伐地那非降阶梯对慢性前列腺炎合并勃起功能障碍的疗效分析

Therapeutic effect of Vardenafil de-escalation therapy on chronic prostatitis with erectile dysfunction

摘要:

目的 分析伐地那非降阶梯对慢性前列腺炎（CP）合并勃起功能障碍（ED）的疗效及安全性，探讨该方案的临床应用价值。方法 以该院2013 年1 月-2016 年1 月收治的240 例CP 合并ED 患者为研究对象。按照随机数字表法将其分为观察组和对照组，每组120 例，均在CP常规治疗的基础上加用伐地那非治疗，对照组治疗方案为伐地那非口服，10 mg/ 次，隔日1 次，持续3 个月；观察组治疗方案为伐地那非降阶梯口服，初始剂量20 mg，隔日1 次，持续1 个月，而后降至10 mg/ 次，隔日1 次，持续1 个月，最终阶段降至5 mg/ 次，隔日1 次，持续1 个月。记录两组患者治疗1~3 个月后国际勃起功能指数（IIEF）、日记插入成功率、完成性交成功率及国前列腺炎症状指数评分（NIH-CPSI）变化，并记录其副反应发生情况，比较2 种治疗方案的临床疗效、安全性。结果 两组患者治疗前IIEF-5 评分、NIH-CPSI 评分、日记插入成功率、完成性交成功率比较，均差异无统计学意义（P >0.05），两组患者治疗后IIEF-5 评分、日记插入成功率、完成性交成功率均较治疗前升高，NIH-CPSI 评分均较治疗前降低，差异有统计学意义（P <0.05），同时期组间IIEF-5 评分、NIH-CPSI 评分、日记插入成功率、完成性交成功率比较，均差异无统计学意义（P >0.05）。两组患者治疗 后SDS 评分、SAS 评分均较治疗前降低，观察组降低更为明显，差异有统计学意义（P <0.05）。两组患者治疗1 个月后副反应比较，差异无统计学意义（P >0.05），观察组治疗2、3 个月后副反应发生率较治疗1 个月后降低，差异有统计学意义（P <0.05）。治疗1 ～ 3 个月后对照组副反应发生率无明显变化，差异无统计学意义（P >0.05）。观察组总有效率为90.83%，对照组总有效率为94.17%，两组患者临床总有效率比较，差异无统计学意义（P >0.05）。结论 伐地那非降阶梯治疗CP 合并ED 能够在保证临床疗效的前提下进一步降低治疗期间副反应，改善患者心理状态，较大剂量持续治疗方案具有更佳的安全性，值得推广。

Abstract:

Objective To analyze the efficacy and safety of Vardenafil de-escalation therapy for chronic prostatitis (CP) with erectile dysfunction (ED) and to explore the clinical application value of the scheme. Methods A total of 240 patients of CP with ED treated in our hospital from January 2013 to January 2016 were enrolled as the research objects. According to the random number table method, they were divided into observation group and control group, each with 120 patients. Both groups received Vardenafil treatment on the basis of conventional treatment for CP. The control group was treated with Vardenafil 10 mg/time, once every other day for 3 months. The observation group was given Vardenafil de-escalation therapy for 3 months, the initial dosage was 20 mg once every other day for 1 month, then the dosage decreased to 10 mg once every other day for 1 month, finally reduced to 5 mg once every other day for 1 month. After treatment for 1, 2 and 3 months, the international index of erectile function(IIEF), daily insertion success rate and success rate of completing intercourse and international prostatitis symptom score index table (NIH-CPSI) changes were recorded in the two groups of patients, and the adverse reactions were also recorded. The clinical efficacy and safety of the two therapies were compared. Results Before treatment, the IIEF-5 score, the NIH-CPSI score, the daily success rate of insertion or the success rate of completing intercourse was not statistically different between the two groups (P > 0.05). After treatment, the IIEF-5 score, the daily success rate of insertion and the success rate of completing intercourse increased and the NIH-CPSI score decreased in both groups, the differences were statistically significant (P < 0.05); however, the IIEF-5 score, the NIH-CPSI score, the daily insertion success rate, the success rate of completing intercourse after treatment were not statistically different between the two groups (P > 0.05). In both groups, the SDS score and the SAS score after treatment were lower than those before treatment, the indexes decreased more significantly in the observation group, the differences were statistically significant (P < 0.05). The incidences of adverse reactions were not statistically different in both groups 1 month after treatment (P > 0.05). In the observation group, the incidences of side effects after treatment for 2 and 3 months were significantly lower than those 1 month after treatment (P < 0.05). In the control group, there were no significant differences in the incidences of adverse reactions after treatment for 1 to 3 months (P > 0.05). The total effective rate was 90.83% in the observation group and 94.17% in the control group, the difference was not statistically significant (P > 0.05). Conclusions Vardenafil de-escalation therapy for CP with ED can guarantee the clinical curative effect and further reduce side effects during treatment, improve the psychological state of the patients. It has better security than large-dosage continuous therapy, and is worthy to be popularized.