPPS的发生及症状的严重程度有密切的相关性。特异性COX-2抑制剂及α-肾上腺素受体阻断药均可降低前列腺液中炎症因子表达,治疗上联合用药可以提高疗效。

Objective To investigate the mechanism of Type ⅢB CPPS and determine reasonable clinical guidance for treatment of it by comparing the efficacy of COX-2 inhibitor and other drugs. Methods The total of 87 patients with CPPS were first screened by physical examination, urine and EPS analysis and NIH-CPSI score, and then they were divided randomly into three groups including 27 cases treated with Terazosin （Group Ⅰ）, 29 cases treated with Celecoxib （Group Ⅱ）, and 31 cases treated with Celecoxib and Terazosin（Group Ⅲ）. All patients received drug therapy for 4 weeks. Symptom scores （NIH-CPSI） and urodynamic indexes were evaluated and the expression of COX-2 and PGE2 in EPS of CPPS patients and normal asymptomatic controls were respectively detected by Western Blot and Enzyme-Linked Immumosorbent Assay pre- and post-treatment. Results （1）Before treatment, the levels of COX-2 and PGE2 in EPS were significantly higher in treated group than those in normal controls （P〈0.05）, but no statistical significance was found between each treated group（P〉0.05）. （2） After treatment, the levels of COX-2 and PGE2 in EPS of treated group were significantly lower than those in EPS of pre-treatment counterparts （P〈0.05） but no statistical significance was found between each group （P〉0.05）. （3）There was a significant difference in NIH-CPSI score of treated group between pre- and post treatment （P〈0.05） whereas no significant difference was found between each group. Conclusion The levels of COX-2 and PGE2 in EPS might play an important role in CPPS and were associated with symptoms of CPPS. All of Selective COX-2 inhibitor and Alpha 1-adrenoceptor antagonist reduced the levels of inflammation factors in EPS. The combination of selective COX-2 inhibitor with alpha 1-adrenoceptor antagonist might improve clinical efficacy for CPPS treatment.