Clinical efficacy of magnetic vibration magnetoelectric therapy in the treatment of chronic prostatitischronic pelvic pain syndrome

BACKGROUND The prominent symptoms of chronic pelvic pain syndrome(CPPS)are urogenital pain,lower urinary tract symptoms,psychological problems,and sexual dysfunction.Traditional pharmacological treatments have poor efficacy and more untoward reaction and complications.Magnetic vibration magnetoelectric therapy is a non-invasive form of physiotherapy.Nevertheless,its effectiveness in improving urinary discomfort and relieving pain in patients requires further exploration.AIM To investigate the clinical efficacy of the magnetic vibration magnetoelectric therapy instrument in the treatment of chronic prostatitis(CP)/CPPS.METHODS Seventy patients with CP/CPPS were collected from the outpatient clinic and ward of the Department of Male Medicine,Jiangsu Province Hospital of Traditional Chinese Medicine,and were treated with magnetic vibration magnetoelectric therapy once a day for a period of 14 d.National Institutes of healthchronic prostatitis symptom index(NIH-CPSI),international index of erectile function 5(IIEF-5),premature ejaculation diagnostic tool(PEDT),generalized anxiety disorder(GAD),patient health questionnaire,the pain catastrophizing scale(PCS)and traditional Chinese medicine syndrome(TCMS)scores were performed before and after treatment.RESULTS The total effective rate of treatment was 58.5%,and the total NIH-CPSI score,pain symptoms,voiding symptoms,quality of life,IIEF-5,PEDT,GAD,PCS and TCMS scores all decreased significantly(P<0.05).CONCLUSION Magnetic vibration magnetotherapy is effective in improving urinary discomfort,relieving pain,improving quality of life,improving sexual dysfunction and relieving negative emotions such as anxiety in patients with CP/CPPS.

Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）

Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients （case group） and 341 nonCP/CPPS patients （control group）. Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin （odds ratio （OR）： 1.66, 95% confidence interval （CI）： 1.04-2.66）. In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 （95% CI, 1.2-2.88）. The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS.

Management of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS):an evidence-based approach

Objective：To evaluate the efficacy and safety of the treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods- The randomized controlled trials （RCTs） about the treatment for CP/CPPS all over the world were searched. MEDLINE （January 1966 to June 2007）, EMBASE （January 1988 to June 2007）, and 4 Chinese databases were electronically searched. The studies included in the refer- ences of eligible studies were additionally searched. Two reviewers independently screened the studies for eli- gibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross- checking. Divergences of opinion were settled by discussion or consulted by the experts. Meta-analysis was performed by using RevMan 4.2 software. Results： Twelve original studies involving 1 003 participants met inclusion criteria. Compared with placebo, alpha-blockers could improve the symptoms of CP/CPPS obvious- ly with WMD of NIH-CPSI, total score and pain score were -4.10 （95%CI： -6. 92 to -1.28） and -1.68 （95 %CI： -2.54 to -0. 82）. Antibiotics could not improve the symptoms obviously with WMD of NIH-CP- SI; total score and pain score were -2.71 （95%CI： -4. 78 to -0. 64） and -0.86 （95%CI： -2.07 to 0.36）. Flavoxate could not improve the NIH-CPSI total score obviously, but could relieve the pain, with WMD of NIH-CPSI total score and pain score being -2.96 （95%CI： -5.17 to -0. 74） and --2.31 （95%CI.. -4.05 to 0.03）. Prostat could improve the NIH-CPSI total score obviously, but could not relieve the pain, with WMD of NIH-CPSI total score and pain score being --7. 60 （95%CI.. -9. 97 to -5.23） and -2. 02 （95%CI： -4.07 to 0. 04）. Conclusion： Drug intervention could improve total symptoms of CP/CPPS in some degree, but no universally effective treatment is available that can prove significant lasting benefit for all the symptoms of CP/CPPS. Future RCT must use an appropriate sample size and optimal duration and fol- low-up of participants. It is important to improve the quality of internal original studies.

