【作者】 米华；

【导师】 莫曾南；

【作者基本信息】 广西医科大学 ， 泌尿外科， 2011， 博士

【摘要】 研究背景和目的:慢性前列腺炎(CP)是泌尿外科门诊最为常见的慢性病之一,临床症状复杂多样化,主要表现为腰部、会阴部疼痛不适,尿频、尿不尽感等排尿异常和性功能障碍如早泄(PE)和勃起功能障碍(ED)等,特别是ED的发病率比较高。CP的发病率高,治愈率低,复发率高,当前临床治疗效果令泌尿外科医师和患者均不满意,对患者的身心健康和生活质量产生严重影响,同时造成医疗资源的极大浪费。在临床诊疗过程中,一方面,在CP患者中,约有50%是因为性功能障碍而就诊的;另一方面,前列腺液(EPS)中的白细胞(WBC)数量常常被临床医师和患者作为CP的诊断、评估病情严重程度及评价疗效的指标。但文献报道,EPS中WBC的数目与CP症状的严重程度并无相关性,因而,其作为炎性CP的标志物及区分ⅢA和ⅢB CP的唯一标准受到了质疑。目前对CP的病因、发病机制和病理生理学改变还不十分清楚,泌尿外科医师对CP的认知及诊治行为仍充满困惑,医师的诊治行为有待进一步规范。迄今为止,我国与前列腺炎相关的流行病学研究文献报道不多,尤其是针对公众和社区居民的大范围普查工作更少见。本研究通过调查广西防城港地区4303例健康男性,进行包括社会人口学资料和生活方式特点调查,国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)和国际勃起功能指数(IIEF-5)等问卷调查,检测EPS中的WBC。目的:(1)调查广西防城港地区男性前列腺炎样症状的患病率及其流行病学特征,研究与前列腺炎样症状有关的危险因素,分析前列腺炎样症状对患者生活质量的影响。(2)调查广西防城港地区男性勃起功能障碍(ED)的患病率及其危险因素,了解前列腺炎样症状对ED的影响,探讨NIH-CPSI与IIEF-5相关性。(3)调查广西防城港地区男性EPS中WBC的数量与前列腺炎样症状严重程度的相关性。为今后我国CP的病因、发病机理研究和防治提供基线资料。资料和方法: 2009年09月-2009年12月调查在广西防城港地区健康体检的4303例年龄在17-88岁的男性,对这些男性进行问卷调查,调查表包括社会人口学资料(年龄、民族、受教育程度、婚姻生育状况和职业),生活方式特点(吸烟、饮酒和体育锻炼情况),美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI),国际勃起功能指数(IIEF-5),测量身高、体重和血压。抽静脉血测定空腹血糖、胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。前列腺按摩,检测EPS中的WBC。用SPSS 17.0软件进行数据分析。结果:1.发放调查表4303份,收到有效调查表3349份(77.8%)。197例(5.9%)被确认有前列腺炎样症状,大部分前列腺炎样症状者的年龄<40岁,疼痛评分为6.98±2.52分,排尿症状评分为2.88±2.55分,QOL评分为6.45±2.37分,CPSI总评分为16.31±5.86。其中,疼痛评分:轻度(4-7)123例(62.44%),中-重度有(≥8)74例(37.56%)。CPSI总评分:轻度(0–14)79例(40.10%),中度(15–30)115例(58.38%),重度(31–43)3例(1.52%);QOL评分:轻度(1-4)32例(16.4%),中度(5-8)113例(57.7%),重度(9-12)41例(20.9%)。前列腺炎样症状者的年龄与疼痛评分有正相关(r=0.178,P=0.013<0.05),与排尿症状评分、QOL评分和CPSI总评分均无相关性(P>0.05)。疼痛评分(F=4.338, P=0.000<0.05)和CPSI总评分(F=15.460, P=0.000<0.05)均对QOL评分产生明显影响。多因素回归分析显示除教育程度(P<0.05)以外,年龄、血压、肥胖、血糖、吸烟、饮酒、体育运动和婚姻状况与前列腺炎样症状的发生没有显著关联(P>0.05)。2.回收有效调查表3193份(74.2%),其中有前列腺炎样症状者188例(5.89%),非前列腺炎样症状者3005例(94.11%)。3193例成年男性中ED者1679例(52.58%),其中重度268例(8.39%),中度101例(3.16%),轻度1310例(41.03%)。不同年龄段IIEF-5评分均值差别有统计学意义(F=129.711, P<0.001,双侧)。188例前列腺炎样症状者中,ED者138例(73.40%),3005例(94.11%)非前列腺炎样症状者中,ED者1541例(51.28%),前列腺炎样症状组ED的发生率高于非前列腺炎样症状组(P<0.05)。按CPSI评分中的疼痛评分,188例前列腺炎样症状者中,轻-中度前列腺炎样症状者(评分4-7分)118例(62.8%),中-重度前列腺炎样症状者(评分≥8分)70例(37.2%)。多因素回归分析显示ED的发病与年龄、教育程度、婚姻状况、CPSI总评分有显著相关性(P<0.05),而与高血压、肥胖、血糖、吸烟、饮酒、体育运动无显著相关性(Ρ>0.05)。在3193例健康调查人群、188例前列腺炎样症状者和3005例非前列腺炎样症状人群中,IIEF-5评分与NIH-CPSI评分中的疼痛评分、排尿症状评分、QOL评分、CPSI总评分、疼痛+排尿症状评分存在负相关关系(P﹤0.01)。调整年龄后的偏相关分析表明,3193例健康体检人群的IIEF-5评分与CPSI评分中的疼痛评分、排尿症状评分、QOL评分、CPSI总评分、疼痛+排尿症状评分仍存在负相关关系( P﹤0.01)。而在188例前列腺炎样症状者和3005例非前列腺炎样症状人群中,除QOL评分外,其IIEF-5评分与CPSI评分中的疼痛评分、排尿症状评分、CPSI总评分、疼痛+排尿症状评分间仍存在负相关关系(P﹤0.01)。3.共有1242例完成填写健康档案表和NIH-CPSI的调查表和取得EPS。1242例健康体检男性中,有前列腺炎样症状者107例(8.6%),非前列腺炎样症状者1135例(91.4%)。1242例健康体检男性EPS中WBC数量与NIH- CPSI评分中的疼痛评分、排尿症状评分、QOL评分及CPSI总评分之间均无线性关系(Ρ值分别为0.130,0.622,0.651,0.320,均>0.05);107例前列腺炎样症状者EPS中WBC数量与NIH- CPSI评分中的疼痛评分、排尿症状评分、QOL评分及CPSI总评分之间也均无线性关系(Ρ值分别为0.192,0.416,0.742,0.278,均>0.05);1135例非前列腺炎样症状者EPS中WBC数量与NIH- CPSI评分中的疼痛评分、排尿症状评分、QOL评分及CPSI总评分之间也均无线性关系(Ρ值分别为0.254,0.968,0.934,0.607,均>0.05)。结论:这是首次在中国南部广西防城港地区进行的有关前列腺炎样症状的大样本流行病学调查,我们的调查结果表明:1.广西防城港地区前列腺炎样症状的患病率与国内文献报道的相似。前列腺炎样症状对患者生活质量的影响明显,生活质量影响程度与NIH-CPSI评分有关。教育程度可能是前列腺炎样症状发生的危险因素之一。对CP的防治重点在于全面改善患者的教育程度,改善患者的生活质量。2.广西防城港地区成年男性中ED的发病率较高,尤其是前列腺炎样症状者,年龄、教育程度、婚姻状况和CPSI总评分可能是ED发病的危险因素。前列腺炎样症状的严重程度与ED症状的轻重程度有相关性。3.无论是在健康体检男性人群中还是在前列腺炎样症状者中,其EPS中WBC数量与NIH-CPSI评分均无相关性。EPS中的WBC数量不适合作为前列腺炎的诊断、病情严重程度评估及疗效观察评价的唯一指标,其指标应综合考虑多种因素,重点在于改善临床症状和生活质量为主。更多还原

