Введение. Монотерапия антибиотиками не обеспечивает достаточную эффективность ни при одной категории простатита, необходимо применение патогенетического лечения, но сегодня нет однозначных рекомендаций по подбору препаратов. Цель. Оценить эффективность энтомопрепарата Аденопросин у больных хроническим абактериальным простатитом с признаками воспаления. Материалы и методы. В исследование были включены 40 больных хроническим абактериальным простатитом, средний возраст 36,2 года. Критерии включения: диагноз «хронический простатит» (ХП) категории 3-а, выраженность симптомов по шкале NIH-CPSI суммарно не менее 15 баллов, давность заболевания не менее 6 мес, число лейкоцитов в секрете простаты – не менее 15 клеток. Базовую терапию проводили в течение 1 мес; ею ограничивались в группе сравнения. Основная группа дополнительно получала ректальные суппозитории Аденопросина ежедневно в течение 30 дней. Оценивали непосредственные результаты лечения сразу после завершения терапии и через 2 мес после ее окончания. Эффективность определяли по уменьшению лейкоцитоза секрета простаты, шкалам симптомов NIH-CPSI и I-PSS и показателям уродинамики. Результаты. Исходно статистически значимых различий в частоте и выраженности основных симптомов не выявлено, обе группы идентичны; в 1/2 случаев в обеих группах наряду с ХП у пациентов выявлена доброкачественная гиперплазия предстательной железы (ДГПЖ). По завершении терапии достоверные различия получены по параметрам «боль», «качество жизни», «нарушение мочеиспускания» и по сумме баллов; мочеиспускание также улучшилось в основной группе более значительно, что подтверждают и данные урофлоуметрии. Международная система суммарной оценки заболеваний предстательной железы I-PSS подтвердила большую эффективность терапии, в комплекс которой входил энтопрепарат. При контрольном обследовании через 2 мес пропорция клинико-лабораторных данных существенных изменений не претерпела, что подтверждает отсроченный пролонгированный эффект Аденопросина. Заключение. В нашем исследовании у 1/2 больных ХП впервые диагностирована ДГПЖ. Мы полагаем, что ХП и ДГПЖ взаимно маскируют и отягощают течение друг друга, поэтому в лечении любого из этих заболеваний целесообразно предпочесть двунаправленный препарат.
Introduction. Antibiotic monotherapy does not provide sufficient effectiveness in any type of prostatitis. Thus, pathogenic treatment is required, but no definite guidelines on medication choice exist nowadays. Objective. To evaluate Adenoprosin entomotherapy effectiveness in patients with chronic abacterial prostatitis with signs of inflammatory process. Materials and methods. The study included 40 patients with chronic abacterial prostatitis, mean age of the patients was 36.2 years. Inclusion criteria: diagnosed chronic prostatitis (CP) 3a category, symptoms severity evaluated by NIH-CPSI total score more than 15 points, disease duration more than 6 months, leucocyte count in prostate fluid more than 15 cells. Baseline therapy was conducted for 1 month. Control group patients received only baseline treatment. Study group patients received Adenoprosin rectal suppositories daily for 30 days in addition to baseline treatment. Treatment results were evaluated right after therapy course was complete and 2 months after. Treatment effectiveness was evaluated by decrease of prostate fluid leucocyte count decrease, symptoms questionnaires NIH-CPSI and I-PSS, and urodynamics characteristics. Results. No statistically significant differences in frequency and severity of main symptoms were found at baseline, the study groups were identical. In 1/2 cases in both groups benign prostatic hyperplasia (BPH) was found in CP patients. After treatment was complete significant differences were found in parameters “pain”, “quality of life”, “urination disorders”, and in total score. Urination in study group was also improved more significantly that was confirmed with uroflowmetry results. International Prostate Symptom Score (I-PSS) confirmed that baseline treatment combined with entomotherapy was more effective. At follow-up after 2 months clinical and laboratory results ratio did not change significantly that illustrates delayed prolonged effect of Adenoprosin. Conclusion. In 1/2 patients with CP in our study BPH was diagnosed for the first time. We suggest that CH and BPH mask and confound each other’s course and that is why it is preferable to use medication with bidirectional effects.
1. Liang CZ, Li HJ, Wang ZP et al. The prevalence of prostatitis-like symptoms in China. J Urol 2009; 182 (2): 558–63. DOI: 10.1016/j.juro.2009.04.011
2. Mi H, Chen K, Mo ZN. Epidemiological characteristics of chronic prostatitis in China. Zhonghua Nan Ke Xue 2012; 18 (7): 579–82.
