包皮环切术联合α受体阻滞剂治疗慢性前列腺炎的临床研究
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摘要
目的:探讨α-受体阻滞剂联合包皮环切术治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)的临床疗效。方法:目标选择2016年7月至2017年10月上海市第一人民医院收治的100例年龄18～50岁的包皮过长同时合并CP/CPPS患者为研究对象,将其随机分为包皮环切术组58例和对照组52例。包皮环切术组的患者接受α-受体阻滞剂治疗的同时进行包皮环切术,对照组仅给予α-受体阻滞剂治疗。采用国际慢性前列腺炎症状指数NIH-CPSI的变化评估和比较两组的治疗效果。结果:以NIH-CPSI总分3个月从基线减少4分为治疗有效,包皮环切术组和对照组治疗有效率分别为82.6%、62.5%,包皮环切术组显著高于对照组(P<0.001)。治疗12周后,包皮环切术组NIH-CPSI总分的中位数从24.0±4.0降至12.0±8.0(P<0.001),对照组从24.0±3.0降至15.0±7.0(P<0.001),两组比较差异具有统计学意义(P<0.001)。包皮环切组NIH-CPSI总分、疼痛评分、尿路评分和生活质量评分均明显低于对照组(P<0.001)。结论:与单独应用α受体阻滞剂相比,联合包皮环切术联合α-受体阻滞剂药物治疗更有效提高CP/CPPS患者的临床疗效,改善患者的慢性前列腺炎症状评分。
Objective: To evaluate the efficacy of circumcision combined with alpha-blocker therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS). Methods: 121 uncircumcised men age 18-50 years old with redundant prepuce and CP/CPPS were selected in Shanghai general hospital from July 2016 to October 2017. Subjects assigned to the circumcision group were given medications(alpha-blocker) and set for surgery the same period in each sites by study clinicians. Subjects assigned to the control group were asked to only take the same medications and remain uncircumcised status. The changes of National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI) were used to compare the therapeutic effect of two groups. Results: The primary outcome was a reduction of at least 4 points in the score on the National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI). The ratio of men with a decrease of at least 4 points in their total NIH-CPSI score from baseline to 12 weeks was 82.6% in the circumcision group and 62.5% in the control group(P<0.001). The median of total NIH-CPSI score decreased significantly from 24.0±3.0 to 12.0±8.0(P<0.001) in the circumcision group, and in the control group the change was from 24.0±3.0 to 15.0±7.0(P<0.001), it could be observed that there was significant difference between circumcision group and control group(P<0.001). Conclusions: Our findings shows that circumcision plus alpha-blocker therapy results in improvement in the NIH-CPSI scores compared with the medications therapy alone for CP/CPPS patients.
Objective: To evaluate the efficacy of circumcision combined with alpha-blocker therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS). Methods: 121 uncircumcised men age 18-50 years old with redundant prepuce and CP/CPPS were selected in Shanghai general hospital from July 2016 to October 2017. Subjects assigned to the circumcision group were given medications(alpha-blocker) and set for surgery the same period in each sites by study clinicians. Subjects assigned to the control group were asked to only take the same medications and remain uncircumcised status. The changes of National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI) were used to compare the therapeutic effect of two groups. Results: The primary outcome was a reduction of at least 4 points in the score on the National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI). The ratio of men with a decrease of at least 4 points in their total NIH-CPSI score from baseline to 12 weeks was 82.6% in the circumcision group and 62.5% in the control group(P<0.001). The median of total NIH-CPSI score decreased significantly from 24.0±3.0 to 12.0±8.0(P<0.001) in the circumcision group, and in the control group the change was from 24.0±3.0 to 15.0±7.0(P<0.001), it could be observed that there was significant difference between circumcision group and control group(P<0.001). Conclusions: Our findings shows that circumcision plus alpha-blocker therapy results in improvement in the NIH-CPSI scores compared with the medications therapy alone for CP/CPPS patients.