【Abstract】 Purpose: Chronic prostatitis (CP) is a common cause of complaint in male adult but information on the prevalence of chronic prostatitis is hindered by the confusion regarding its definition, and debate over the relative significance of histopathological, clinical and symptom related definitions. The symptoms are varied and include suprapubic pain, low back pain , orchialgia, dysuria at the tip of the penis and urinary frequency and urgency as well as sex dysfunction,these symptoms are ambiguous, diagnostic methods are controversial, and treatments are long and produce inconsistent results. Thus, although not life threatening, CP has become one of those diseases that is difficult for the patient and for the physician who attempts to help, sometimes without success. Treatment is often unsatisfactory to the patient and physician, and cure is elusive for many. The etiology of the disease is largely obscure. The methods used to estimate the prevalence of CP are inconsistent due to the lack of a definitive diagnostic tool. To date there have been few epidemiological studies on the prevalence of prostatitis-like symptoms in China, especially in southern China. The first objective of the current study was to investigate the prevalence and risk factors for prostatitis-like symptoms and impact of prostatitis-like symptoms on the quality of life among a large male adult population in Guangxi Fangchenggang district; the second objective was to identify the prevalence of ED in Guangxi Fangchenggang district male adult and to determine possible risk factors of ED, the correlation between NIH-CPSI and IIEF-5. The third objective was to investigate the correlation between the amount of WBC in expressed prostatic secretion ( EPS ) and NIH-CPSI in male adult. The identification and characterization of prevalence and these relevant risk factors might accelerate or augment the development of preventive, diagnostic and therapeutic strategies for the treatment of CP.Methods: From 2009.09 to 2009.12, a total of 4303 male residents aged 17-88 years having medical checkup as usual in Fangchenggang district of Guangxi provinces were invited to take part in the survey to complete the questionnaire , which consisted of social-demographics (age, education, marital status,occupation,etc), lifestyle characteristics (smoking, alcohol consumption, and physical activity), health status, and medical history . score of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function-5.(IIEF-5). expressed prostatic secretion(EPS) evaluation of WBC. Data analysis was conducted using SPSS software.Results:1. 3349 qualified questionnaires were received giving a response rate of 77.8% ,Of all subjects, 197 (5.9 % ) reported prostatitis–like symptoms, most of them are less than 40 years old. The average CPSI-pain score is 6.98±2.52,CPSI-urinary score is 2.88±2.55,CPSI-QOL score is 6.45±2.37, total CPSI score is 16.31±5.86. According to CPSI-pain score, 123(62.44%) reporting mild and 74(37.56%) reporting moderate to severe prostatitis–like symptoms; According to total CPSI score, 79(40.10%)reporting mild, 115(58.38%) reporting moderate and 3(1.52%) reporting severe prostatitis–like symptoms .According to QOL- score, 32(16.4%) reporting mild, 113(57.7%)reporting moderate and 41(20.9%)reporting severe. A statistically significant positive correlation was observed between age and CPSI-pain score (r=0.178,P=0.013<0.05),but a statistically significant correlation was not observed between age and CPSI-urinary score,CPSI-QOL score , total CPSI score(P>0.05)for subjects with prostatitis–like symptoms.the degree of impairment of QOL were correlative to CPSI-pain score (F=4.338, P=0.000<0.05)and total CPSI score(F=15.460, P=0.000<0.05). In a multivariate analysis, there is a correlation between education degree and prostatitis–like symptoms(P<0.05). there is not correlation between age ,hypertension,obesity,fasting blood glucose level,smoking,alcohol consumption,physical activity, marital status and prostatitis–like symptoms( P>0.05).2. 