3. Tripp DA, Nickel JC, Pikard JL, Katz L. Chronic prostatitis-like symptoms in African males aged 16–19 years. Can J Urol 2012; 19 (1): 6081–7.
4. Кульчавеня Е.В., Холтобин Д.П., Шевченко С.Ю. и др. Частота хронического простатита в структуре амбулаторного урологического приема. Экспериментальная и клиническая урология. 2015; 1: 16–9.
[Kulchavenya E.V., Holtobin D.P., Shevchenko S.Yu. et al. The frequency of chronic prostatitis in the structure of outpatient urological administration. Exp Clin Urol 2015; 1: 16–9 (in Russian).]
5. Bartoletti R, Cai T, Mondaini N et al; Italian Prostatitis Study Group. Prevalence, incidence estimation, risk factors and characterization of chronic prostatitis/chronic pelvic pain syndrome in urological hospital outpatients in Italy: results of a multicenter case-control observational study. J Urol 2007; 178 6): 2411–5; dis. 2415.
6. Кульчавеня Е.В. Как повысить качество жизни больных хроническим простатитом. Справочник поликлинического врача. 2019; 4: 64–9.
[Kulchavenya E.V. How to improve the quality of life of patients with chronic prostatitis. Handbook of Outpatient Physician. 2019; 4: 64–9 (in Russian).]
7. Mändar R, Korrovits P, Rahu K et al. Dramatically deteriorated quality of life in men with prostatitis-like symptoms. Andrology 2020; 8 (1): 101–9. DOI: 10.1111/andr.12647
8. Porter CM, Shrestha E, Peiffer LB, Sfanos KS. The microbiome in prostate inflammation and prostate cancer. Prostate Cancer Prostatic Dis 2018; 21 (3): 345–54. DOI: 10.1038/s41391-018-0041-1
9. Zhang JL, Yuan B, Wang MQ et al. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Bleomycin-Eluting versus Bland Microspheres in a Canine Model. J Vasc Interv Radiol 2020; 31 (5): 820–30. DOI: 10.1016/j.jvir.2019.11.028
10. Zhang M, Luo C, Cui K et al. Chronic inflammation promotes proliferation in the prostatic stroma in rats with experimental autoimmune prostatitis: study for a novel method of inducing benign prostatic hyperplasia in a rat model. World J Urol 2020 Jan 21. DOI: 10.1007/s00345-020-03090-6
11. Zhang J, Liang C, Shang X, Li H. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis. Am J Mens Health 2020; 14 (1): 1557988320903200.
12. Franco JVA, Turk T, Jung JH et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int 2020. DOI: 10.1111/bju.14988
13. Nickel JC. Chronic prostatitis/chronic pelvic pain syndrome: it is time to change our management and research strategy. BJU Int 2020; 125 (4): 479–80. DOI: 10.1111/bju.15036
14. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol 1998; 159: 1224–8.
15. Shukla P, Gulwani HV, Kaur S. Granulomatous prostatitis: clinical and histomorphologic survey of the disease in a tertiary care hospital. Prostate Int 2017; 5 1): 29–34. DOI: 10.1016/j.prnil.2017.01.003
16. Кульчавеня Е.В. Контроль внелегочного туберкулеза в Сибири и на Дальнем Востоке. Проблемы туберкулеза и болезней легких. 2008; 85 (9): 16–9.
[Kulchavenya E.V. Extrapulmonary tuberculosis control in Siberia and the Far East. Problems of tuberculosis and lung diseases. 2008; 85 (9): 16–9 (in Russian).]
17. Chen CH, Lin J, Lin JS, Chen YM. Mycobacterium abscessus complex bacteremia due to prostatitis after prostate biopsy. Indian J Tuberc 2016; 63 (4): 273–5. DOI: 10.1016/j.ijtb.2015.07.014
18. Кульчавеня Е.В., Жукова И.И. Внелегочный туберкулез – вопросов больше, чем ответов. Туберкулез и болезни легких. 2017; 95 (2): 59–63. DOI: 10.21292/2075-1230-2017-95-2-59-63
[Kulchavenya E.V., Zhukova I.I. Extrapulmonary tuberculosis – there are more questions than answers. Tuberculosis and lung diseases. 2017; 95 (2): 59–63. DOI: 10.21292/2075-1230-2017-95-2-59-63 (in Russian).]
