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  

Effect of extracorporeal shock wave therapy combined with tamsulosin on category ⅢB chronic prostatitis/chronic pelvic pain syndrome and the mechanism

作　　者：林斌[1] 张兴艳[1] 王亮[2] 

机构地区：[1]金堂县第一人民医院(四川大学华西医院金堂医院)泌尿外科,成都610400 [2]重庆市肿瘤医院泌尿外科,重庆400037

出　　处：《第三军医大学学报》2017年第14期1498-1502,共5页Journal of Third Military Medical University

摘　　要：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。Objective To investigate the effect of extracorporeal shock wave therapy（ ESWT）combined with tamsulosin on category ⅢB chronic prostatitis/chronic pelvic pain syndrome（ CP/CPPS） and explore the possible mechanisms. Methods A total of 120 patients with category Ⅲ B CP/CPPS were randomized into ESWT group and control group（ n = 60） to receive treatments with ESWT plus tamsulosin and tamsulosin alone,respectively. After 4 weeks of treatment,the improvements of clinical symptoms（ NIH-CPSI and IPSS score）,levels of tumor necrosis factor-α（ TNF-α）,interleukin-6（ IL-6） and lecithin bodies in the prostatic fluid, and levels of CD3^＋,CD4^＋,CD8^＋,CD4^＋CD25^＋,CD4^＋CD25^＋Foxp3^＋cells and transforming growth factor（ TGF）-β1 in the peripheral blood were determined. Results After 4 weeks of treatment,the patients in ESWT group showed a significantly higher overall response rate than those in the control group（ 93. 3% vs 63. 3%,P〈0. 05） with and significantly decreased scores of NIH-CPSI（ 13. 12 ±1. 71 vs 23. 16 ± 1. 33） and IPSS（ 8. 23 ± 2. 28 vs 13. 14 ± 2. 69）. Compared with those in the control group,the content of lecithin body was significantly increased and the levels of inflammatory factors TNF-α and IL-1were significantly decreased in ESWT group; the contents of CD3^＋,CD4^＋,CD8^＋,CD4^＋CD25^＋,CD4^＋CD25^＋Foxp3^＋cells and TGF-β1 level in peripheral blood were significantly increased in ESWT group.Conclusion ESWT combined with tamsulosin is safe and effective for treatment of category ⅢB CP/CPPS possibly by improving the immune function and reducing the local inflammatory response in the prostate.

关 键 词：体外冲击波治疗 炎症 免疫反应 慢性前列腺炎 慢性盆腔疼痛综合征 

分 类 号：R392.32[医药卫生—免疫学] R454.4[医药卫生—基础医学]