【摘要】 目的:观察慢性前列腺炎患者前列腺液环氧化酶2细胞表达和炎性因子水平变化与中药前列安栓临床疗效的关系。方法:①选择2005-05/2006-05川北医学院附属医院泌尿外科住院的慢性前列腺炎男性患者43例,年龄25～67岁。均符合世界卫生组织慢性前列腺炎分类诊断标准,且均对治疗方案和检测指标知情同意。随机将患者分为抗生素组20例(对照组)和前列安栓组23例(治疗组)。分组干预:对照组口服罗红霉素胶囊(武汉同济现代医药有限公司)治疗,150mg/次,2次/d;治疗组在此基础上给予前列安栓(丽珠集团丽珠制药厂,国药准字Z10980066,主要成分有黄柏、虎杖、泽兰、栀子、大黄等)局部治疗,1次/d,晚间入睡前纳入肛门内3～5cm。②治疗前及治疗4周后对临床有关症状尿频、排尿不尽感、尿痛、会阴涨痛进行观察并记录,检查前列腺压痛。于治疗前,治疗1,2,3,4周后应用尿流动力仪进行尿流率检测(最大尿流率、平均尿流率),进行前列腺液细胞环氧化酶2免疫组化染色及白细胞介素6、丙二醛、肿瘤坏死因子α含量和超氧化物歧化酶活性检测。400倍视野下计环氧化酶2阳性细胞数及阳性率。疗程结束后评价疗效。③计数资料差异比较采用χ2检验,计量资料差异比较采用t检验。结果:因对照组1例患者未能完成第3周的治疗,最终进入治疗3周后的结果分析42例。①疗效:治疗组总有效率明显高于对照组[47%(9/19),83%(19/23),χ2=5.815,P<0.05]。②治疗后症状和体征改善情况:治疗组尿频、排尿不尽感、尿痛、会阴胀痛及前列腺压痛改善率明显高于对照组(χ2=6.617～10.756,P<0.05～0.01)。③尿流率测定结果:对照组治疗2～4周后和治疗组治疗1～4周后最大尿流率和平均尿流率明显大于治疗前(t=2.567～6.478,P<0.05～0.01),治疗组治疗2～4周后明显大于对照组(t=2.368～5.593,P<0.05～0.01)。④前列腺液细胞环氧化酶2阳性细胞数和阳性率:对照组治疗2～4周后和治疗组治疗1～4周后明显少于或低于治疗前(t=2.124～6.372,P<0.05～0.01),治疗组治疗2～4周后明显少于或低于对照组(t=3.617～5.545,P<0.01)。⑤前列腺液炎性因子、丙二醛含量和超氧化物歧化酶活性变化:对照组治疗2～4周后和治疗组治疗1～4周后前列腺液白细胞介素6、丙二醛、肿瘤坏死因子α含量明显低于治疗前,超氧化物歧化酶含量明显高于治疗前(t=2.364～5.569,P<0.05～0.01)。治疗组治疗2～4周后前列腺液白细胞介素6、丙二醛、肿瘤坏死因子α含量明显低于对照组,超氧化物歧化酶含量明显高于对照组(t=2.028～6.127,P<0.05～0.01)。结论:环氧化酶2表达和炎性因子及丙二醛、超氧化物歧体酶活性变化在慢性前列腺炎的发生发展中起重要作用,前列安栓应用可通过改善上述指标起到减轻临床症状和体征的作用。更多还原

【Abstract】 AIM: To investigate cellular expression of cyclooxygenase-2 (Cox-2) and level of some inflammatory factors in prostatic fluid and the effect of qianlie anshuan on the patients suffered from chronic prostatitis (CP). METHODS: ①A total of 43 male inpatients suffered from CP were enrolled from the Affiliated Hospital of North Sichuan Medical College between May 2005 and May 2006,and the age was 25-67 years. They all accorded the diagnosis criteria for CP by World Health Organization and were classified into antibiotic group (control group,20 patients) and qianlie anshuan group (test group,23 patients),with their informed consents. Patients in the control group were given 150 mg Roxithromycin granules (Wuhan Tongji Modern Medicine Co.,Ltd) orally,2 times one day. Roxithromycin and qianlie anshuan (Livzon Pharmaceutical Factory) were both given in test group every day,3-5 cm into anus.②The treatment effect was evaluated before treatment and 4 weeks after treatment respectively,including frequent micturition,incomplete urination,perineal pain,odynuria and pressing pain on prostate as well. Urine flow rate (maximum and average) was detected at the 1st,2nd,3rd and 4th weeks after treatment by urodynamics radiometer. Cox-2 in liquor prostaticus was detected by immunohistochemical stain method. The level of malondialdehyde (MDA),tumor necrosis factor alpha (TNF-α),interleukin (IL)-6 and activity of superoxide dismutase (SOD) were detected. The positive rate of COX-2 was counted under 400× microscope.③Measurement data and numeration data were compared by t test or χ2 test,separately. RESULTS: Owing to one patient of control group was lost at 3rd week,totally 42 cases were involved in the result analysis.①Curative effect: The total effective rate of testreated group was obviously higher than that in control group 83% (19/23),47% (9/19),χ2=5.815,P < 0.05 .②Improvements of symptom and sign: The symptom improvement rate of test group was obviously higher than that in the control group (χ2=6.617-10.756,P < 0.05-0.01).③Urine flow rate: Both the maximum and average flow rates of test group at the 1st,2nd,3rd and 4th weeks after treatment and control group at 2nd,3rd and 4th weeks after treatment were significantly higher than those before treatment (t =2.567-6.478,P < 0.05-0.01),and were significantly higher in test group at the 2nd,3rd and 4th weeks after treatment than in control group (t = 2.368-5.593,P < 0.05-0.01).④The positive Cox-2 expressed cells and positive rate were obviously less in test group at the 1st,2nd,3rd and 4th weeks after treatment and control group at the 2nd,3rd and 4th weeks after treatment,compared with those before treatment (t =2.124-6.372,P < 0.05-0.01),and obviously lower in test group at the 2nd,3rd and 4th weeks after treatment than in control group (t =3.617-5.545,P < 0.01).⑤The levels of IL-6,MDA and TNF-α decreased,and the activity of SOD increased after treatment (t =2.364-5.569,P < 0.05-0.01). The level of IL-6,MDA and TNF-α were less in the testreated group at the 2nd,3rd and 4th weeks after treatment than in the control group,whereas the activity of SOD were more (t =2.028-6.127,P < 0.05-0.01). CONCLUSION: The expression of Cox-2 and the level of IL-6,MDA,SOD and TNF-α play important roles in the development of CP. The therapy of qianlie anshuan can relieve the clinical symptom and sign of the CP.更多还原