19. Cai T, Tamanini I, Kulchavenya E et al. The role of nutraceuticals and phytotherapy in the management of urinary tract infections: What we need to know? Archivo Italiano di Urologia e Andrologia. 2017; 89: 1–6. DOI: 10.4081/aiua2017.1
20. De Nunzio C, Giglio S, Stoppacciaro A et al. Autophagy deactivation is associated with severe prostatic inflammation in patients with lower urinary tract symptoms and benign prostatic hyperplasia. Oncotarget 2017 Feb 7. DOI: 10.18632/oncotarget.15144. DOI: 10.1177/1557988320903200
21. Hajighorbani M, Ahmadi-Hamedani M, Shahab E et al. Evaluation of the protective effect of pentoxifylline on carrageenan-induced chronic non-bacterial prostatitis in rats. Inflammopharmacology 2017 Mar 9. DOI: 10.1007/s10787-017-0335-2
22. Han WJ, Guo YG, Wang YQ, Wang JW. The effectiveness of electrical stimulation for the management of benign prostatic hyperplasia: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99 (19): e19921. DOI: 10.1097/MD.0000000000019921
23. Kim HB, Kim YI, Jeon JH et al. Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker: Study protocol for an assessor-blinded, randomized controlled clinical trial. Medicine (Baltimore) 2020; 99 (15): e19678. DOI: 10.1097/MD.0000000000019678
24. Li J, Dong L, Yan X et al. Is Acupuncture Another Good Choice for Physicians in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome? Review of the Latest Literature. Pain Res Manag 2020; 2020: 921038. DOI: 10.1155/2020/5921038
25. Liu JW, Lin TC Naouar S et al. Spontaneous rupture into the peritoneal cavity: Unusual presentation of prostatic abscess. Int J Surg Case Rep 2017; 32: 73–5. DOI: 10.1016/j.ijscr.2017.02.006
26. Magri V, Wagenlehner FM, Marras E et al. Influence of infection on the distribution patterns of NIH-Chronic Prostatitis Symptom Index scores in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Exp Ther Med 2013; 6 (2): 503–8.
27. Kohnen PW, Drach GW. Patterns of inflammation in prostatic hyperplasia: a histologic and bacteriologic study. J Urol 1979; 21 6): 755–60. DOI: 10.1016/s0022-5347(17)56980-3
28. Mishra VC, Allen DJ, Nicolaou C et al. Does intraprostatic inflammation have a role in the pathogenesis and progression of benign prostatic hyperplasia? BJU Int 2007; 100 (2): 327–31. DOI: 10.1111/j.1464-410X.2007.06910.x
29. Robert G, Descazeaud A, Nicolaiew N et al. Inflammation in benign prostatic hyperplasia: a 282 patients’ immunohistochemical analysis. Prostate 2009; 69 (16): 1774–80. DOI: 10.1002/pros.21027
30. Wu ZL, Yuan Y, Geng H, Xia SJ. Influence of immune inflammation on androgen receptor expression in benign prostatic hyperplasia tissue. Asian J Androl 2012; 14 (2): 316–9. DOI: 10.1038/aja.2011.154
31. Bostanci Y, Kazzazi A, Momtahen S et al. Correlation between benign prostatic hyperplasia and inflammation. Curr Opin Urol 2013; 23 (1): 5–10. DOI: 10.1097/MOU.0b013e32835abd4a
32. Ishola IO, Tijani HK, Dosumu OO et al. Atorvastatin attenuates testosterone-induced benign prostatic hyperplasia in rats: role of peroxisome proliferator-activated receptor-gamma and cyclo-oxygenase-2. Fundam Clin Pharmacol 2017; 31 (6): 652–62. DOI: 10.1111/fcp.12301
33. Jena AK, Vasisht K, Sharma N et al. Amelioration of testosterone induced benign prostatic hyperplasia by Prunus species. J Ethnopharmacol 2016; 190: 3–45. DOI: 10.1016/j.jep.2016.05.052
34. Dumbraveanu I, Ciuhrii C, Tanase A. Anti-inflammatory activity of Adenoprosin in nonbacterial prostatitis. Moldovan Medical Journal 2017; 60 (4): 4–10.
