易剑锋 叶蓁蓁 王新平 邢喜平 田洹 杨彦林

摘要：目的 探讨大黄消痔栓联合四环素片治疗纳米细菌致Ⅲ型前列腺炎的临床疗效。方法 选取纳米细菌致Ⅲ型前列腺炎患者120例，随机分为治疗组和对照组各60例。2组均停用抗感染药及其他相关制剂，进行饮食及生活干预。2组均予四环素片，每次1片，每日2次，口服。治疗组并予大黄消痔栓，每次1粒，每日1次，置入肛门3～4 cm。均10 d为1个疗程，连续3个疗程。观察2组临床疗效、主要症状改善时间及治疗前后美国国立卫生研究院慢性前列腺炎症状积分指数（NIH-CPSI），检测前列腺液（EPS）白细胞、卵磷脂小体数量、尿流率及肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-8水平。结果 治疗组总有效率为100.0%（60/60），对照组为83.3%（50/60），治疗组优于对照组（P<0.05）。治疗组骨盆疼痛、排尿症状、阴囊潮湿改善时间均低于对照组（P<0.05）。与治疗前比較，2组治疗后NIH-CPSI疼痛评分、排尿症状评分、生活质量评分及总分，EPS白细胞、TNF-α、IL-6、IL-8水平均降低（P<0.05），卵磷脂小体+++～++++者增多（P<0.05），尿流率提高（P<0.05）；治疗后治疗组NIH-CPSI疼痛评分、排尿症状评分、生活质量评分及总分，EPS白细胞、卵磷脂小体++++者及TNF-α、IL-6、IL-8水平与对照组比较，差异有统计学意义（P<0.05）。结论 大黄消痔栓可提高四环素片治疗纳米细菌致Ⅲ型前列腺炎的临床疗效，减轻前列腺炎症。

关键词：纳米细菌；Ⅲ型前列腺炎；大黄消痔栓；直肠给药

DOI：10.3969/j.issn.1005-5304.2017.08.009

中图分类号：R277.573.3 文献标识码：A 文章编号：1005-5304（2017）08-0036-05

Clinical Study on Dahuang Xiaozhi Suppository Combined with Tetracycline in Treating Type Ⅲ Prostatitis Infected with Nano-bacteria YI Jian-feng1，2， YE Zhen-zhen1， WANG Xin-ping2， XING Xi-ping2， TIAN Yuan2， YANG Yan-lin2 （1. Clinical School， Gansu University of Chinese Medicine， Lanzhou 730000， China； 2. Affiliated Hospital of Gansu University of Chinese Medicine， Lanzhou 730000， China）

Abstract： Objective To investigate the clinical efficacy of Dahuang Xiaozhi Suppository combined with tetracycline in treating type Ⅲ prostatitis infected with nano-bacteria. Methods Totally 120 patients of type Ⅲ prostatitis infected with nano-bacteria were randomly divided into treatment group and control group， with 60 cases in each group. Both groups were disabled anti-infective drugs and other preparations for diet and life intervention. Both groups received tetracycline， once a tablet， twice a day， orally. The treatment group received Dahuang Xiaozhi Suppository， once a capsule， once a day， placing in the anus 3–4 cm. 10 d was a treatment course， for 3 courses. The clinical efficacy， major symptoms improving time， NIH-CPSI， leukocyte count and ecithin corpuscles in expressed prostatic secretion （EPS）， urinary flow rate， and cytokine content of TNF-α， IL-6， IL-8， were evaluated. Results The total effective rate was 100.0% （60/60） in treatment group and 83.3% （50/60） in the control group， and treatment group was higher than the control group （P<0.05）. Pelvic pain， urinary symptom， and scrotum wet improvement time of treatment group were lower than the control group （P<0.05）. Compared with before the treatment， the NIH-CPSI pain scores， urinary symptom scores， life quality score， leukocyte count and TNF-α， IL-6， IL-8 content of EPS in both groups were significantly lower after treatment （P<0.05）， and the cases with lecithin corpuscles +++ – ++++ in both

基金项目：国家自然科学基金（81060304）；甘肃省中医药管理局科研课题（GEK-2015-63）；甘肃中医药大学附属医院科研及技术创新基金项目（2014年）

通讯作者：王新平，E-mail：lzyywxp@sina.com

groups significantly increased after treatment （P<0.05）. The urinary peak flow rate and mean flow rate in both groups were higher after treatment （P<0.05）. There was statistical significance in the scores of NIH-CPSI pain， urinary symptom and life quality， leukocyte count and TNF-α， IL-6， IL-8 content of EPS， and the cases with lecithin corpuscles ++++ between the two groups （P<0.05）. Conclusion Dahuang Xiaozhi Suppository can improve the efficacy of treating type Ⅲ prostatitis infected with nano-bacteria. Combining Dahuang Xiaozhi Suppository with tetracycline can reduce prostate inflammation， with obvious efficacy.

Key words： nano-bacteria； type Ⅲ prostatitis； Dahuang Xiaozhi Suppository； rectal administration

Ⅲ型前列腺炎病因复杂，发病机制尚不明确，通过前列腺组织活检及前列腺液（expressed prostatic secretion，EPS）细菌分离培养很难找到病原学证据，临床疗效多不理想。研究表明，患者前列腺组织存在炎症，EPS中细菌16SrRNA的检出率高达78.9%[1-2]，说明细菌感染可能是该病的主要病因。研究发现，纳米细菌与Ⅲ型前列腺炎关系密切[3-5]，四环素治疗有效[6]。但由于血-前列腺屏障和慢性炎症导致的前列腺周围瘢痕纤维化或脓腔周围纤维化的屏障作用，口服或静脉给药均无法使前列腺病灶内达到有效的药物浓度，疗效不显著，复发率高。……