肠道菌群失调相关慢性前列腺炎发生机制及治疗研究进展

徐新宇; 崔云; 吴骏

doi:10.16766/j.cnki.issn.1674-4152.003213

肠道菌群失调相关慢性前列腺炎发生机制及治疗研究进展

doi: 10.16766/j.cnki.issn.1674-4152.003213

徐新宇¹,
崔云^2, ,,
吴骏²

1.
浙江中医药大学第三临床医学院, 浙江杭州 310053
2.
浙江中医药大学附属宁波中医院男科, 浙江宁波 315010

基金项目:

浙江省自然科学基金项目 LY21H270015

崔云全国名老中医药专家传承工作室建设项目国中医药人教函[2022]75号

浙江省中医药科学研究基金项目 2022ZB337

浙江省中医药科学研究基金项目 2022ZB311

宁波市医疗卫生品牌学科资助项目 PPXK2018-07

详细信息

通讯作者:
崔云，E-mail: nbszyy@sina.com

中图分类号: R37 R697.33
计量
- 文章访问数: 479
- HTML全文浏览量: 104
- PDF下载量: 35
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-17
- 网络出版日期: 2023-11-23

Research progress in the pathogenesis and treatment of chronic prostatitis associated with intestinal microbiota dysregulation

XU Xinyu¹,
CUI Yun^{2
, ,},
WU Jun²

1.
The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China

摘要

摘要: 慢性前列腺炎(CP)是泌尿男科常见病和多发病，典型表现为精神心理症状(焦虑、压抑、认知及行为异常、生活质量下降)、盆腔疼痛症状(泌尿生殖区疼痛、腹部和盆腔肌肉压痛、射精痛、排尿疼痛)、性功能障碍症状(阳痿、性欲低下、射精功能障碍)以及下尿路症状(尿频、尿急、夜尿增多、尿后余沥、尿不尽等)。现代医学认为CP的发生机制与免疫失调、内分泌紊乱和局部微循环障碍密切相关，但核心发病机制尚不清晰。肠道菌群与人体健康息息相关，近年来国内外学者对肠道菌群与CP关系的研究愈加广泛，为揭示CP发生机制提供全新视角。肠道菌群失调通过介导炎症因子增加、下丘脑-垂体-肾上腺轴活动亢进而激素水平紊乱以及神经递质功能异常诱发CP精神心理症状，通过诱发炎症因子释放、背根神经节神经元敏化及大脑胶质细胞活化等引发CP盆腔疼痛症状，通过影响睾酮及神经递质水平等导致性功能障碍症状，通过直接感染及影响盆底肌功能引发CP下尿路症状。通过增加有益菌、减少有害菌来恢复肠道菌群稳态成为CP治疗的新方向。目前主要借助补充益生菌以及低聚糖类、蛋白水解物和中药多糖等益生元来调节肠道菌群治疗CP，取得显著效果。现对肠道菌群失调相关慢性前列腺炎发生机制与治疗的概况进行综述，以期为泌尿男科医生诊治CP提供新的思路和依据。
- 肠道菌群 /
- 慢性前列腺炎 /
- 益生菌 /
- 植物多糖 /
- 神经递质
Abstract: Chronic prostatitis (CP) is a common and frequent disease in urology. Typical performance are mental symptoms (anxiety, depression, cognitive and behavioral abnormalities, lower quality of life), pelvic pain symptoms (urogenital area pain, abdominal and pelvic muscle tenderness, ejaculatory pain, painful urination) symptoms, sexual dysfunction (impotence, low sexual desire, ejaculatory dysfunction), as well as the urinary tract symptoms (frequent urination, urinary urgency, increased nocturia, posturinary leaking, dysuria, etc.). Modern medicine believes that the pathogenesis of CP is closely related to immune disorders, endocrine disorders and local microcirculation disorders, but the core pathogenesis is still unclear. Intestinal microbiota is closely related to human health. In recent years, domestic and foreign scholars have increasingly studied the relationship between gut microbiota and CP, which provides a new perspective for revealing the mechanism of CP. The dysregulation of gut microbiota induces CP mental and psychological symptoms by mediating the increase of inflammatory factors, the hyperactivity of hypothalamic-pituitary-adrenal then disturb hormone level and the abnormal function of neurotransmitters, and induces CP pelvic pain symptoms by inducing the release of inflammatory factors, the sensitization of dorsal root ganglion neurons and the activation of brain glial cells. It can lead to sexual dysfunction symptoms by affecting the levels of testosterone and neurotransmitters, and lead to CP lower urinary tract symptoms by direct infection and affecting the function of pelvic floor muscles. It has become a new direction of CP treatment to restore intestinal microbiota homeostasis by increasing beneficial bacteria and reducing harmful bacteria. At present, probiotics and prebiotics such as oligosaccharides, protein hydrolysates and traditional Chinese medicine polysaccharides are mainly used to regulate intestinal microbiota in the treatment of CP, which has achieved remarkable results and opened up a new direction of CP diagnosis and treatment. This article reviews the pathogenesis and treatment of chronic prostatitis related to intestinal microbiota dysregulation at home and abroad, in order to provide new ideas and basis for urologists to diagnose and treat CP.
- Intestinal microbiota /
- Chronic prostatitis /
- Probiotics /
- Plant polysaccharides /
- Neurotransmitter