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men： a preliminary investigation

The expressed prostatic secretions （EPSs） of men with chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）, infertile men and normal men were subjected to microbiological study. EPSs were collected from the subjects, which included 26 normal men, 11 infertile patients and 51 CP/CPPS patients. DNA was extracted from each specimen, and the V3 regions of the 16S rRNA genes were amplified using universal bacterial primers. The results showed that the EPS 16S rRNA gene-positive rate in the CP/CPPS and infertile patients was much higher than in the normal men, but without any difference among the three patient groups. The denaturing gradient gel electrophoresis （DGGE） method was used to characterize the EPS bacterial community structure of the prostate fluid from patients with CP/CPPS or infertility issues. Principal component analysis （PCA） and partial least squares （PLS） analyses of PCR-DGGE profiles revealed that the EPS bacterial community structure differed among the three groups. Three bands were identified as the key factors responsible for the discrepancy between CP/CPPS patients and infertile patients （P〈O.05）. Two bands were identified as priority factors in the discrepancy of category IliA and category IIIB prostatitis patients （P〈O.05）. According to this research, the ecological balance of the prostate and low urethra tract, when considered as a microenvironment, might play an important role in the maintenance of a healthy male reproductive tract.

Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome:An Italian prospective multicenter study

Objective:To assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatitis and chronic pelvic pain syndrome(CP/CPPS).Methods:Patients with type IIIa and type IIIb CP/CPPS received one rectal suppository a day for 15 days per month for 3 consecutive months.Participants were evaluated with National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI),the International Prostate Symptom Scores(IPSS),International Index of Erectile Function(IIEF),four-glass test,uroflowmetry,and prostate-specific antigen assessments at baseline and at Week 4,and Week 12.Primary endpoints were improvement in pain domain of NIH-CPSI and improvement of NIH-CPSI total score.Secondary outcomes included improvement of micturition and quality of life(QoL)domains of NIH-CPSI questionnaire.Results:A total of 61 males were enrolled.No adverse events were reported.Significant improvements from baseline to Day 30 were reported for NIH-CPSI total score(mean difference:-9.2;p<0.01),NIH-CPSI pain domain(mean difference:-5.5;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score(mean difference:-5.6;p<0.01).No significant changes from baseline in terms of IIEF score or maximum flow rate were observed.At final follow-up(Day 90),further significant improvements in terms of NIH-CPSI total score(mean difference:-12.2;p<0.01),NIH-CPSI pain domain(mean difference:-6.6;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score were reported.Conclusion:Rectal administration of Boswellia resin extract and propolis derived polyphenols is well tolerated and delivers a significant symptomatic improvement in most patients with type IIIa and type IIIb CP/CPPS.

Updates on therapies for chronic prostatitis/chronic pelvic pain syndrome

Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four distinct categories by National Institutes of Health namely(1) acute bacterial prostatitis;(2) chronic bacterial prostatitis;(3) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and(4)asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thoroughinformation about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubM ed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria's have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Preand Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment nave population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local aswell as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.

Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

Objective：To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome （CPPS）. Methods： A total of 36 men with recalcitrant （TPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl （10 ml of 0. 125% Bupivacaine, 0.05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12） into sacral space once a week for 4 weeks. The National Institute of Heahh Chronic Prostatitis Symptom Index （NIH-CPSI）, maximum and average flow rate were performed al the start and the end of 4 weeks＇ therapy. Results：Mean NIH-CPSI total score was decreased from 26. 5±1.6 to 13.4±2.0 （p〈0.001）. Significant improvement was seen in each subscore domain. A total of 32 patients （89%） had at least 25% improvement on NIH-CPSI and 22 （61%） had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3. 8 to 23. 6±4. 2 and 10. 9±2.6 to 14.3±2.4 respectively. Conclusion： Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacred spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Berberine hydrochloride alleviates chronic prostatitis/chronic pelvic pain syndrome by modifying gut microbiome signaling

Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)is highly prevalent worldwide and poses a significant threat to men’s health,particularly affecting young men.However,the exact causes and mechanisms behind CP/CPPS remain unclear,leading to challenges in its treatment.In this research,a CP/CPPS rat model was established with complete Freund’s adjuvant(CFA),and berberine hydrochloride was administered through daily gavage to assess its therapeutic effects.The alterations in the gut microbiome induced by CP/CPPS and berberine hydrochloride were investigated through 16S ribosomal RNA sequencing of cecum content and colonic epithelial cells.To investigate the impact of the gut microbiome on CP/CPPS,a pseudo germ-free rat model was established,and fecal microbiome transplantation(FMT)was performed on these rats.In all,berberine hydrochloride demonstrated effective reduction of inflammation and oxidative stress in the prostate,offering significant therapeutic advantages for CP/CPPS.Through analysis of the gut microbiome using 16S ribosome RNA sequencing,distinct differences were observed between CP/CPPS rats and control rats,and Clostridium butyricum was identified as a key bacteria.Pseudo germ-free rats that underwent FMT from CP/CPPS rats or rats treated with berberine hydrochloride displayed varying levels of inflammatory cytokine production,oxidative stress,and activity of associated signaling pathways.In conclusion,the therapeutic potential of berberine hydrochloride in addressing CP/CPPS is highly significant.The gut microbiome has emerged as a critical factor in the development of CP/CPPS and plays a pivotal role in mediating the therapeutic effects of berberine hydrochloride.

基于改良UPOINT(S)系统的个体化治疗对CP/CPPS合并SD患者的疗效分析

目的基于改良UPOINT(S)临床表现分型系统,对慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)合并以勃起功能障碍(ED)、早泄(PE)为代表的性功能障碍(SD)患者采用以临床症状为导向的标准化诊断和个体化治疗,验证其临床疗效,并为选择临床治疗方案提供依据。方法选取2018年1月至2021年12月中国人民解放军联勤保障部队第九四○医院门诊治疗的160例CP/CPPS合并以ED和/或PE为代表的SD患者作为研究对象,随机分为常规药物治疗的对照组(n=53)、基于传统UPOINT临床表现分型系统指导治疗的传统组(n=49)和基于改良UPOINT(S)临床表现分型系统指导治疗的改良组(n=58)。根据各组治疗前后美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)评分、最大尿流率(Qmax)、视觉模拟评分法(VAS)评分、国际勃起功能指数5(IIEF-5)评分、中国早泄患者性功能评分表(C-ISFPE)评分、前列腺液中白细胞(EPS-WBC)计数的变化,评价三组临床疗效差异。结果治疗前三组临床资料差异均无统计学意义(P>0.05)。治疗后,与对照组比较,传统组和改良组在所有指标上均改善显著,差异均具有统计学意义(P<0.05);与传统组比较,改良组在治疗ED[IIEF-5评分(22.0±1.2)分vs.(19.8±2.0)分,P=0.006]和PE[C-ISFPE评分(25.5±1.8)分vs.(19.5±2.2)分,P=0.005]方面改善更加显著,差异均具有统计学意义(P<0.05)。结论基于改良UPOINT(S)临床表现分型系统指导的个体化治疗,可显著改善CP/CPPS合并SD患者的性功能异常状况,相较于常规治疗和基于传统UPOINT临床表现分型系统指导治疗的疗效更好。

Effect of thermophilic bacterium HB27 manganese superoxide dismutase in a rat model of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)

We investigated the therapeutic effects of superoxide dismutase(SOD)from thermophilic bacterium HB27 on chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)and its underlying mechanisms.A Sprague–Dawley rat model of CP/CPPS was prepared and then administered saline or Thermus thermophilic(Tt)-SOD intragastrically for 4 weeks.Prostate inflammation and fibrosis were analyzed by hematoxylin and eosin staining,and Masson staining.Alanine transaminase(ALT),aspartate transaminase(AST),serum creatinine(CR),and blood urea nitrogen(BUN)levels were assayed for all animals.Enzyme-linked immunosorbent assays(ELISA)were performed to analyze serum cytokine concentrations and tissue levels of malondialdehyde,nitric oxide,SOD,catalase,and glutathione peroxidase.Reactive oxygen species levels were detected using dichlorofluorescein diacetate.The messenger ribonucleic acid(mRNA)expression of tissue cytokines was analyzed by reverse transcription polymerase chain reaction(RT-PCR),and infiltrating inflammatory cells were examined using immunohistochemistry.Nuclear factor-κB(NF-κB)P65,P38,and inhibitor of nuclear factor-κBα(I-κBα)protein levels were determined using western blot.Tt-SOD significantly improved histopathological changes in CP/CPPS,reduced inflammatory cell infiltration and fibrosis,increased pain threshold,and reduced the prostate index.Tt-SOD treatment showed no significant effect on ALT,AST,CR,or BUN levels.Furthermore,Tt-SOD reduced inflammatory cytokine expression in prostate tissue and increased antioxidant capacity.This anti-inflammatory activity correlated with decreases in the abundance of cluster of differentiation 3(CD3),cluster of differentiation 45(CD45),and macrophage inflammatory protein 1α(MIP1α)cells.Tt-SOD alleviated inflammation and oxidative stress by reducing NF-κB P65 and P38 protein levels and increasing I-κBαprotein levels.These findings support Tt-SOD as a potential drug for CP/CPPS.

