【摘要】：目的：1.觀察左氧氟沙星、特拉唑嗪單獨和聯(lián)合治療Ⅲ型慢性前列腺炎的療效；2.比較各組中ⅢA型和ⅢB型前列腺炎的治療效果,評估Ⅲ型慢性前列腺炎分型為ⅢA和ⅢB兩個亞型的臨床價值；3.探討Ⅲ型慢性前列腺炎的發(fā)病機(jī)制。材料與方法：按照美國國立衛(wèi)生研究院(National Institutes of Health,NIH)診斷標(biāo)準(zhǔn),將115例Ⅲ型前列腺炎患者隨機(jī)分成3組,左氧氟沙星組38例；特拉唑嗪組38例；聯(lián)合治療組39例。按國際慢性前列腺炎癥狀評分(chronic prostatitis symptom index, CPSI)標(biāo)準(zhǔn)對所有患者進(jìn)行總評分,并分別進(jìn)行排尿癥狀評分、疼痛癥狀評分以及生活質(zhì)量影響評分；國際勃起功能指數(shù)-5(International Index of Erectile Function-5, IIEF-5)評分了解患者性功能狀況；顯微鏡下檢測前列腺液標(biāo)本中白細(xì)胞(white blood cell, WBC):和卵磷脂小體(small particle of lecithin, SPL)數(shù)量；經(jīng)腹行前列腺彩色多普勒檢查了解前列腺組織的炎癥程度；并測定最大尿流率(maximum flow rates, MFR)和平均尿流率(average flow rate, AFR)。治療6周后,觀察各組治療前后NIH-CPSI評分、ⅡEF-5評分、前列腺按摩液檢查及尿流動力學(xué)指標(biāo)的變化。結(jié)果：1.經(jīng)過6周治療后,NIH-CPSI評分左氧氟沙星組由治療前(24.1±7.1)分降至(13.2±4.4)分,特拉唑嗪組由治療前(22.4±6.8)分降至(17.8±5.3)分,聯(lián)合治療組由治療前(22.6±6.6)分降至(11.3±2.3)分。左氧氟沙星組與特拉唑嗪組對比在統(tǒng)計學(xué)上有顯著性差異(P0.01)；聯(lián)合治療組與特拉唑嗪組療效對比有顯著性差異(P0.01)；左氧氟沙星組與聯(lián)合治療組比較無顯著性差異(p0.05)。2.前列腺液(expressed prostatic secretion,EPS)白細(xì)胞數(shù)左氧氟沙星組治療前后分別是(13.4±4.6)、(6.8±2.9)；特拉唑嗪組分別是(12.7±4.3)、(10.1±3.8)；聯(lián)合治療組分別是(12.6±4.4)、(6.0±2.3)。左氧氟沙星組與特拉唑嗪組比較在統(tǒng)計學(xué)上有顯著性差異(P0.01)；聯(lián)合治療組與特拉唑嗪組比較有顯著性差異(P0.01)；左氧氟沙星組與聯(lián)合治療組比較無顯著性差異(p0.05)。3.ⅡEF.5評分左氧氟沙星組治療前后分別是(10.8±2.9)、(16.1±4.4)；特拉唑嗪組分別是(11.1±3.0)、(16.8±4.6)；聯(lián)合治療組分別是(11.2±3.2)、(17.2±4.3)；三組比較無顯著性差異(p0.05)。4.最大尿流率(MFR)左氧氟沙星組治療前后分別是(16.1±5.8)ml/s和(19.3±6.1)ml/s；特拉唑嗪組分別是(16.5±6.3)ml/s.(20.1± 6.7)ml/s；聯(lián)合治療組分別是(16.2±6.0)ml/s.(19.7±6.4)ml/s；三組比較無顯著性差異(p0.05)。5.平均尿流率(AFR)左氧氟沙星組治療前后分別是(8.3±3.4)ml/s和(9.9±3.3)ml/s；特拉唑嗪組分別是(8.0±3.1)ml/s.(10.1±3.2)ml/s；聯(lián)合治療組分別是(8.2±2.9)ml/s.(10.3±3.1)ml/s；三組比較無顯著性差異(p0.05)。6.各組中治療前后NIH-CPSI評分ⅢA型ⅢB型對比不存在顯著性差異(p0.05)。7.各組中治療前后EPS-SPL數(shù)量變化ⅢA型和ⅢB型對比不存在顯著性差異(p0.05)。結(jié)論：1.對于一個6周的短期治療單用左氧氟沙星比單用特拉唑嗪效果明顯；2.單用左氧氟沙星與左氧氟沙星和特拉唑嗪的聯(lián)合治療療效相比無顯著性差異；3.各組中ⅢA型和ⅢB型前列腺炎治療效果對比無顯著性差異；4.以EPS-WBC分型為ⅢA和ⅢB兩個亞型對診斷及評價療效幫助有限,分型的意義有待進(jìn)一步明確。
[Abstract]:Objective: 1. To observe the efficacy of levofloxacin and terazosin alone and in combination in the treatment of type III chronic prostatitis; 2. To compare the therapeutic effects of type III A and type III B prostatitis in each group, and to evaluate the clinical value of type III chronic prostatitis classified into two subtypes: type III A and type III B; 3. To explore the pathogenesis of type III chronic prostatitis. Methods: According to the National Institutes of Health (NIH) diagnostic criteria, 115 patients with type III prostatitis were randomly divided into three groups: levofloxacin group (38 cases), terazosin group (38 cases) and combined treatment group (39 cases). All patients were scored with a total score, and urinary symptom score, pain symptom score and quality of life impact score; International Index of Erectile Function-5 (IIEF-5) score to understand the sexual function of patients; microscopic detection of white blood cell (WB) in prostatic fluid