Shahed A R, Shoskes D A
Division of Urology, Harbor-UCLA Medical Center, Torrance, California, USA.
J Androl. 2000 Sep-Oct;21(5):669-75.
The etiology of chronic pelvic pain syndrome (CPPS)/chronic prostatitis category III remains unknown. Whereas a subset of men respond to antimicrobial therapy, gram positive bacteria isolated from expressed prostatic secretions (EPS) are often considered to be commensal rather than pathogenic. We wished to study oxidative stress as a marker of tissue injury and response in EPS of men with CPPS to determine whether infection with gram positive bacteria is associated with increased oxidative stress. A total of 300 EPS specimens from 100 men with CPPS were collected for microscopy, culture, and biochemical and molecular assays. Oxidant injury was measured by 8-isoprostane F2alpha (IsoP) levels and total antioxidant capacity as Trolox equivalents. Total RNA from EPS was used for gene expression of heme oxygenase-1 (HO-1) and granzyme B. The only bacteria found in EPS were gram positive. For our analysis, these men were classified as having chronic bacterial prostatitis (category II). IsoP levels (pg/mL) were highest in men with category II prostatitis (7315 +/- 1428) followed by nonbacterial prostatitis (category IIIa, 2043 +/- 561), prostatodynia (category IIIb, 319 +/- 81), and asymptomatic controls (298 +/- 99). IsoP levels decreased significantly after successful treatment with antibiotics or an antioxidant supplement (Prosta-Q). Antioxidant capacity was detected in 11 out of 18, 4 out of 16, and 1 out of 16 men tested with category II, IIIa, and IIIb prostatitis, respectively. No correlation was observed between IsoP levels and the number of white blood cells in EPS. HO-1 and granzyme B expression was highest in men with category II prostatitis than in men with either category III prostatitis or asymptomatic controls. On the basis of elevated oxidative stress, clinical response to antibiotics, and post-treatment reduction in oxidative stress, we conclude that gram positive bacteria in some men with CPPS may be pathogens. It is speculated that oxidative stress may be a key pathway in some men with CPPS that can be targeted with antioxidant therapy.
慢性盆腔疼痛综合征（CPPS）/Ⅲ型慢性前列腺炎的病因仍不明。虽然一部分男性对抗菌治疗有反应，但从前列腺按摩液（EPS）中分离出的革兰氏阳性菌通常被认为是共生菌而非致病菌。我们希望研究氧化应激作为CPPS男性EPS中组织损伤和反应的标志物，以确定革兰氏阳性菌感染是否与氧化应激增加有关。收集了100例CPPS男性的总共300份EPS标本用于显微镜检查、培养以及生化和分子检测。通过8-异前列腺素F2α（IsoP）水平和以Trolox当量表示的总抗氧化能力来测量氧化损伤。EPS的总RNA用于血红素加氧酶-1（HO-1）和颗粒酶B的基因表达。EPS中发现的唯一细菌是革兰氏阳性菌。为了我们的分析，这些男性被分类为患有慢性细菌性前列腺炎（Ⅱ型）。Ⅱ型前列腺炎男性的IsoP水平（pg/mL）最高（7315±1428），其次是非细菌性前列腺炎（Ⅲa型，2043±561）、前列腺痛（Ⅲb型，319±81）和无症状对照组（298±99）。用抗生素或抗氧化补充剂（Prosta-Q）成功治疗后，IsoP水平显著下降。在分别检测的Ⅱ型、Ⅲa型和Ⅲb型前列腺炎男性中，18例中有11例、16例中有4例和16例中有1例检测到抗氧化能力。未观察到IsoP水平与EPS中白细胞数量之间的相关性。Ⅱ型前列腺炎男性的HO-1和颗粒酶B表达高于Ⅲ型前列腺炎男性或无症状对照组。基于氧化应激升高、对抗生素的临床反应以及治疗后氧化应激的降低，我们得出结论，一些CPPS男性中的革兰氏阳性菌可能是病原体。据推测，氧化应激可能是一些CPPS男性的关键途径，可通过抗氧化治疗作为靶点。