泌尿男科医师应用《CUA前列腺炎诊断治疗指南》诊疗CPPS的调查

目的:了解中华医学会泌尿外科学分会(CUA)《前列腺炎诊断治疗指南》(以下简称《指南》)的推广和应用效果,及其对我国泌尿男科医师诊断、治疗CPPS的观念和实践的影响。方法:在全国21个城市173家医院泌尿男科发放问卷,回收问卷后,对有效问卷进行统计分析。结果:发放问卷1 056份,回收有效问卷851份(80.6%)。答卷者中,71.6%来自三级医院,高级和中级职称的医师占80.7%,97.5%的医师学习过《指南》。绝大多数医师认同Ⅲ型前列腺炎是一种临床综合征,诊断需要排除其他引起类似症状的疾病,治疗目标是缓解疼痛、改善排尿症状、提高生活质量。在学过或没学过指南的医师中,对部分观点的认同也有差异。在临床实际工作中,泌尿男科医师给CPPS患者最常选用的治疗方法(多选)是心理治疗(80.7%)、药物治疗(80.4%)、调整生活方式(79.6%);最常用的前3类药物是植物药(80.0%)、α受体阻滞剂(68.9%)和抗生素(61.0%)。结论:CUA《前列腺炎诊断治疗指南》得到了广泛的推广,其主要内容得到了深入的领会和应用,推动了我国泌尿男科医师规范化诊治CPPS的进程。

体外冲击波调控免疫反应对ⅢB型CP/CPPS患者的疗效及其机制研究

目的探讨体外冲击波治疗(extracorporeal shock wave therapy,ESWT)对ⅢB型慢性前列腺炎(CP)/慢性盆腔疼痛综合征(CPPS)患者免疫反应的影响,并观察其疗效。方法收集2014年1月至2016年9月于我院就诊的120例CP/CPPS患者,采用随机数字表法分为试验组与对照组,各60例。对照组给予坦索罗辛治疗,试验组予ESWT+坦索罗辛治疗,两组均治疗4周。治疗后收集两组患者慢性前列腺炎症状评分(NIH-CPSI),国际前列腺症状评分(IPSS),前列腺液中TNF-α、IL-6、卵磷脂小体及外周血中CD3^+、CD4^+、CD8^+、CD4^+CD25^+、TGF-β1、CD4^+CD25^+Foxp3^+的表达变化。结果治疗4周后,与对照组相比,试验组总体有效率明显提高(63.3%vs 93.3%,P<0.05);NIH-CPSI评分(13.12±1.71 vs 23.16±1.33)和IPSS评分(8.23±2.28 vs 13.14±2.69)明显降低。在炎症和免疫影响方面,与对照组相比,试验组前列腺液中卵磷脂小体明显升高,炎性因子TNF-α、IL-1β水平明显降低;外周血中CD3^+、CD4^+、CD8^+、CD4^+CD25^+、TGF-β1、CD4^+CD25^+Foxp3^+表达均明显提高。结论 ESWT治疗ⅢB型CP/CPPS安全有效,其可能的作用机制与提高患者的免疫功能、降低前列腺局部炎症应答有关。