3193 qualified questionnaires were received giving a response rate of 74.2% .Of all subjects, 188 (5.89% ) reported prostatitis–like symptoms and 3005 (94.11%)reported no prostatitis–like symptoms.the prevalence of ED in Guangxi Fangchenggang district male adult is 52.58% (1679/3193) ,with 268(8.39%) reporting severe , 101(3.16%)reporting moderate and 1310(41.03%) reporting mild symptoms of ED. Subjects with prostatitis-like symptoms had higher prevalence of ED compare to those without prostatitis-like symptoms ( 73.40% vs 51.28%, P<0.005). Significant risk factors of ED include age, education degree, marital status and total CPSI score ( P<0.005). There is a negative correlation between NIH-CPSI and IIEF-5 in all subjects , the subjects with prostatitis-like symptoms and those without prostatitis - like symptoms(P<0.01).After adjustment for age, the result is the same. In subjects with prostatitis-like symptoms and those without prostatitis - like symptoms, there is a negative correlation between IIEF-5 and NIH-CPSI pain score, NIH-CPSI urinary score, total NIH-CPSI score and NIH-CPSI pain plus urinary score except NIH-CPSI QOL score(P﹤0.01).3. 1242 were entered into this study. 107 (8.6% ) reported prostatitis–like symptoms and 1135 (91.4%)reported no prostatitis–like symptoms. there were no linear correlation between the amount of WBC in EPS and CPSI scores in all subjects (n=1242)(TheΡvalue were 0.130,0.622,0.651,0.320 respectively. They were all >0.05).In the subjects with prostatitis-like symptoms(n=107), there were also no linear correlation between the amount of WBC in EPS and CPSI scores. (TheΡvalue were 0.192,0.416,0.742,0.278 respectively,They were all >0.05). In the subjects without prostatitis-like symptoms(n=1135), there were also no linear correlation between the amount of WBC in EPS and CPSI scores. (TheΡvalue were 0.254,0.968,0.934,0.607 respectively,They were all >0.05).Conclusion: This is the first epidemiological study with prostatitis-like symptoms among a large male adult population in southern China. The results of this study demonstrated that:1. Prostatitis-like symptoms are common among male adult in Guangxi Fangchenggang district, similar to other citys in China . prostatitis–like symptoms exerted a significant impact on QOL, the degree of impairment of QOL were correlative to CPSI-pain score and total CPSI score. Education degree may be one of a risk factor for prostatitis–like symptoms. We should major in improving the education degree and QOL of sbujects for CP prevention and treatment.2. ED is very common among male adult in Guangxi Fangchenggang district, especially for subjects with prostatitis-like symptoms. Age, education degree, marital status and total CPSI score may be risk factors for ED. Whether in all subjects or in the subjects with prostatitis-like symptoms ,there is a negative correlation between IIEF-5 and NIH-CPSI.The severity of Chronic prostatitis symptoms can predict the risk of ED.3. Whether in all subjects or in the subjects with prostatitis-like symptoms ,there were no linear correlation between the amount of WBC in EPS and the severity symptom.So the amount of WBC in EPS was unsuitable to apply as a the only index of diagnosising , evaluating and observing curative effect. The index should be taken into account in a variety of factors. The improvement of clinical symptom and QOL was the key.更多还原