骶神经磁刺激联合体外冲击波治疗ⅢB型前列腺炎临床研究

Sacral nerve magnetic stimulation combined with extracorporeal shockwave for the treatment of type-ⅢB chronic prostatitis

目的:探讨骶神经磁刺激联合体外冲击波治疗ⅢB型前列腺炎的临床疗效。方法:收治70例ⅢB型前列腺炎患者,年龄(34.56±7.47)岁,病程(12.95±10.73)个月,均分为治疗组和对照组,治疗组采用骶神经磁刺激联合体外冲击波疗法治疗,对照组采用生物反馈联合电刺激疗法治疗。两组患者均每次治疗40 min,每周3次,隔天1次,共治疗24次。两组患者分别于治疗前、治疗4、8周后进行慢性前列腺炎症状评分(NIH-CPSI)、最大尿流率(Qmax)、平均尿流率(Qavg)检测及抑郁自评量表(SDS)和焦虑自评量表(SAS)评分,并记录治疗期间不良反应,同时对两组患者临床疗效进行比较。结果:治疗组33例,对照组32例完成试验。治疗组治疗4、8周后,疼痛评分、排尿评分、生活质量评分和NIH-CPSI总评分均较治疗前有明显改善(P<0.05),治疗8周后各项指标改善程度均显著优于治疗4周后(P<0.05);与对照组比较,治疗8周后,各项指标改善程度均优于对照组(P<0.05);治疗4、8周后Qmax和Qavg较治疗前明显提高(P<0.05)。治疗组治疗4、8周后SDS,SAS评分均明显改善(P<0.05),且改善程度明显优于对照组(P<0.05)。33例治疗组患者中25例有效(75.8%),其中治愈/临床控制+显效的患者14例(42.4%);治疗组患者治疗有效率明显高于对照组[7例(46.9%),P<0.01]。所有患者在治疗期间均未发生明显的不良事件。结论:骶神经磁刺激联合体外冲击波能够有效改善ⅢB型前列腺炎的临床症状、提高患者的生活质量,该疗法安全无痛,具有较高的推广和应用价值,但其远期疗效有待于进一步观察。

Objective: To investigate the clinical therapeutic effects of sacral nerve magnetic stimulation(SNMS) combined with extracorporeal shockwave(ECSW) in the treatment of type-ⅢB chronic prostatitis. Methods: This study included 65 cases of type-ⅢB chronic prostatitis treated in Renji Hospital between March 2017 and August 2018. The patients were aged 34.56 + 7.47 years and had an average disease course of 12.95 + 10.73 months. We randomly assigned the patients to an experimental(n = 33) and a control group(n = 32) to be treated by SNMS+ECSW and biofeedback combined with electrical stimulation, respectively, qd alt, 40 minutes once, for a total of 24 times. Before and after 4 and 8 weeks of treatment, we obtained the NIH-CPSI scores, maximum urinary flow rate(Qmax), average urinary flow rate(Qavg), Self-Rating Depression Scale(SDS) scores and Self-Rating Anxiety Scale(SAS) scores of the patients, recorded their adverse reactions and compared the clinical therapeutic effects between the two groups of patients. Results:After treatment, the experimental group showed significant improvement in the pain score, urination score, quality of life(QOL) score and NIH-CPSI total scores in comparison with the baseline(P < 0.05), even more significant after 8 than after 4 weeks of treatment(P < 0.05), and in all the indexes as compared with the control group(P < 0.05). Qmax and Qavg were remarkably improved at 8 weeks(P < 0.05) and so were SDS and SAS scores at 4 and 8 weeks(P < 0.05), even more significantly in the experimental than in the control group(P < 0.05). Among the 33 patients in the experimental group, 25(75.8%) responded(14 [42.4%] cured or with excellent effect), with a significantly higher effectiveness rate than the control group(7[46.9%], P < 0.01). No obvious adverse events were observed in any of the patients during the treatment. Conclusion: SNMS+ECSW can effectively improve the clinical symptoms and QOL of the patients with type-ⅢB chronic prostatitis, without causing obvious adverse reactions. Its long-term therapeutic effect, however, remains to be further studied.