中药直肠滴注对CAP/CPPS患者炎症因子MCP-1及PDGF-BB表达的影响

目的观察中药直肠滴注对慢性非细菌性前列腺炎/慢性盆腔疼痛综合征(CAP/CPPS)患者炎症因子单核细胞趋化因子-1(MCP-1)及血小板衍生生长因子-BB(PDGF-BB)的影响,探讨其作用机制。方法将CAP/CPPS患者(湿热夹瘀证)40例随机分为2组。治疗组20例予灌肠I号方直肠滴入,对照组20例予邦列安纳米银抗菌水凝胶肛门给药。4周后对2组的疗效进行评价,观察治疗前后中医证候积分、美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)、前列腺液白细胞(EPS-WBC)计数及前列腺液中MCP-1、PDGF-BB水平的变化。结果灌肠Ⅰ号方可显著降低中医证候评分,减少EPS-WBC计数,并降低MCP-1、PDGF-BB水平,但2组在总有效率、改善NIH-CPSI症状评分方面,差异无统计学意义。结论调控炎症因子MCP-1及PDGF-BB可能是灌肠Ⅰ号方直肠滴注治疗CAP/CPPS的重要免疫机制之一。

隔姜灸联合盐酸坦索罗辛胶囊治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)临床疗效及机制研究

目的:观察隔姜灸联合盐酸坦索罗辛胶囊治疗CP/CPPS患者的治疗效果及可能的机制。方法:将CP/CPPS患者360例随机分为实验组120例,对照组120例及空白对照组120例。实验组予口服盐酸坦索罗辛胶囊,每次0.2mg,每日1次,并行隔姜灸治疗,每日1次。对照组仅口服盐酸坦索罗辛胶囊,每次0.2mg,每日1次。空白对照组不给于任何关于CP/CPPS相关治疗处理。三组均治疗30天。观察治疗后各组患者临床症状的改善情况、EPS中WBC阳性例数、EPS中TNF-α、IL-1β、卵磷脂小体含量变化及外周血中CD3^+、CD4^+、CD8^+、CD4^+CD25^+、CD4^+CD25^+Foxp3^+、TGF-β1的表达水平。结果:治疗后,实验组NIH-CPSI总体评分明显低于对照组及空白对照组;实验组EPS中卵磷脂小体含量明显高于对照组及空白对照组;实验组EPS中炎性因子TNF-α、IL-1β水平明显低于对照组及空白对照组;治疗组EPS中WBC阳性总例数由治疗前的86例减少为治疗后的20例,明显优于对照组及空白对照组;治疗后实验组及对照组患者外周血CD3^+、CD4^+、CD8^+、CD4^+CD25^+、CD4^+CD25^+Foxp3^+、TGF-β1含量均明显提高,但治疗后实验组水平均明显高于对照组及空白对照组。结论:隔姜灸可显著改善CP/CPPS患者的临床症状,其治疗作用可能与隔姜灸提高患者的免疫功能有关。

特拉唑嗪及与双氯芬酸钠联合治疗CP/CPPS的研究

目的:比较单用特拉唑嗪与特拉唑嗪联合双氯芬酸钠治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)的效果。方法:将106例CP/CPPS患者随机分为2组,A组予特拉唑嗪治疗(2 mg/d),B组予特拉唑嗪(2 mg/d)加双氯芬酸钠(25 mg/d)治疗。采用美国国立卫生研究所慢性前列腺炎症状评分(NIH-CPSI)、亚评分(疼痛及生活指数)及国际前列腺症状评分(IPSS)标准评价患者治疗8周后的效果。结果:2组治疗后的NIH-CPSI、亚评分及IPSS均明显减少,且2组之间评分无显著性差异。结论:特拉唑嗪单独治疗与联合双氯芬酸钠治疗CP/CPPS的效果相当。

