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目的应用特异性COX-2抑制剂及特拉唑嗪分组治疗ⅢB型CPPS,探讨其可能发生机制及选择合理的治疗方案。方法以两杯法及尿常规、前列腺液常规检查及NIH-CPSI评分筛选ⅢB型CPPS患者87例,并随机分为特拉唑嗪治疗组27例,塞来昔布治疗组29例及两者联合用药组31例,分别连续药物治疗4周。治疗前后分别进行NIH-CPSI评分,并对正常对照组及入组患者治疗前后的前列腺液标本应用westernblot方法进行COX-2表达水平测定及应用ELISA方法进行PGE2浓度测定。结果(1)治疗前各治疗组COX-2表达及PGE2浓度测定结果均明显高于正常对照组,有显著性差异(P<0.05),各治疗组间无显著性差异(P>0.05)。(2)治疗后各治疗组COX-2表达及PGE2浓度测定结果比较治疗前有显著性差异(P<0.05),但组间比较无显著性差异。(3)CPSI评分各治疗组治疗后每个变量与治疗前比较均有显著性差异(P<0.05);且组间比较有显著性差异(P<0.05)。结论本研究表明CPPS患者前列腺液中COX-2和PGE2的表达水平与CPPS的发生及症状的严重程度有密切的相关性。特异性COX-2抑制剂及α-肾上腺素受体阻断药均可降低前列腺液中炎症因子表达,治疗上联合用药可以提高疗效。
Objective To investigate the possible mechanism and choose a reasonable treatment regimen for the treatment of type Ⅲ B CPPS with specific COX-2 inhibitors and terazosin subgroups. Methods Eighty-seven patients with type ⅢB CPPS were screened by two-cup method and routine urine test, prostatic fluid routine examination and NIH-CPSI score. They were randomly divided into terazosin treatment group (n = 27), celecoxib treatment group (n = 29) Combination therapy group of 31 cases, respectively, continuous drug treatment for 4 weeks. The NIH-CPSI scores were measured before and after treatment. The levels of COX-2 in the normal control group and prostatic fluid samples before and after treatment were measured by western blot and the concentration of PGE2 was measured by ELISA. Results (1) The expression of COX-2 and the concentration of PGE2 in each treatment group before treatment were significantly higher than those in normal control group (P <0.05). There was no significant difference between each treatment group (P> 0.05). (2) After treatment, the COX-2 expression and PGE2 concentration in each treatment group were significantly different (P <0.05), but there was no significant difference between the two groups. (3) The CPSI score of each treatment group after treatment, each variable compared with before treatment were significantly different (P <0.05), and there was significant difference between groups (P <0.05). Conclusions This study shows that the expression of COX-2 and PGE2 in prostatic fluid of CPPS patients is closely related to the occurrence of CPPS and the severity of symptoms. Specific COX-2 inhibitors and α-adrenergic receptor blockers can reduce the expression of inflammatory cytokines in prostatic fluid, the combination therapy can improve the therapeutic effect.