α-受体阻滞剂、COX-2抑制剂和抗抑郁药联合治疗慢性前列腺炎/慢性盆底疼痛综合征

Combination therapy of α-blockers, COX-2 inhibitors and antidepressive drug in the treatment of chronic prostatitis/chronic pelvic pain syndrome

目的研究α-受体阻滞剂、COX-2抑制剂和抗抑郁药联合治疗慢性前列腺炎/慢性盆底疼痛综合征(CP/CPPS)的效果。方法本组57例被诊断为CP/CPPS的患者,平均年龄33岁(18～58岁)。均有骨盆区域疼痛不适、尿频、尿不尽感及紧张、焦虑等症状。平均病程10月(3月～2年)。均有抗生素治疗史,疗效不佳。采用α-受体阻滞剂(多沙唑嗪控释片4mg/d口服)、COX-2抑制剂(塞来昔布200mg/d口服)、抗抑郁药(舍曲林50mg/d口服)联合疗法,3月为一疗程。在治疗前、治疗后4周、8周和12周对患者进行美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)评分并记录不良反应情况。疗效评定标准为:(1)显效:NIH-CPSI较治疗前下降>15分;(2)有效:NIH-CPSI较治疗前下降>5分;(3)无效:NIH-CPSI较治疗前下降<5分或上升。总有效率为显效率与有效率之和。结果显效31例,有效18例,无效4例,总有效率92%(49/53)。2例患者因药物不良反应退出治疗。结论α-受体阻滞剂、COX-2抑制剂和抗抑郁药联合治疗方案安全有效,可以明显缓解CP/CPPS患者的临床症状。

Objective To investigate the clinical effect of α-receptor inhibitor, COX-2 inhibitors and antidepressive drug in the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods A total of 57 patients diagnosed as CP/CPPS were enrolled in this study. Their acerage age was 33 years old （range from 18 to 58）. All the patients presented symptoms of discomfort or pain in the pelvic region, frequency, mental stress and anxiety. All of them had ever been treated with antibiotics but with poor effect. Mean course of disease was 10 months（range from 3 to 24）. All patients underwent the 3-month-combination therapy of α-receptor inhibitor （doxazosin 4mg/d）, COX-2 inhibitors （celecoxib 200mg/d） and antidepressive drug （sertraling 50mg/d）. They were evaluated with the National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI） and adverse events at the entry and the time of 4, 8, 12 weeks after the treatment. Assessment criteria included： Omarked effective： decrease of NIH-CPSI score was more than 15; ① effective： the decrease of NIH-CPSI score was more than 5; ②no effect： the decrease of NIH-CPSI score was less than 5. The total effective rate was the sum of marked effective and effective. Results Marked effective was found in 31 patients, effective in 18 patients and no effect in 4 patients. Total effective rate was ninety-two percent （49/53 patients）. 2 patients withdrew the treatment due to adverse drug reaction. Conclusion Combination therapy of α -receptor inhibitor, COX-2 inhibitors and antidepressive drug was safe and effective in managing CP/CPPS patients.