坦索罗辛与艾司西酞普兰联合治疗骨盆疼痛综合征焦虑抑郁共病的研究

孙景存; 张洪亮

doi:10.16766/j.cnki.issn.1674-4152.003427

坦索罗辛与艾司西酞普兰联合治疗骨盆疼痛综合征焦虑抑郁共病的研究

doi: 10.16766/j.cnki.issn.1674-4152.003427

孙景存^1, ,,
张洪亮²

1.
河北省沧州中西医结合医院西药学部，河北沧州 061001
2.
河北省沧州中西医结合医院泌尿外一科

基金项目:

河北省卫计委课题 20180967

详细信息

通讯作者:
孙景存，E-mail：sunjingcun@126.com

中图分类号: R971.4 R681.6 R749.4
计量
- 文章访问数: 93
- HTML全文浏览量: 58
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-01
- 网络出版日期: 2024-05-27

A randomized controlled study of the combined treatment of tamsulosin and escitalopram for pelvic pain syndrome with comorbid anxiety and depression

SUN Jingcun^{1
, ,},
ZHANG Hongliang²

1.
Department of Pharmacy, Cangzhou Hospital of Integrated TCM-WM, Cangzhou, Hebei 061001, China

摘要

摘要: 目的在慢性骨盆疼痛综合征(CPPS)合并焦虑抑郁患者中，明确坦索罗辛与艾司西酞普兰联合治疗与一般治疗的差异，以期评估联合方案的临床应用潜力。方法选取2019年7月—2022年7月河北省沧州中西医结合医院泌尿外科收治的150例CPPS合并焦虑抑郁共病患者，根据随机数字表法分为观察组与对照组，各75例。观察组给予坦索罗辛+艾司西酞普兰治疗，对照组给予坦索罗辛+安慰剂治疗，治疗3个月后进行有效性及安全性比较。结果观察组临床总有效率明显高于对照组[96.00%(72/75) vs. 84.00%(63/75), P＜0.05]。治疗后，观察组美国国立卫生研究院-慢性前列腺炎症状量表排尿症状、疼痛与不适评分明显降低，生活质量较前好转(P＜0.05)。与对照组比较，治疗后观察组汉密尔顿焦虑量表[(8.37±1.89)分vs. (11.85±2.67)分]、汉密尔顿抑郁量表[(6.71±1.64)分vs. (9.26±2.42)分]评分显著降低。联合用药后，观察组血清炎症因子TNF-α、IL-8均低于对照组(P＜0.05)。2组间不良反应总发生率差异无统计学意义[9.33%(7/75) vs. 12.00%(9/75)，P＞0.05]。结论坦索罗辛和艾司西酞普兰联合治疗不仅能够减轻心理症状，降低焦虑抑郁评分，还能够改善炎症水平，提升患者生活质量，用于治疗CPPS合并焦虑抑郁共病患者具备良好的安全性和有效性，值得推广应用。
- 坦索罗辛 /
- 艾司西酞普兰 /
- 骨盆疼痛综合征 /
- 焦虑 /
- 抑郁 /
- 负性情绪
Abstract: Objective To determine the difference between the combination therapy of tamsulosin and escitalopram and conventional therapy in patients with chronic pelvic pain syndrome (CPPS) complicated with anxiety and depression, and to evaluate the clinical application potential of the combination therapy. Methods A total of 150 CPPS patients comorbid with anxiety and depression admitted to the Department of Urology at the Integrated Traditional Chinese and Western Medicine Hospital in Cangzhou, Hebei Province, from July 2019 to July 2022 were selected. They were randomly divided into an observation group and a control group, with 75 cases in each. The observation group received tamsulosin plus escitalopram, while the control group received tamsulosin plus a placebo. The effectiveness and safety were compared after a 3-month course of treatment. Results The clinical efficacy showed that the total effective rate in the observation group was significantly higher than that in the control group [96.00% (72/75) vs. 84.00% (63/75), P < 0.05]. In the observation group, urinary symptoms, pain, and discomfort on the National Institutes of Health chronic prostatitis symptom index scale significantly decreased, and the quality of life dimension improved compared to before (P < 0.05). Compared with the control group, the Hamilton anxiety scale (8.37±1.89 vs. 11.85±2.67) and Hamilton depression scale (6.71±1.64 vs. 9.26±2.42) scores in the observation group showed a significant reduction in negative emotional scores. After combined medication, the levels of serum inflammatory factors TNF-α and IL-8 in the observation group were significantly lower than those in the control group (P < 0.05). The total incidence of adverse reactions [9.33% (7/75) vs. 12.00% (9/75)] showed no statistically significant difference between the groups (P > 0.05). Conclusion The combination of tamsulosin and escitalopram not only alleviates psychological symptoms and reduces anxiety and depression scores but also improves inflammatory levels and enhances the quality of life in patients with CPPS comorbid with anxiety and depression. This combination therapy demonstrates good safety and effectiveness in patients with this comorbidity and is worthy of promotion.
- Tamsulosin /
- Escitalopram /
- Pelvic pain syndrome /
- Anxiety /
- Depression /
- Negative emotions