引文
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[8] Fei X, Jin W, Hua S, et al. Prospective Study on Association of Prostatic Calcifications with Clinical Symptoms and Results of Treatment in Men with type III prostatitis[J]. Sci Rep, 2017, 7(1):5234
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[10] Obiri-Yeboah D, Akakpo PK, Mutocheluh M,et al. Epidemiology of cervical human papillomavirus(HPV)infection and squamous intraepithelial lesions(SIL)among a cohort of HIV-infected and uninfected Ghanaian women[J]. BMC Cancer, 2017, 17(1):688
[11] Westercamp N, Mehta SD, Jaoko W, et al. Penile coital injuries in men decline after circumcision:Results from a prospective study of recently circumcised and uncircumcised men in western Kenya[J].PloS one, 2017, 12(10):e0185917
[12] Grabowski MK, Serwadda DM, Gray RH, et al. HIV Prevention Efforts and Incidence of HIV in Uganda[J]. The New England journal of medicine, 2017, 377(22):2154-2166
[13] Liu A, Yang Y, Liu L, et al. Differential compartmentalization of HIV-targeting immune cells in inner and outer foreskin tissue[J]. PloS one, 2014, 9(1):e85176
[14] Ihsan AU, Khan FU, Nawaz W, et al. Establishment of a rat model of chronic Prostatitis/Chronic Pelvic Pain Syndrome(CP/CPPS)induced by immunization with a novel peptide T2[J]. Biomed Pharmacother,2017, 91:687-692
[15] Ye C, Xiao G, Xu J, et al. Differential expression of immune factor between patients with chronic prostatitis/chronic pelvic pain syndrome and the healthy volunteers[J]. Int Urol Nephrol, 2018, 50(3):395-399
[16] Ugor E, Prenek L, Pap R, et al. Glucocorticoid hormone treatment enhances the cytokine production of regulatory T cells by upregulation of Foxp3 expression[J]. Immunobiology, 2018, 223(4-5):422-431
[17] Wagenlehner FM, Schneider H, Ludwig M, et al. A pollen extract(Cernilton)in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome:a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study[J]. European urology,2009, 56(3):544-551
[18] Junghans RP, Ma Q, Rathore R, et al. Phase I Trial of Anti-PSMA Designer CAR-T Cells in Prostate Cancer:Possible Role for Interacting Interleukin 2-T Cell Pharmacodynamics as a Determinant of Clinical Response[J]. Prostate, 2016, 76(14):1257-1270
[19] Jiang Y, Wang X, Guo Y, et al. Expression of Heat Shock Protein 27in Benign Prostatic Hyperplasia with Chronic Inflammation[J]. Med Sci Monit, 2015, 21:2976-2985
[20] Kim SS, Kim JH, Han IH, et al. Inflammatory Responses in a Benign Prostatic Hyperplasia Epithelial Cell Line(BPH-1)Infected with Trichomonas vaginalis[J]. Korean J Parasitol, 2016, 54(2):123-132
[21] Han P, Lai YJ, Chen J, et al. Protective potential of the methanol extract of Macrothelypteris oligophlebia rhizomes for chronic non-bacterial prostatitis in rats[J]. Pak J Pharm Sci, 2016, 29(4):1217-1221
[22] Dos Santos Gomes FO, Oliveira AC, Ribeiro EL, et al. Intraurethral injection with LPS:an effective experimental model of prostatic inflammation[J]. Inflamm Res, 2018, 67(1):43-55
[23] Liu X, Fan S, Zheng M, et al. The mediation of interleukin-17 and chemokine ligand 2 in pelvic pain of experimental autoimmune prostatitis[J]. Exp Ther Med, 2017, 14(1):51-58
[24] Cunningham AL, Carbone F, Geijtenbeek TB. Langerhans cells and viral immunity[J]. European journal of immunology, 2008, 38(9):2377-2385
[25] Hayashi Y, Kohri K. Circumcision related to urinary tract infections,sexually transmitted infections, human immunodeficiency virus infections, and penile and cervical cancer[J]. International journal of urology:official journal of the Japanese Urological Association, 2013, 20(8):769-775
[26] Bai J, Wang S, Liu J, et al. Characterization of circulating CD4+CD25high regulatory T cells in men with chronic prostatitis/chronic pelvic pain syndrome[J]. Urology, 2010, 75(4):938-942
[27] Liu CM, Hungate BA, Tobian AA, et al. Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria[J].mBio, 2013, 4(2):e00076
[28] Dellabella M, Milanese G, Sigala S, et al. The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome[J]. Inflamm Res, 2009, 58(12):829-836
[29] Shen X, Ming A, Li X, et al. Nanobacteria:a possible etiology for type III prostatitis[J]. The Journal of urology, 2010, 184(1):364-369
[30] Dennis LK, Lynch CF, Torner JC. Epidemiologic association between prostatitis and prostate cancer[J]. Urology, 2002, 60(1):78-83
[31] Zhao Z, Zhang J, He J, et al Clinical utility of the UPOINT phenotype system in Chinese males with chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS):a prospective study[J]. PloS one, 2013, 8(1):e52044
[2] Wagenlehner FM, van Till JW, Magri V, et al. National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI)symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome[J]. Eur Urol, 2013, 63(5):953-959
[3] Zhao YY, Xu DL, Zhao FJ, et al. Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)[J]. Asian journal of andrology, 2014, 16(5):774-777
[4] Nickel JC, Shoskes DA, Wagenlehner FM. Management of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS):the studies, the evidence, and the impact[J]. World journal of urology, 2013, 31(4):747-753