HTML全文

参考文献(35)

[1]	俞旭君, 高庆和. 慢性前列腺炎中西医结合多学科诊疗指南[J]. 中华男科学杂志, 2020, 26(4): 369-376. doi: 10.13263/j.cnki.nja.2020.04.015 YU X J, GAO Q H. Multidisciplinary diagnosis and treatment guide of integrated Chinese and Western medicine for chronic prostatitis[J]. National Journal of Andrology, 2020, 26(4): 369-376. doi: 10.13263/j.cnki.nja.2020.04.015
[2]	GUU S J, GENG J H, CHAO I T, et al. Efficacy of low-intensity extracorporeal shock wave therapy on men with chronic pelvic pain syndrome refractory to 3-as therapy[J]. Am J Mens Health, 2018, 12(2): 441-452. doi: 10.1177/1557988317736585
[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, YAO X F, HUANG S Q, et al. Clinical observation on the treatment of chronic prostatitis with prostate decoction number 2 combined with clysis and acupoint application[J]. Chinese Journal of General Practice, 2020, 18(4): 662-665. doi: 10.16766/j.cnki.issn.1674-4152.001324
[4]	王帅. 慢性前列腺炎/慢性盆腔疼痛综合征患者肠道菌群特征的研究[D]. 济南: 山东大学, 2020. WANG S. Characteristics of intestinal flora in patients with chronic prostatitis/chronic pelvic pain syndrome[D]. Jinan: Shandong University, 2020.
[5]	DANIĈ M, STANIMIROV B, PAVLOVIĈ N, et al. Pharmacological applications of bile acids and their derivatives in the treatment of metabolic syndrome[J]. Front Pharmacol, 2018, 9: 1382. doi: 10.3389/fphar.2018.01382
[6]	KHAN S, IMRAN A, MALIK A, et al. Bacterial imbalance and gut pathologies: association and contribution of E. coli in inflammatory bowel disease[J]. Crit Rev Clin Lab Sci, 2019, 56(1): 1-17. doi: 10.1080/10408363.2018.1517144
[7]	冯莉娟, 李子纯, 刘小伟. 肠道菌群-肠-脑轴的研究进展[J]. 中华消化杂志, 2022, 42(2): 134-136. doi: 10.3760/cma.j.cn311367-20210128-00066 FENG L J, LI Z C, LIU X W. Research progress of microbiota-gut-brain axis[J]. Chinese Journal of Digestion, 2022, 42(2): 134-136. doi: 10.3760/cma.j.cn311367-20210128-00066
[8]	王冬, 汤艳清. 重度抑郁症与肠道菌群关系的研究进展[J]. 中国医科大学学报, 2022, 51(3): 259-262. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK202203012.htm WANG D, TANG Y Q. The relationship between major depressive disorder and gut microbiota[J]. Journal of China Medical University, 2022, 51(3): 259-262. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK202203012.htm
[9]	宋月红, 江海峰, 彭素芳, 等. 肠道菌群在抑郁症、焦虑症及物质使用障碍中的作用[J]. 上海交通大学学报(医学版), 2019, 39(10): 1199-1203. doi: 10.3969/j.issn.1674-8115.2019.10.017 SONG Y H, JIANG H F, PENG S F, et al. Research progress of gut microbiota in depression, anxiety and substance use disorders[J]. Journal of Shanghai Jiaotong University(Medical Science), 2019, 39(10): 1199-1203. doi: 10.3969/j.issn.1674-8115.2019.10.017
[10]	赵香婷, 杜英杰, 刘爽. 5-羟色胺能致幻剂: 抑郁症治疗的新策略[J]. 中国药理学与毒理学杂志, 2022, 36(4): 282-287. https://www.cnki.com.cn/Article/CJFDTOTAL-YLBS202204006.htm ZHAO X T, DU Y J, LIU S. Serotonergic psychedelics: a novel treatment for depression[J]. Chinese Journal of Pharmacology and Toxicology, 2022, 36(4): 282-287. https://www.cnki.com.cn/Article/CJFDTOTAL-YLBS202204006.htm
[11]	HALEEM D J. Targeting serotonin1A receptors for treating chronic pain and depression[J]. Curr Neuropharmacol, 2019, 17(12): 1098-1108. doi: 10.2174/1570159X17666190811161807