HTML全文

表 1 2组CPPS合并焦虑抑郁共病男性患者基线资料比较

Table 1. Comparison of baseline data between two groups of male patients with CPPS combined with anxiety and depression

项目	观察组(n=75)	对照组(n=75)	统计量	P值
年龄(x±s, 岁)	38.57±11.63	38.16±15.59	0.945^a	0.860
BMI(x±s)	22.30±1.41	22.41±1.38	1.290^a	0.093
病程(x±s, 月)	12.87±3.39	12.62±3.43	1.690^a	0.780
收缩压(x±s, mmHg)	105.65±20.52	109.21±20.29	0.934^a	0.352
舒张压(x±s, mmHg)	80.41±10.17	79.27±11.22	0.253^a	0.801
高血压[例(%)]			0.060^b	0.806
是	9(12.00)	10(13.33)
否	66(88.00)	65(86.67)
糖尿病[例(%)]			＜0.001^b	0.999
是	4(5.33)	5(6.67)
否	71(94.67)	70(93.33)
冠心病[例(%)]			＜0.001^b	0.999
是	3(4.00)	2(2.67)
否	72(96.00)	73(97.33)
脑血管病[例(%)]				0.999^c
是	0	1(1.33)
否	75(100.00)	74(98.67)
睡眠障碍[例(%)]			＜0.001^b	0.999
是	1(1.33)	2(2.67)
否	74(98.67)	73(97.33)
注：^a为t值，^b为χ²值，^c为采用Fisher精确检验。1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 2组CPPS合并焦虑抑郁共病男性患者临床总有效率比较[例(%)]

Table 2. Comparison of clinical efficacy between two groups of male patients with CPPS combined with anxiety and depression [cases (%)]

组别	例数	显效	有效	无效	总有效
观察组	75	46(61.33)	26(34.67)	3(4.00)	72(96.00)
对照组	75	30(40.00)	33(44.00)	12(16.00)	63(84.00)
注：2组总有效率比较，χ²=6.000，P=0.014。

下载: 导出CSV

表 3 2组CPPS合并焦虑抑郁共病男性患者NIH-CPSI评分比较(x±s, 分)

Table 3. Comparison of NIH-CPSI scores between two groups of male patients with CPPS combined with anxiety and depression (x±s, points)

组别	例数	排尿症状		疼痛与不适		生活质量
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	75	7.15±1.63	3.67±0.87^a	17.33±2.45	8.65±1.59^a	9.16±1.68	5.02±1.11^a
对照组	75	7.20±1.59	4.98±0.96^a	17.42±2.53	10.71±1.64^a	9.09±1.72	6.87±1.26^a
t值		0.190	8.757	0.221	7.810	0.252	9.541
P值		0.849	＜0.001	0.825	＜0.001	0.801	＜0.001
注：与组内治疗前比较，^aP＜0.05。

下载: 导出CSV

表 4 2组CPPS合并焦虑抑郁共病男性患者负性情绪评分比较(x±s, 分)

Table 4. Comparison of negative mood scores between two groups of male patients with CPPS combined with anxiety and depression (x±s, points)

