男性慢性前列腺炎與生活形態的相關聯研究

Abstract

背景與目標: 前列腺又稱攝護腺，是男性特有的腺體，位於膀胱出口處，包圍著尿道的一部份。前列腺的生理功能，包括有括約肌的功能、外分泌腺的功能、以及內分泌腺的功能。根據臨床上的統計, 50歲以上的男性大約有50%可能有前列腺肥大的現象；但是前列腺炎在泌尿科門診中，卻比較常見於30歲到50歲青壯年男性的疾病；罹患前列腺炎可以全無症狀，也可以引起持續或者反復發作的泌尿生殖系統的不適。而其中對於慢性非細菌性前列腺炎的治療，由於臨床症狀複雜且併發症多，加上症狀容易復發，是一種很難纏的慢性疾病；更由於致病機轉並不完全清楚，所以相對的也沒有很有效的治療方法，而且症狀容易反覆發作，嚴重影響病患生活品質。此外其病因及治療方式也引發醫學界許多爭議，是泌尿科醫師臨床治療疾病當中最棘手的問題之一。 臺安醫院是由『基督復臨安息日會』所創辦，為安息日會全球七百多所醫療機構之一。長期以來便以健康促進為理念，在民國86年便全力推展健康生活計劃，也就是NEWSTART計劃，包含營養、運動、水分、陽光、節制、空氣、休息、信靠等八大生活原則，希望藉由生活的教導，改善國人日益嚴重的健康問題，讓癌症、腦血管疾病、心臟病、糖尿病及現代人的諸多慢性病都可以減少，同時也可以降低醫療資源的浪費。本次研究便希望能透過臺安醫院「新起點健康生活計畫」介入前列腺疾病的治療，並經由正面的實驗結果，證實慢性非細菌性前列腺炎能經由生活及飲食習慣的改變，而能獲得較有效且完整的治療效果。 方法: 本研究分為實驗組與對照組，分別給予藥物治療及配合復健治療而不介入健康促進生活計畫治療3個月(對照組)；或者病患可選擇只接受健康促進生活計畫介入性治療或配合復健治療，而不給予藥物治療 (實驗組)。這兩組分別觀察其主觀症狀治療前以及治療3個月的變化，評分問卷包括慢性前列腺炎症狀評分表(NIH-CPSI National Institute of Health –Chronic Prostatitis Symptoms Index)、國際前列腺症狀評分問卷(IPSS, International Prostate Symptom Score)、男性性功能問卷(IIEF-5, International Index of Erectile Function-5)、及健康相關生活品質問卷(HRQL, Health-Related Quality of Life)等，採用Paired sample t test，來分析治療前後各項統計量平均值的差異。 結果: 我們所有的統計資料在進行分析前都先使用Cronbach's α係數檢定，來測量本次研究問卷量表的一致性(consistency)及穩定性(stability)，發現量表整體信度為0.823，表示本研究測量的信度皆在可接受的範圍內。從我們初步追蹤三個月的研究結果來看,，實驗組(25位)與對照組(20位)的病人，不管在CPSI、IPSS的total scores以及CPSI的各項指標(包括疼痛、排尿以及生活品質)表現上，發現病人在接受治療後都有明顯的改善，而且治療前後在統計學上的差異，也都有顯著的意義(P< 0.05)；雖然實驗組在性功能勃起功能障礙(IIEF-5)部分，在追蹤三個月後並沒有獲得改善，但也許性功能障礙所牽扯的因素非常廣泛，不易經由慢性前列腺炎的單一因素的治療，而得到全面性的進步；而這也是我們將來在長期追蹤研究中，期待經由生活型態的改變，能觀察到病患在性功能障礙部分，是否可以更進一步改善的重點。 結論: 而從這項研究結果所獲得的初步意義，在於我們發現經由健康促進生活計畫介入性治療，可以使慢性非細菌性前列腺炎患者不用使用其他的藥物，就可以達到與藥物治療同樣改善的效果，甚至有更好的長期治療效果及預防復發的可能性，但這些都需要更長期的追蹤才能得到進一步的結論，也是未來我們將持續努力的研究目標。

Background: The prostate is a gland unique to men, the part surrounding the urethra at the opening of the urinary bladder. The prostate functions physiologically as a sphincter, an exocrine, and an endocrine. According to clinical statistics, males over 50 years old have a chance around 50% to have enlarged prostates, but in urology outpatients departments, prostatitis is an illness more usually seen in males between 30 and 50. Suffering from prostatitis could yield no symptoms at all, but it could also cause persistent or recurrent discomfort of the urinary system. Among these is the chronic non-bacterial prostatitis. The etiologies of chronic pelvic pain syndrome (CPPS) are not fully understood, and the symptoms tend to relapse, resulting in serious impact on quality of life of the patients. In addition, the treatment for chronic prostatitis (CP) is controversial in the medical field, making it one of the most troublesome problems an urologist can find in clinical practice. Taiwan Adventist Hospital is one of over 700 healthcare institutions operated by the Seventh-day Adventist Church in a worldwide mission system. We have been promoting the NEWSTART project ever since 1997. The project includes emphasis on nutrition, exercise, water, sunshine, temperance, air, rest, and trust. We hope to improve increasingly serious health problems through everyday life, decreasing the chances for cancer, cerebrovascular disease, heart disease, diabetes and many other modern chronic diseases, while also decreasing waste of medical resources. In this study we hope to find positive results in the involvement of the NEWSTART project in CPPS treatment, thus proving effective and complete treatment can be yielded through changes in eating and living habits. Method: We divide patients into an experimental group and a control group. Patients can choose between receiving medical treatment, rehabilitation and take no part in the NEWSTART program (control group), or NEWSTART intervention only without medical treatment (experimental group). All the patients in the control group are given antibiotics, anti-inflammatory drugs/muscle relaxants, and other rehabilitative treatment, including infrared, magnetic therapy etc., but for patients in the experimental group, we only suggest that they accept NEWSTART treatment. We use questionnaires including NIH-CPSI (National Institute of Health –Chronic Prostatitis Symptoms Index)、IPSS (International Prostate Symptom Score)、IIEF-5 (International Index of Erectile Function-5) etc. After 3-month intervention treatment, we compare the subjective symptoms change of both groups. Using SPSS v.19, the data analysis was carried out with paired sample t test as statistic method. Result: All of our statistics are assessed with Cronbach 's Alpha before analysis with an aim to measure the consistency and stability of our study questionnaire. We found overall reliability to be 0.823, which shows that the credibility of our studies is within acceptable range. From the data we have seen from the first three months, patients of study group (n=25) and control group (n=20) show obvious improvements not only in the total scores of CPSI and IPSS, but also in the domains of CPSI including pain, urination and quality of life. Furthermore, statistical differences before and after treatment also show significant differences (P value < 0.05). Although patients in the experimental group have no improvements in IIEF-5 after three months follow-up, this might result from the factors which are extensive and complicated in etiologies of sexual erectile dysfunction (ED). It could be hard to achieve significant improvement of ED just through the treatment of chronic prostatitis; and this is also a focal point for us when observing if sexual erectile dysfunction can be treated through lifestyle changes in future long-term follow-up studies. Conclusion: The preliminary significance of this study lies in that through NEWSTART intervention, patients with CPPS can receive the same amount of improvement achievable through medical treatment without the use of drugs. However, it need more long-term follow-up to reach further conclusions.