慢性非细菌性前列腺炎的中西医治疗进展

Advancements in the Integrated Traditional Chinese and Western Medicine Treatment of Chronic Nonbacterial Prostatitis

摘要: 慢性非细菌性前列腺炎(CNP)是泌尿男科高发且难治的疾病，占慢性前列腺炎的90%以上，以盆腔疼痛、排尿异常及性功能障碍为主要表现，发病机制涉及隐匿性微生物感染、自身免疫、氧化应激、内分泌失调、尿液返流及心理因素等多因素交互作用。西医因缺乏明确病原体且药物难以达病灶，疗效常不理想。中医药治疗CNP具有多靶点、多途径的综合优势，机制涵盖抗炎(下调IL-1β、TNF-α、COX-2、NF-κB等)、免疫调节、改善前列腺微循环与尿流动力学、调控PGE2镇痛及调节肠道菌群。临床研究证实，中药口服、灌肠、栓剂及针灸等疗法，尤其联合西药或物理治疗，可显著提高总有效率(如中药灌肠联合口服达86.7%)，优于单一疗法。近年系统综述为中医药应用提供了实验与循证依据。未来需深化活性成分靶点研究，并开展大样本随机对照试验以提升证据等级。中医药在CNP治疗中展现出独特优势和广阔前景。

Abstract: Chronic nonbacterial prostatitis (CNP) represents a prevalent and challenging-to-treat condition within the fields of urology and andrology, constituting more than 90% of chronic prostatitis cases. Its primary clinical manifestations include pelvic pain, urinary abnormalities, and sexual dysfunction. The pathogenesis of CNP is multifactorial, involving latent microbial infections, autoimmune responses, oxidative stress, endocrine dysregulation, urine reflux, and psychological factors, among others. Western medical approaches often yield suboptimal outcomes due to the absence of a clearly identifiable pathogen and the challenge of delivering drugs effectively to the affected site. Traditional Chinese medicine (TCM) offers a multifaceted therapeutic advantage in the management of CNP, targeting multiple pathways and mechanisms, including anti-inflammatory effects (downregulation of IL-1β, TNF-α, COX-2, NF-κB, etc.), immune modulation, enhancement of prostate microcirculation and urodynamics, regulation of PGE2-mediated analgesia, and modulation of the intestinal microbiota. Clinical investigations have demonstrated that TCM interventions, such as oral herbal formulations, enemas, suppositories, and acupuncture, particularly when used in conjunction with Western medications or physical therapies, significantly elevate the overall response rate (e.g., reaching up to 86.7% with enema combined with oral administration), outperforming monotherapy approaches. Recent systematic reviews have furnished both experimental and evidence-based support for the application of TCM. Moving forward, it is imperative to advance research on the targets of active ingredients and undertake large-scale randomized controlled trials to elevate the quality of evidence. TCM exhibits distinct advantages and holds promising potential in the treatment of CNP.