【Cochrane简语概要】治疗男性慢性前列腺炎和慢性骨盆疼痛的干预
系统综述问题
对于前列腺和骨盆周围长期疼痛和不适，即有慢性前列腺炎/慢性骨盆疼痛综合征（chronic prostatitis/chronic pelvic pain syndrome, CP/CPPS）的男性，药物干预的效果如何？
研究背景
CP/CPPS是一种常见的疾病，男性在排尿时会感到骨盆疼痛或有令人烦恼的症状（或两者兼有）。其原因不明，对这种疾病有很多不同的治疗方法。
研究特征
证据截止至2019年7月。我们发现，在1983年至2016年期间有96项研究，涉及了8646名患有CP/CPPS的男性，评估了16种药物干预。这些干预在门诊治疗的患者中进行。大多数研究没有具体说明其资金来源；21项研究报告接受了制药公司的资助。
主要结果
α受体阻断剂：我们不确定α受体阻断剂对前列腺炎症状的影响。α受体阻断剂可能会增加不良反应，如头晕和低血压。α受体阻断剂在导致性问题、生活质量或焦虑和抑郁方面几乎没有差异。
5alpha还原酶抑制剂（5-ARI）：5-ARI可以减轻前列腺炎症状，与服用安慰剂的男性相比，可能不会有更多的不良反应。没有关于性问题、生活质量、焦虑和抑郁的信息。
抗生素：抗生素可以减轻前列腺炎症状，可能与不良反应无关。抗生素在性问题和生活质量方面几乎没有差异。没有关于焦虑和抑郁的信息。
抗炎药：抗炎药可减轻前列腺炎症状，可能与不良反应无关。没有关于性问题、生活质量、焦虑和抑郁的信息。
植物疗法：植物疗法可以减轻前列腺炎症状，可能与不良反应无关。植物疗法可能不会改善性问题。没有关于生活质量、焦虑和抑郁的信息。
A型肉毒毒素（Botulinum toxin A, BTA）：将这种毒素注射到前列腺可以使前列腺炎症状大为减轻，但如果其应用于骨盆肌肉，BTA可能不会有这种效果。这些注射可能与不良反应无关。没有关于性问题、生活质量、焦虑和抑郁的信息。
别嘌醇：别嘌醇在前列腺炎症状方面几乎没有差异，可能与不良反应无关。没有关于性问题、生活质量、焦虑和抑郁的信息。
中医（Traditional Chinese Medicine, TCM）：中医可以减轻前列腺炎症状，可能与不良反应无关。中医可能不会改善性问题，也可能不会改善焦虑和抑郁的症状。没有关于生活质量的信息。
证据质量
在大多数情况下，证据的质量从低到极低，这意味着结果存在很大的不确定性。在纳入的研究中发现的最常见问题是设计不充分、样本量小和随访时间短（通常为12周）。
作者结论:
我们发现低至极低质量的证据显示，α受体阻断剂、抗生素、5-ARI、抗炎药、植物疗法、前列腺内注射BTA和中药可以在短期内减轻前列腺炎症状，而不会增加不良事件的发生率，除了α受体阻断剂可能与轻度不良事件增加有关。我们发现很少有使用活性药物对照组的试验，也几乎没有证据表明这些药物对性功能障碍，生活质量或焦虑和抑郁有影响。未来的临床试验应对其方法进行完整报告，包括充分的盲法、对所有患者重要结局的一致性评估，包括潜在的治疗相关不良事件，以及适当的样本量。
作者:Franco JVA, Turk T, Jung J, Xiao Y, Iakhno S, Tirapegui F, Garrote V, Vietto V；译者：任相颖，河南大学护理与健康学院；审校：靳英辉，武汉大学中南医院循证与转化医学中心；编辑排版：索于思，北京中医药大学循证医学中心
【Cochrane Plain Language Summary】Intervention for treating chronic prostatitis and chronic pelvic pain in men
Review question
What are the effects of medical therapies in men with longstanding pain and discomfort around their prostate and pelvis, so-called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?
Background
CP/CPPS is a common disorder in which men feel pelvic pain or have bothersome symptoms (or both of these) when urinating. Its cause is unknown and there are many different treatments for this condition.
Study characteristics
The evidence was current to July 2019. We found 96 studies that were conducted between 1983 and 2016 in 8646 men with CP/CPPS, with assessment of 16 types of pharmacological interventions. These therapies were given to men in an outpatient setting. Most studies did not specify their funding sources; 21 studies reported funding from pharmaceutical companies.
Key results
Alpha blockers: we are uncertain about the effects of alpha blockers on prostatitis symptoms. Alpha blockers may increase side-effects, for example dizziness and low blood pressure. Alpha blockers probably result in little to no difference in sexual problems, quality of life or anxiety and depression.
5-alpha reductase inhibitors (5-ARI): 5-ARI probably reduce prostatitis symptoms and may not be associated with more side effects than seen in men taking a placebo. There was no information on sexual problems, quality of life or anxiety and depression.
Antibiotics: antibiotics may reduce prostatitis symptoms and are probably not associated with side effects. Antibiotics probably result in little to no difference in sexual problems and quality of life. There was no information on anxiety and depression.
Anti-inflammatories: anti-inflammatories may reduce prostatitis symptoms and may not be associated with side effects. There was no information on sexual problems, quality of life or anxiety and depression.
Phytotherapy: phytotherapy may reduce prostatitis symptoms and may not be associated with side effects. Phytotherapy may not improve sexual problems. There was no information on quality of life and anxiety and depression.
Botulinum toxin A (BTA): the injection of this toxin into the prostate may cause a large reduction in prostatitis symptoms, but if it is applied to muscles of the pelvis, BTA may not cause this effect. These injections may not be associated with side effects. There was no information on sexual problems, quality of life or anxiety and depression.
Allopurinol: allopurinol may result in little to no difference in prostatitis symptoms and may not be associated with side effects. There was no information on sexual problems, quality of life or anxiety and depression.
Traditional Chinese Medicine (TCM): TCM may reduce prostatitis symptoms and may not be associated with side effects. TCM probably does not improve sexual problems and it may not improve symptoms of anxiety and depression. There was no information on quality of life.
Quality of the evidence
The quality of the evidence was low to very low in most cases, meaning that there is much uncertainty surrounding the results. The most frequent problems detected in the included studies were an inadequate design, a small sample size and a short follow-up time (usually 12 weeks).
Authors' conclusions:
We found low- to very low-quality evidence that alpha blockers, antibiotics, 5-ARI, anti-inflammatories, phytotherapy, intraprostatic BTA injection, and traditional Chinese medicine may cause a reduction in prostatitis symptoms without an increased incidence of adverse events in the short term, except for alpha blockers which may be associated with an increase in mild adverse events. We found few trials with active comparators and little evidence of the effects of these drugs on sexual dysfunction, quality of life or anxiety and depression. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes, including potential treatment-related adverse events, and appropriate sample sizes.
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