组别	例数	HAMA		HAMD
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	75	24.54±4.26	8.37±1.89^a	21.61±3.17	6.71±1.64^a
对照组	75	24.48±4.32	11.85±2.67^a	21.44±3.25	9.26±2.42^a
t值		0.086	9.213	0.324	7.554
P值		0.932	＜0.001	0.746	＜0.001
注：与组内治疗前比较，^aP＜0.05。

下载: 导出CSV

表 5 2组CPPS合并焦虑抑郁共病男性患者炎症因子水平比较(x±s, pg/mL)

Table 5. Comparison of inflammatory factor levels between two groups of male patients with CPPS combined with anxiety and depression (x±s, pg/mL)

组别	例数	TNF-α		IL-8
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	75	125.49±24.77	75.36±16.51^a	326.70±64.27	217.31±46.53^a
对照组	75	124.63±25.15	94.22±15.49^a	328.44±66.19	263.82±49.11^a
t值		0.211	7.215	0.163	5.954
P值		0.833	＜0.001	0.871	＜0.001
注：与组内治疗前比较，^aP＜0.05。

下载: 导出CSV

表 6 2组CPPS合并焦虑抑郁共病男性患者不良反应发生率比较[例(%)]

Table 6. Comparing the incidence of adverse reactions between two groups of male patients with CPPS combined with anxiety and depression [cases (%)]

组别	例数	精神症状	消化道症状	心悸	感觉障碍	总发生
观察组	75	2(2.67)	1(1.33)	2(2.67)	2(2.67)	7(9.33)
对照组	75	1(1.33)	2(2.67)	3(4.00)	3(4.00)	9(12.00)
注：2组不良反应总发生率比较，χ²=0.280，P=0.597。

下载: 导出CSV

参考文献(21)