CP/CPPS患者中UPOINT分类因子与性功能障碍的相关性分析

目的:在CP/CPPS患者中,探究UPOINT分类因子与早泄(PE)、勃起功能障碍(ED)间的相关性。方法:2016年12月至2017年12月,共收集453例CP/CPPS患者的病史资料,包括患者的一般情况、前列腺炎发病的相关症状、性生活史、阴道内射精潜伏期(IELT)、美国国立卫生研究院前列腺炎症状指数表(NIH-CPSI)、国际勃起功能指数表(IIEF-5)。所有患者依据UPOINT分类系统进行分类。结果:453例CP/CPPS患者年龄(32.75±6.85)岁,204例诊断为ED(45.03%),196例诊断为PE(43.27%)。UPOINT分类因子阳性率分别为U 68.78%,P 60.21%,O 77.45%,I 20.34%,N 46.83%,T 65.12%;Logisitic多元回归分析表明,UPOINT分类因子中,社会心理异常(P)是PE[OR(95%CI):4.55(2.75~8.06),P<0.05]、ED[OR(95%CI):3.35(2.02~6.25),P<0.05]发病的独立危险因素。结论:CP/CPPS患者UPOINT分类系统中社会心理异常(P)在PE和ED发病过程中起着重要作用。

CP/CPPS模型大鼠Th1、Th17细胞L5~S2脊髓浸润及其中枢敏化机制研究

目的:探讨慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)疼痛的中枢敏化机制。方法:3~4周龄、体重250~350 g成年雄性SPF级SD大鼠40只随机均分为对照组和CP/CPPS模型组,构建模型成功后运用流式细胞术、实时荧光定量PCR(RT-qPCR)、免疫荧光检测等方法分析CD4^(+)T细胞亚群L5~S2脊髓的浸润情况,检测L5~S2脊髓GFAP、CR3的表达水平。结果:与对照组相比,CP/CPPS模型组L5~S2脊髓组织中单个核细胞中CD4^(+)T细胞表达量显著升高(P<0.01);RT-qPCR显示Th1细胞分泌的γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-α),Th17细胞分泌的白介素17(IL-17)和视黄酸相关孤儿受体γt(RORγt),细胞因子IL-6、IL-1β,趋化因子CCL2、CCL20、CXCL10等mRNA表达水平显著升高(P<0.01);免疫荧光染色显示Th1、Th17细胞的分子标志物IFN-γ、IL-17,星形胶质细胞和小胶质细胞的分子标志物胶质纤维酸性蛋白(GFAP)、补体受体3(CR3)荧光表达显著增强。结论:CP/CPPS模型大鼠L5~S2脊髓神经元中存在CD4^(+)T细胞浸润,具体亚群为Th1、Th17细胞,其分泌的炎症因子可能损伤神经元细胞并影响神经传导,促进中枢敏化并激活星形胶质细胞及小胶质细胞,导致疼痛的发生和发展。

CPPS病人血清与前列腺按摩液CuZn-SOD和MDA检测及意义

目的通过对慢性骨盆疼痛综合征(CPPS)病人和健康男性的血清和前列腺按摩液(EPS)中铜锌超氧化物歧化酶(CuZn-SOD)活力、丙二醛(MDA)含量测定,探讨其在CPPS诊断、治疗中的意义。方法将门诊确诊的40例CPPS病人分为炎性组和非炎性组,以20例健康男性为对照组,采用黄嘌呤氧化酶法测定CuZn-SOD活力,硫代巴比妥酸(TBA)法测定MDA含量。结果各组血清中CuZn-SOD活力比较差异无显著性(P>0.05)。炎性组及非炎性组血清中MDA含量明显高于对照组(F=25.70,q=8.21、9.26,P<0.01),炎性组与非炎性组间比较差异无显著性(P>0.05)。炎性组EPS中CuZn-SOD活力明显低于非炎性组及对照组(F=34.78,q=9.30、10.93,P<0.01);非炎性组与对照组间比较差异无显著性(P>0.05)。炎性组EPS中MDA含量明显高于非炎性组及对照组(F=441.63,q=35.73、37.03,P<0.01);非炎性组与对照组之间比较差异无显著性(P>0.05)。结论炎性CPPS病人前列腺氧化应激水平高于健康男性,非炎性CPPS病人前列腺氧化应激水平与健康男性无明显差别;血清及EPS中CuZn-SOD、MDA水平可作为CPPS诊断和判断疗效的有意义的辅助指标,SOD制剂在CPPS的治疗中可能具有重要作用。