________________________________________________
1. Liang CZ, Li HJ, Wang ZP et al. The prevalence of prostatitis-like symptoms in China. J Urol 2009; 182 (2): 558–63. DOI: 10.1016/j.juro.2009.04.011
2. Mi H, Chen K, Mo ZN. Epidemiological characteristics of chronic prostatitis in China. Zhonghua Nan Ke Xue 2012; 18 (7): 579–82.
3. Tripp DA, Nickel JC, Pikard JL, Katz L. Chronic prostatitis-like symptoms in African males aged 16–19 years. Can J Urol 2012; 19 (1): 6081–7.
4. Kulchavenya E.V., Holtobin D.P., Shevchenko S.Yu. et al. The frequency of chronic prostatitis in the structure of outpatient urological administration. Exp Clin Urol 2015; 1: 16–9 (in Russian).
5. Bartoletti R, Cai T, Mondaini N et al; Italian Prostatitis Study Group. Prevalence, incidence estimation, risk factors and characterization of chronic prostatitis/chronic pelvic pain syndrome in urological hospital outpatients in Italy: results of a multicenter case-control observational study. J Urol 2007; 178 6): 2411–5; dis. 2415.
6. Kulchavenya E.V. How to improve the quality of life of patients with chronic prostatitis. Handbook of Outpatient Physician. 2019; 4: 64–9 (in Russian).
7. Mändar R, Korrovits P, Rahu K et al. Dramatically deteriorated quality of life in men with prostatitis-like symptoms. Andrology 2020; 8 (1): 101–9. DOI: 10.1111/andr.12647
8. Porter CM, Shrestha E, Peiffer LB, Sfanos KS. The microbiome in prostate inflammation and prostate cancer. Prostate Cancer Prostatic Dis 2018; 21 (3): 345–54. DOI: 10.1038/s41391-018-0041-1
9. Zhang JL, Yuan B, Wang MQ et al. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Bleomycin-Eluting versus Bland Microspheres in a Canine Model. J Vasc Interv Radiol 2020; 31 (5): 820–30. DOI: 10.1016/j.jvir.2019.11.028
10. Zhang M, Luo C, Cui K et al. Chronic inflammation promotes proliferation in the prostatic stroma in rats with experimental autoimmune prostatitis: study for a novel method of inducing benign prostatic hyperplasia in a rat model. World J Urol 2020 Jan 21. DOI: 10.1007/s00345-020-03090-6
11. Zhang J, Liang C, Shang X, Li H. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis. Am J Mens Health 2020; 14 (1): 1557988320903200.
12. Franco JVA, Turk T, Jung JH et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int 2020. DOI: 10.1111/bju.14988
13. Nickel JC. Chronic prostatitis/chronic pelvic pain syndrome: it is time to change our management and research strategy. BJU Int 2020; 125 (4): 479–80. DOI: 10.1111/bju.15036
14. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol 1998; 159: 1224–8.
15. Shukla P, Gulwani HV, Kaur S. Granulomatous prostatitis: clinical and histomorphologic survey of the disease in a tertiary care hospital. Prostate Int 2017; 5 1): 29–34. DOI: 10.1016/j.prnil.2017.01.003
16. Kulchavenya E.V. Extrapulmonary tuberculosis control in Siberia and the Far East. Problems of tuberculosis and lung diseases. 2008; 85 (9): 16–9 (in Russian).
17. Chen CH, Lin J, Lin JS, Chen YM. Mycobacterium abscessus complex bacteremia due to prostatitis after prostate biopsy. Indian J Tuberc 2016; 63 (4): 273–5. DOI: 10.1016/j.ijtb.2015.07.014
18. Kulchavenya E.V., Zhukova I.I. Extrapulmonary tuberculosis – there are more questions than answers. Tuberculosis and lung diseases. 2017; 95 (2): 59–63. DOI: 10.21292/2075-1230-2017-95-2-59-63 (in Russian).