[1]	PENA V N, ENGEL N, GABRIELSON A T, et al. Diagnostic and management strategies for patients with chronic prostatitis and chronic pelvic pain syndrome[J]. Drugs Aging, 2021, 38(10): 845-886. doi: 10.1007/s40266-021-00890-2
[2]	LIU Y, MIKRANI R, XIE D, et al. Chronic prostatitis/chronic pelvic pain syndrome and prostate cancer: study of immune cells and cytokines[J]. Fundam Clin Pharmacol, 2020, 34(2): 160-172. doi: 10.1111/fcp.12517
[3]	孙涛, 黄新飞, 姚诗清, 等. 前列腺2号方联合灌肠、穴位贴敷治疗慢性前列腺炎疗效观察[J]. 中华全科医学, 2020, 18(4): 662-665. doi: 10.16766/j.cnki.issn.1674-4152.001324 SUN T, HUANG X F, YAO S Q, et al. Effect of prostate-2 formula combined with enema and acupoint application on chronic prostatitis[J]. Chin J Gen Med, 2020, 18(4): 662-665. doi: 10.16766/j.cnki.issn.1674-4152.001324
[4]	QIN Z, ZHANG C, GUO J, et al. Oral pharmacological treatments for chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis of randomised controlled trials[J]. E Clinical Medicine, 2022, 48: 101457. DOI: 10.1016/j.eclinm.2022.101457.
[5]	项瑞君, 张春雷, 张斌, 等. 慢性前列腺炎患者心理状况与勃起功能障碍相关性的研究进展[J]. 解放军医学院学报, 2023, 44(3): 312-316. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX202303017.htm XIANG R J, ZHANG C L, ZHANG B, et al. Research progress on the correlation between psychological status and erectile dysfunction in patients with chronic prostatitis[J]. Academic Journal of Chinese Pla Medical School, 2023, 44(3): 312-316. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX202303017.htm
[6]	LI A S, VAN NIEKERK L, WONG A L Y, et al. Psychological management of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review[J]. Scand J Pain, 2023, 23(1): 25-39. doi: 10.1515/sjpain-2022-0049
[7]	中华医学会男科学分会, 慢性前列腺炎/慢性盆腔疼痛综合征诊疗指南编写组, 商学军, 等. 慢性前列腺炎/慢性盆腔疼痛综合征诊疗指南[J]. 中华男科学杂志, 2022, 28(6): 544-559. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202306006.htm Chinese Medical Association Andrology Branch, Chronic Prostatitis/Chronic Pelvic Pain Syndrome Diagnosis And Treatment Guidelines, SHANG X J, et al. Diagnosis and treatment guidelines for chronic prostatitis/chronic pelvic pain syndrome[J]. Chin J Androl, 2022, 28(6): 544-559. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202306006.htm
[8]	王俊力, 罗卫东, 张琦, 等. 盐酸度洛西汀治疗膀胱过度活动综合征合并焦虑抑郁共病的随机对照研究[J]. 实用医学杂志, 2020, 36(15): 2133-2137. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202015023.htm WANG J L, LUO W D, ZHANG Q, et al. Randomized controlled study of duloxetine hydrochloride in the treatment of overactive bladder syndrome with anxiety and depression comorbiditis[J]. J Pract Med, 2020, 36(15): 2133-2137. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202015023.htm
[9]	刘璐, 李晓军, 张潇潇, 等. 盐酸度洛西汀联合盐酸曲唑酮治疗缺血性脑卒中后焦虑抑郁共病状态的效果[J]. 临床和实验医学杂志, 2022, 21(20): 2155-2159. doi: 10.3969/j.issn.1671-4695.2022.20.008 LIU L, LI X J, ZHANG X X, et al. Effect of duloxetine hydrochloride combined with Trazodone hydrochloride on anxiety and depression comorbidities after ischemic stroke[J]. Clin Exp Med, 2022, 21(20): 2155-2159. doi: 10.3969/j.issn.1671-4695.2022.20.008
[10]	王莉, 翟天元, 黄月娥, 等. 生物反馈电刺激疗法联合沙巴棕软胶囊治疗慢性前列腺炎/慢性骨盆疼痛综合征的疗效分析[J]. 中华男科学杂志, 2022, 28(1): 43-47. https://www.cnki.com.cn/Article/CJFDTOTAL-NKXB202201008.htm WANG L, ZHAI T Y, HUANG Y E, et al. Effect analysis of biofeedback electrical stimulation combined with Saba Brown softgel in the treatment of chronic prostatitis/chronic pelvic pain syndrome[J]. Chin J Andro, 2022, 28(1): 43-47. https://www.cnki.com.cn/Article/CJFDTOTAL-NKXB202201008.htm
[11]	AKTAR N, MOUDUD A, CHEN T, et al. Recent advances in pharmacological interventions of chronic prostatitis/chronic pelvic pain syndrome[J]. Curr Pharm Des, 2021, 27(25): 2861-2871. doi: 10.2174/1381612827666210322125054