samples. C: and the number of small particle of lecithin (SPL); the degree of inflammation of prostate tissue was detected by transabdominal prostate color Doppler imaging; and the maximum flow rates (MFR) and average flow rate (AFR) were measured. After 6 weeks of treatment, the NIH-CPSI score and the second EF-5 score were observed before and after treatment. Results: 1. After 6 weeks of treatment, the NIH-CPSI score of levofloxacin group decreased from 24.1 (+ 7.1) to 13.2 (+ 4.4) points, that of terazosin group from 22.4 (+ 6.8) to 17.8 (+ 5.3) points, and that of combined treatment group from 22.6 (+ 6.6) to 11.3 (+ 2.3) points. There was significant difference between the two groups (P 0.01). There was no significant difference between the levofloxacin group and the combined treatment group (P 0.05). 2. Levofloxacin group and the combined treatment group (P 0.05). 2. Levofloxacin group (expressed prostatic secretion, EPS) white blood cell count. Before and after treatment were (13.4 [4.6], (6.8 [2.9], terazosin group were (12.7 [4.3], (10.1 [3.8]), combined treatment group were (12.6 [4.4], (6.0 [2.3], levofloxacin group and terazosin group were statistically significant (P 0.01); combined treatment group and terazosin group were significantly different (P 0.01); There was no significant difference between ofloxacin group and combined treatment group (p0.05). 3. II EF.5 scores of levofloxacin group before and after treatment were (10.8 + 2.9), (16.1 + 4.4); terazosin group was (11.1 + 3.0), (16.8 + 4.6); combined treatment group was (11.2 + 3.2), (17.2 + 4.3); there was no significant difference among the three groups (p0.05). 4. The rate (MFR) of levofloxacin group before and after treatment was (16.1+5.8) ml/s and (19.3+6.1) ml/s respectively; that of terazosin group was (16.5+6.3) ml/s. (20.1+6.7) ml/s respectively; that of combined treatment group was (16.2+6.0) ml/s. (19.7+6.4) ml/s; that of levofloxacin group was (p0.05). 5. (8.3 + 3.4) ml / s and (9.9 + 3.3) ml / s; terazosin group was (8.0 + 3.1) ml / s. (10.1 + 3.2) ml / s; combined treatment group was (8.2 + 2.9) ml / s. (10.3 + 3.1) ml / s; there was no significant difference among the three groups before and after treatment (p0.05). There was no significant difference in the NIH-CPSI score between the three groups before and after treatment (p0.05). 7. There was no significant difference in the number of PS-SPL between type III A and type III B (p0.05). Conclusion: 1. Levofloxacin alone was more effective than terazosin alone for a short-term treatment of 6 weeks; 2. Levofloxacin alone was not significantly different from levofloxacin and terazosin combined therapy; 3. There was no significant difference between the therapeutic effect of type III B prostatitis and that of type III B prostatitis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R697.3

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