[12]	高勇. 慢性前列腺炎/慢性盆腔疼痛综合征的全外显子组关联分析及肠道微生物宏基因组学研究[D]. 南宁: 广西医科大学, 2019. GAO Y. Exome-wide association study and metagenomic analysis of intestinal microbiota in patients of chronic prostatitis/chronic pelvic pain syndrome[D]. Nanning: Guangxi Medical University, 2019.
[13]	GUO R, CHEN L H, XING C G, et al. Pain regulation by gut microbiota: molecular mechanisms and therapeutic potential[J]. Br J Anaesth, 2019, 123(5): 637-654. doi: 10.1016/j.bja.2019.07.026
[14]	HA H, GONZALEZ A. Migraine headache prophylaxis[J]. Am Fam Physician, 2019, 99(1): 17-24.
[15]	MATSUDA M, HUH Y, JI R R. Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain[J]. J Anesth, 2019, 33(1): 131-139. doi: 10.1007/s00540-018-2579-4
[16]	王丹丹, 孙大林, 金保方. 慢性前列腺炎/慢性盆腔疼痛综合征发病机制的研究进展[J]. 中华泌尿外科杂志, 2021, 42(10): 797-800. doi: 10.3760/cma.j.cn112330-20200109-00022 WANG D D, SUN D L, JIN B F. Advances in pathogenesis of chronic prostatitis/chronic pelvic pain syndrome[J]. Chinese Journal of Urology, 2021, 42(10): 797-800. doi: 10.3760/cma.j.cn112330-20200109-00022
[17]	李华强. 慢性前列腺炎对男性不育及性功能障碍的影响及临床治疗分析[J]. 中国卫生标准管理, 2021, 12(12): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-WSBZ202112015.htm LI H Q. The effect of chronic prostatitis on male infertility and sexual dysfunction and its clinical treatment[J]. China Health Standard Management, 2021, 12(12): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-WSBZ202112015.htm
[18]	程嘉豪, 张唯力. 慢性前列腺炎/慢性盆腔疼痛综合征伴发性功能障碍的研究进展[J]. 医学研究生学报, 2018, 31(11): 1222-1227. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201811023.htm CHENG J H, ZHANG W L. Research progress on chronic prostatitis/chronic pelvic pain syndrome accompanied by sexual dysfunction[J]. Journal of Medical Postgraduates, 2018, 31(11): 1222-1227. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201811023.htm
[19]	孙远, 裴世其, 郭孝伟, 等. 肠道菌群与勃起功能障碍相关性研究进展[J]. 中华男科学杂志, 2020, 26(7): 656-659. https://www.cnki.com.cn/Article/CJFDTOTAL-NKXB202007018.htm SUN Y, PEI S Q, GUO X W, et al. Correlation between gut microbiota and erectile dysfunction: an update[J]. National Journal of Andrology, 2020, 26(7): 656-659. https://www.cnki.com.cn/Article/CJFDTOTAL-NKXB202007018.htm
[20]	牛阳九, 杨培, 牛立盼, 等. 氧化应激诱导勃起功能障碍机制的研究进展[J]. 医学综述, 2022, 28(10): 1890-1895. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202210004.htm NIU Y J, YANG P, NIU L P, et al. Advances in study of oxidative stress-induced erectile dysfunction[J]. Medical Recapitulate, 2022, 28(10): 1890-1895. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202210004.htm
[21]	LI D, LIU R, WANG M, et al. 3β-Hydroxysteroid dehydrogenase expressed by gut microbes degrades testosterone and is linked to depression in males[J]. Cell Host Microbe, 2022, 30(3): 329-339.
[22]	LIU P H, LI R, TIAN X L, et al. Co-exposure to fluoride and arsenic disrupts intestinal flora balance and induces testicular autophagy in offspring rats[J]. Ecotoxicol Environ Saf, 2021, 222: 112506. DOI: 10.1016/j.ecoenv.2021.112506.
[23]	樊晓, 刘春, 刘宇翔. 自噬与性激素失衡慢性前列腺炎相关性的研究进展[J]. 中国性科学, 2020, 29(11): 11-13. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ202011006.htm FAN X, LIU C, LIU Y X. Research progress of the correlation between autophagy and sex hormone imbalance in chronic prostatitis[J]. Chinese Journal of Human Sexuality, 2020, 29(11): 11-13. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ202011006.htm