19. Cai T, Tamanini I, Kulchavenya E et al. The role of nutraceuticals and phytotherapy in the management of urinary tract infections: What we need to know? Archivo Italiano di Urologia e Andrologia. 2017; 89: 1–6. DOI: 10.4081/aiua2017.1
20. De Nunzio C, Giglio S, Stoppacciaro A et al. Autophagy deactivation is associated with severe prostatic inflammation in patients with lower urinary tract symptoms and benign prostatic hyperplasia. Oncotarget 2017 Feb 7. DOI: 10.18632/oncotarget.15144. DOI: 10.1177/1557988320903200
21. Hajighorbani M, Ahmadi-Hamedani M, Shahab E et al. Evaluation of the protective effect of pentoxifylline on carrageenan-induced chronic non-bacterial prostatitis in rats. Inflammopharmacology 2017 Mar 9. DOI: 10.1007/s10787-017-0335-2
22. Han WJ, Guo YG, Wang YQ, Wang JW. The effectiveness of electrical stimulation for the management of benign prostatic hyperplasia: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99 (19): e19921. DOI: 10.1097/MD.0000000000019921
23. Kim HB, Kim YI, Jeon JH et al. Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker: Study protocol for an assessor-blinded, randomized controlled clinical trial. Medicine (Baltimore) 2020; 99 (15): e19678. DOI: 10.1097/MD.0000000000019678
24. Li J, Dong L, Yan X et al. Is Acupuncture Another Good Choice for Physicians in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome? Review of the Latest Literature. Pain Res Manag 2020; 2020: 921038. DOI: 10.1155/2020/5921038
25. Liu JW, Lin TC Naouar S et al. Spontaneous rupture into the peritoneal cavity: Unusual presentation of prostatic abscess. Int J Surg Case Rep 2017; 32: 73–5. DOI: 10.1016/j.ijscr.2017.02.006
26. Magri V, Wagenlehner FM, Marras E et al. Influence of infection on the distribution patterns of NIH-Chronic Prostatitis Symptom Index scores in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Exp Ther Med 2013; 6 (2): 503–8.
27. Kohnen PW, Drach GW. Patterns of inflammation in prostatic hyperplasia: a histologic and bacteriologic study. J Urol 1979; 21 6): 755–60. DOI: 10.1016/s0022-5347(17)56980-3
28. Mishra VC, Allen DJ, Nicolaou C et al. Does intraprostatic inflammation have a role in the pathogenesis and progression of benign prostatic hyperplasia? BJU Int 2007; 100 (2): 327–31. DOI: 10.1111/j.1464-410X.2007.06910.x
29. Robert G, Descazeaud A, Nicolaiew N et al. Inflammation in benign prostatic hyperplasia: a 282 patients’ immunohistochemical analysis. Prostate 2009; 69 (16): 1774–80. DOI: 10.1002/pros.21027
30. Wu ZL, Yuan Y, Geng H, Xia SJ. Influence of immune inflammation on androgen receptor expression in benign prostatic hyperplasia tissue. Asian J Androl 2012; 14 (2): 316–9. DOI: 10.1038/aja.2011.154
31. Bostanci Y, Kazzazi A, Momtahen S et al. Correlation between benign prostatic hyperplasia and inflammation. Curr Opin Urol 2013; 23 (1): 5–10. DOI: 10.1097/MOU.0b013e32835abd4a
32. Ishola IO, Tijani HK, Dosumu OO et al. Atorvastatin attenuates testosterone-induced benign prostatic hyperplasia in rats: role of peroxisome proliferator-activated receptor-gamma and cyclo-oxygenase-2. Fundam Clin Pharmacol 2017; 31 (6): 652–62. DOI: 10.1111/fcp.12301
33. Jena AK, Vasisht K, Sharma N et al. Amelioration of testosterone induced benign prostatic hyperplasia by Prunus species. J Ethnopharmacol 2016; 190: 3–45. DOI: 10.1016/j.jep.2016.05.052
34. Dumbraveanu I, Ciuhrii C, Tanase A. Anti-inflammatory activity of Adenoprosin in nonbacterial prostatitis. Moldovan Medical Journal 2017; 60 (4): 4–10.
Авторы
Е.В. Кульчавеня*1,2, А.А. Бреусов3
1 ФГБУ «Новосибирский научно-исследовательский институт туберкулеза» Минздрава России, Новосибирск, Россия;
2 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
3 Медицинский центр «БИОВЭР», Новосибирск, Россия
*urotub@yandex.ru
________________________________________________
Ekaterina V. Kulchavenya*1,2, Aleksandr A. Breusov3
1 Novosibirsk TB Research Institute, Novosibirsk, Russia;
2 Novosibirsk State Medical University, Novosibirsk, Russia;
3 Medical Center "BIOVER", Novosibirsk, Russia
*urotub@yandex.ru