[12]	NAGASUBRAMANIAN S, JOHN N T, ANTONISAMY B, et al. Tamsulosin and placebo vs tamsulosin and tadalafil in male lower urinary tract symptoms: a double-blinded, randomised controlled trial[J]. BJU Int, 2020, 125(5): 718-724. doi: 10.1111/bju.15027
[13]	樊松, 刘祎, 虞勤舟, 等. 慢性前列腺炎/慢性盆腔疼痛综合征患者抑郁症状的危险因素分析及预测模型构建[J]. 中国男科学杂志, 2020, 34(4): 7-12. https://www.cnki.com.cn/Article/CJFDTOTAL-NXXX202004002.htm FAN S, LIU Y, YU Q Z, et al. Risk factors analysis and prediction model construction of depressive symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome[J]. Chin J Andro, 2020, 34(4): 7-12. https://www.cnki.com.cn/Article/CJFDTOTAL-NXXX202004002.htm
[14]	王东星, 安花花, 张斌, 等. 心理干预对西藏阿里地区慢性前列腺炎/慢性盆腔疼痛综合征患者NIH-CPSI评分及各维度的影响[J]. 现代泌尿外科杂志, 2023, 28(7): 603-607. doi: 10.3969/j.issn.1009-8291.2023.07.012 WANG D X, AN H H, ZHANG B, et al. Effects of psychological intervention on NIH-CPSI score and its dimensions in patients with chronic prostatitis/Chronic pelvic pain syndrome in Ali area of Xizang Province[J]. J Mod Urol, 2023, 28(7): 603-607. doi: 10.3969/j.issn.1009-8291.2023.07.012
[15]	李健, 祁娜. 慢性前列腺炎/慢性盆腔疼痛综合征患者的心理弹性及其影响因素分析[J]. 中国性科学, 2022, 31(12): 60-63. doi: 10.3969/j.issn.1672-1993.2022.12.015 LI J, QI N. Analysis of mental resilience and its influencing factors in patients with chronic prostatitis/chronic pelvic pain syndrome[J]. Chin Sex Sci, 2022, 31(12): 60-63. doi: 10.3969/j.issn.1672-1993.2022.12.015
[16]	HOGE E A, BUI E, METE M, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial[J]. JAMA Psychiatry, 2023, 80(1): 13-21. doi: 10.1001/jamapsychiatry.2022.3679
[17]	章晓梅, 张伟英, 张红波, 等. 艾司西酞普兰联合捏脊法治疗首发抑郁症患者的临床疗效研究[J]. 中国全科医学, 2021, 24(14): 1800-1804. doi: 10.12114/j.issn.1007-9572.2021.00.477 ZHANG X M, ZHANG W Y, ZHANG H B, et al. Clinical efficacy of escitalopram combined with chiropractic therapy in the treatment of patients with first episode depression[J]. Chin J Gen Med, 2021, 24(14): 1800-1804. doi: 10.12114/j.issn.1007-9572.2021.00.477
[18]	高兴, 刘海燕, 陈丽萍, 等. 艾司西酞普兰联合胰岛素治疗2型糖尿病合并抑郁患者临床效果及对抑郁症状、血糖水平影响[J]. 临床误诊误治, 2020, 33(2): 42-46. doi: 10.3969/j.issn.1002-3429.2020.02.010 GAO X, LIU H Y, CHEN L P, et al. Clinical effect of escitalopram combined with insulin in the treatment of type 2 diabetes mellitus with depression and its influence on depressive symptoms and blood glucose level[J]. Clin Misdiag Treat, 2020, 33(2): 42-46. doi: 10.3969/j.issn.1002-3429.2020.02.010
[19]	李洁, 张媛, 张俊勤, 等. 经皮神经电刺激联合布洛芬缓释胶囊对盆腔炎性疾病所致慢性盆腔疼痛患者血清炎症因子和致痛物质水平的影响[J]. 现代生物医学进展, 2023, 23(1): 192, 197-200. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202301039.htm LI J, ZHANG Y, ZHANG J Q, et al. Effects of percutaneous electrical nerve stimulation combined with ibuprofen sustained-release capsule on serum levels of inflammatory factors and pain-causing substances in patients with chronic pelvic pain caused by pelvic inflammatory disease[J]. Adv Mod Biomed, 2023, 23(1): 192, 197-200. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202301039.htm
[20]	吴世鹏, 周文芝, 赵得晟, 等. 阿立派唑联合草酸艾司西酞普兰治疗精神分裂症合并抑郁焦虑的疗效及对血清因子的影响[J]. 中南医学科学杂志, 2021, 49(2): 219-222. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYY202102020.htm WU S P, ZHOU W Z, ZHAO D S, et al. Effect of ariprazole combined with escitalopram oxalate in the treatment of schizophrenia complicated with depression and anxiety and its influence on serum factors[J]. J Cent South Univ, 2021, 49(2): 219-222. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYY202102020.htm
[21]	金华, 张毅. 艾司西酞普兰联合感觉统合治疗抑郁症的疗效及其对患者神经功能因子的影响[J]. 川北医学院学报, 2021, 36(10): 1342-1346. doi: 10.3969/j.issn.1005-3697.2021.10.018 JIN H, ZHANG Y. Curative effect of Escitalopram combined with sensory integration in the treatment of depression and its influence on neurological function factors in patients[J]. J North Sichuan Med Coll, 2021, 36(10): 1342-1346. doi: 10.3969/j.issn.1005-3697.2021.10.018