[24]	STANDWITZ P. Neurotransmitter modulation by the gut microbiota[J]. Brain Res, 2018, 1693(Pt B): 128-133.
[25]	WU Y, JIANG H Y, TAN M B, et al. Screening for chronic prostatitis pathogens using high-throughput next-generation sequencing[J]. Prostate, 2020, 80(7): 577-587.
[26]	MICHEL M C, BIRDER L A. Re: PIEZO2 in sensory neurons and urothelial cells coordinate urination[J]. Eur Urol, 2021, 80(2): 255-256.
[27]	LAHIRI S, KIM H, GARCIA-PEREZ I, et al. The gut microbiota influences skeletal muscle mass and function in mice[J]. Sci Transl Med, 2019, 11(502): eaan5662. DOI: 10.1126/scitranslmed.aan5662.
[28]	KONKOL Y, KESKITALO A, VUORIKOSKI H, et al. Chronic nonbacterial prostate inflammation in a rat model is associated with changes of gut microbiota that can be modified with a galactoglucomannan-rich hemicellulose extract in the diet[J]. BJU Int, 2019, 123(5): 899-908.
[29]	CHEN Y J, GUO K M, NAGY T, et al. Chronic oral exposure to glycated whey proteins increases survival of aged male NOD mice with autoimmune prostatitis by regulating the gut microbiome and anti-inflammatory responses[J]. Food Funct, 2020, 11(1): 153-162.
[30]	CHIANCONE F, CARRINO M, MECCARIELLO C, et al. The use of a combination of vaccinium macracarpon, lycium barbarum L. and Probiotics (Bifiprost^®) for the prevention of chronic bacterial prostatitis: a double-blind randomized study[J]. Urol Int, 2019, 103(4): 423-426.
[31]	MANFREDI C, CALACE F P, FUSCO F, et al. Escherichia coli Nissle 1917 as adjuvant therapy in patients with chronic bacterial prostatitis: a non-blinded, randomized, controlled trial[J]. World J Urol, 2021, 39(12): 4373-4379.
[32]	李旭, 张雪燕, 杨世培, 等. 中药多糖抗衰老作用机制研究进展[J]. 中国实验方剂学杂志, 2022, 28(4): 271-282. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202204034.htm LI X, ZHANG X Y, YANG S P, et al. Anti-aging mechanism of Chinese medicinal polysaccharides: a review[J]. Chinese Journal of Experimental Traditional Medical Formulae, 2022, 28(4): 271-282. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202204034.htm
[33]	任青河. 植物多糖与富氢水对大鼠Ⅲ型前列腺炎干预效果的初步研究[D]. 西安: 中国人民解放军空军军医大学, 2018. REN Q H. A preliminary study on the pairing of plant polysaccharides with hydrogen-rich water[D]. Xi'an: The People's Liberation Army Air Force Medical University, 2018.
[34]	LIU J S, LIU L, ZHANG G W, et al. Poria cocos polysaccharides attenuate chronic nonbacterial prostatitis by targeting the gut microbiota: comparative study of Poria cocos polysaccharides and finasteride in treating chronic prostatitis[J]. Int J Biol Macromol, 2021, 189: 346-355.
[35]	张春玲, 范顺明, 李星, 等. 知母黄柏盐制前后组成滋肾丸对慢性前列腺炎及肠道菌群的对比研究[J]. 中药药理与临床, 2021, 37(1): 34-40. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYL202101007.htm ZHANG C L, FAN S M, LI X, et al. Comparative study on effects of different Zishen Pills composed of raw or salted anemarrhenae rhizoma and phellodendri chinensis cortex on chronic prostatitis and intestinal flora[J]. Pharmacology and Clinics of Chinese Materia Medica, 2021, 37(1): 34-40. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYL202101007.htm