[5] Polackwich AS, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome:a review of evaluation and therapy[J]. Prostate Cancer Prostatic Dis, 2016, 19(2):132-138
[6] Thakkinstian A, Attia J, Anothaisintawee T, et al. alpha-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome[J]. BJU international,2012, 110(7):1014-1022
[7] Zhang M, Li H, Ji Z, Dong D, et al. Clinical study of duloxetine hydrochloride combined with doxazosin for the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome:An observational study[J]. Medicine(Baltimore), 2017, 96(10):e6243
[8] Fei X, Jin W, Hua S, et al. Prospective Study on Association of Prostatic Calcifications with Clinical Symptoms and Results of Treatment in Men with type III prostatitis[J]. Sci Rep, 2017, 7(1):5234
[9] Shoskes DA, Nickel JC. Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system[J]. World journal of urology, 2013, 31(4):755-760
[10] Obiri-Yeboah D, Akakpo PK, Mutocheluh M,et al. Epidemiology of cervical human papillomavirus(HPV)infection and squamous intraepithelial lesions(SIL)among a cohort of HIV-infected and uninfected Ghanaian women[J]. BMC Cancer, 2017, 17(1):688
[11] Westercamp N, Mehta SD, Jaoko W, et al. Penile coital injuries in men decline after circumcision:Results from a prospective study of recently circumcised and uncircumcised men in western Kenya[J].PloS one, 2017, 12(10):e0185917
[12] Grabowski MK, Serwadda DM, Gray RH, et al. HIV Prevention Efforts and Incidence of HIV in Uganda[J]. The New England journal of medicine, 2017, 377(22):2154-2166
[13] Liu A, Yang Y, Liu L, et al. Differential compartmentalization of HIV-targeting immune cells in inner and outer foreskin tissue[J]. PloS one, 2014, 9(1):e85176
[14] Ihsan AU, Khan FU, Nawaz W, et al. Establishment of a rat model of chronic Prostatitis/Chronic Pelvic Pain Syndrome(CP/CPPS)induced by immunization with a novel peptide T2[J]. Biomed Pharmacother,2017, 91:687-692
[15] Ye C, Xiao G, Xu J, et al. Differential expression of immune factor between patients with chronic prostatitis/chronic pelvic pain syndrome and the healthy volunteers[J]. Int Urol Nephrol, 2018, 50(3):395-399
[16] Ugor E, Prenek L, Pap R, et al. Glucocorticoid hormone treatment enhances the cytokine production of regulatory T cells by upregulation of Foxp3 expression[J]. Immunobiology, 2018, 223(4-5):422-431
[17] Wagenlehner FM, Schneider H, Ludwig M, et al. A pollen extract(Cernilton)in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome:a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study[J]. European urology,2009, 56(3):544-551
[18] Junghans RP, Ma Q, Rathore R, et al. Phase I Trial of Anti-PSMA Designer CAR-T Cells in Prostate Cancer:Possible Role for Interacting Interleukin 2-T Cell Pharmacodynamics as a Determinant of Clinical Response[J]. Prostate, 2016, 76(14):1257-1270
[19] Jiang Y, Wang X, Guo Y, et al. Expression of Heat Shock Protein 27in Benign Prostatic Hyperplasia with Chronic Inflammation[J]. Med Sci Monit, 2015, 21:2976-2985
[20] Kim SS, Kim JH, Han IH, et al. Inflammatory Responses in a Benign Prostatic Hyperplasia Epithelial Cell Line(BPH-1)Infected with Trichomonas vaginalis[J]. Korean J Parasitol, 2016, 54(2):123-132
[21] Han P, Lai YJ, Chen J, et al. Protective potential of the methanol extract of Macrothelypteris oligophlebia rhizomes for chronic non-bacterial prostatitis in rats[J]. Pak J Pharm Sci, 2016, 29(4):1217-1221
[22] Dos Santos Gomes FO, Oliveira AC, Ribeiro EL, et al. Intraurethral injection with LPS:an effective experimental model of prostatic inflammation[J]. Inflamm Res, 2018, 67(1):43-55
[23] Liu X, Fan S, Zheng M, et al. The mediation of interleukin-17 and chemokine ligand 2 in pelvic pain of experimental autoimmune prostatitis[J]. Exp Ther Med, 2017, 14(1):51-58
[24] Cunningham AL, Carbone F, Geijtenbeek TB. Langerhans cells and viral immunity[J]. European journal of immunology, 2008, 38(9):2377-2385
[25] Hayashi Y, Kohri K. Circumcision related to urinary tract infections,sexually transmitted infections, human immunodeficiency virus infections, and penile and cervical cancer[J]. International journal of urology:official journal of the Japanese Urological Association, 2013, 20(8):769-775
[26] Bai J, Wang S, Liu J, et al. Characterization of circulating CD4+CD25high regulatory T cells in men with chronic prostatitis/chronic pelvic pain syndrome[J]. Urology, 2010, 75(4):938-942
[27] Liu CM, Hungate BA, Tobian AA, et al. Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria[J].mBio, 2013, 4(2):e00076
[28] Dellabella M, Milanese G, Sigala S, et al. The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome[J]. Inflamm Res, 2009, 58(12):829-836
[29] Shen X, Ming A, Li X, et al. Nanobacteria:a possible etiology for type III prostatitis[J]. The Journal of urology, 2010, 184(1):364-369
[30] Dennis LK, Lynch CF, Torner JC. Epidemiologic association between prostatitis and prostate cancer[J]. Urology, 2002, 60(1):78-83
[31] Zhao Z, Zhang J, He J, et al Clinical utility of the UPOINT phenotype system in Chinese males with chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS):a prospective study[J]. PloS one, 2013, 8(1):e52044