慢性前列腺炎疗效与患者精神状况及相关因素Cox回归分析

Correlation of the Prognosis of Chronic Prostatitis/Chronic Pelvic Pain Syndrome with Psychological and Other Factors:A Cox Regression Analysis

目的:筛选验证与慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)相关的精神心理因素,采用Cox回归分析方法研究这些精神心理因素及其他相关因素对CP/CPPS治疗效果的影响,为CP/CPPS治疗过程中有针对性的精神心理干预提供科学依据。方法:连续调查于我院就诊的291名CP/CPPS患者(病例组)的年龄、文化程度、职业、性格类型、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、病程、NIH慢性前列腺炎症状指数(NIH-CP-SI)和前列腺液白细胞计数,同时选择相同年龄阶段的健康男性100名(对照组)进行病例对照研究,筛选验证与CP/CPPS相关的精神心理因素。调查结束后,病例组所有患者均接受为期6周的统一方案治疗并进行随访(6周),以治疗是否有效为终结事件,以治疗见效时间为时间变量,采用单因素和多因素Cox回归分析研究与CP/CPPS相关的精神心理因素及其他可能影响CP/CPPS治疗效果的因素,筛选能够影响CP/CPPS治疗效果的相关因素。结果:病例组回收有效问卷258份,对照组回收有效问卷87份。病例组SAS和SDS评分分别为(42.8±11.43)分和(48.15±11.49)分,均显著高于对照组[SAS(32.12±9.68)分,SDS(35.12±10.81)分,P<0.01]。病例组焦虑、抑郁以及焦虑或/和抑郁障碍的检出率分别为25.97%、21.71%和34.50%,均显著高于对照组(P<0.01);内向性格和外向性格的检出率亦分别高于和低于对照组(P<0.01);提示焦虑、抑郁和内向性格与CP/CPPS具有正联系,而外向性格与CP/CPPS具有负联系。病例组接受为期6周统一治疗后的总有效率达70.54%,Cox回归分析显示,在上述与CP/CPPS相关的4个因素(焦虑、抑郁、内向性格、外向性格)和另外可能影响CP/CPPS治疗效果的4个因素(年龄、病程、前列腺液中白细胞计数、CPSI)中,对CP/CPPS治疗效果有确切负性影响的危险因素有焦虑、抑郁和病程。结论:焦虑和抑郁等精神心理障碍在CP/CPPS发生、发展及治疗转归过程中具有重要作用;在CP/CPPS治疗过程中,应充分重视患者的精神心理状况,必要时应有针对性地给予适当的精神心理干预。

Objective ： To establish the role of psychological factors in the etiology and symptomatology of chronic prostatitis / chronic pelvic pain syndrome （ CP/CPPS）, analyze the influence of the psychological obstacles and other relative factors on the prognosis of CP/CPPS by univariate and multivariate Cox regression analyses, and provide a scientific basis for psychotherapy of the problem. Methods： A total of 291 CP/CPPS patients and 100 normal controls were investigated in age, education, occupation, character, disease course, NIH chronic prostatitis syndrome index （NIH-CPSI） and leukocyte count in EPS and by self-rating anxiety scale （SAS） and self-rating depression scale （SDS） to establish the psychological factors related with CP/CPPS. Then, all the CP/CPPS patients were treated with the same method and followed up for 6 weeks. Based on the therapeutic results, the influence of psychological and other relative factors on the prognosis of CP/CPPS was analyzed with univariate and multivariate Cox regression. Results ： All together 258 valid questionnaires were collected from the patients and 87 from the normal controls. Of the 258 CP/CPPS patients, the mean scores on SAS and SDS were 42.8 ± 11.43 and 48.15 ± 11.49 respectively, both significantly higher than those of the controls （32.12 ± 9.68 and 35.12 ± 10.81 ） （P 〈 0.01 ）. The rates of anxiety, depression and anxiety and/or depression in the CP/CPPS group were 25.97, 21.71 and 34.50 % respectively, all significantly higher than in the control group （P 〈 0.01 ）. The rate of introversion was significantly higher while that of extroversion significantly lower in the former than in the latter （ P 〈 0.01 ）. The total effectiveness rate of treatment was 70.54 % in the CP/CPPS patients. Univariate and multivariate analyses with Cox regression revealed that anxiety, depression and disease course were the definite factors that negatively affected the prognosis of CP/CPPS, while the other factors, such as age, CPSI, character and leukocyte count in EPS had no influence. Conclusion： Such psychological obstacles as anxiety and depression play an important role in the pathogenesis, development and prognosis of CP/CPPS. In the treatment of CP/ CPPS, importance should be attached to the patients＇psychological status and proper psychological intervention is sometimes necessary.