| Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) is a common disease of male reproductive system, mainly to the reproductive pelvic pain and abnormal urination.The etiology and the pathogenesis of CPPS are not yet clear by now. Because of the high incidence of the disease, lack of typical symptoms, and difficult to treat, CPPS seriously impacts on the quality of life in patients. Recently studies have shown that CPPS is the result of a variety of factors working together, and autoimmune reactions play an important role in the pathogenesis, which is mediated by inflammatory cytokines. Traditional Chinese Medicine has some advantages in the treatment of chronic prostatitis by treatment based on syndrome differentiation, and already became one of the important ways of the clinical treatment. Qianlietongyu-tang is a Chinese medicine that can promote blood flow, relieve fever and promote urination. It can achieve a significant effect in treating CPPS, especially to relieve pain.Research shows that prostaglandin E2 (PGE2) in CPPS prostatic fluid was significantly increased, and is the main cause of pain. Tissue injury, inflammation, and local infection, etc can cause increased production of interleukin-1 (IL-1). Increased IL-1 can induce the expression of cyclooxygenase-2 (COX-2) gene, resulting in a rapidly increase of COX-2, which induces a high production of PGE2 in the cells。High concentrations of PGE2 can inhibit the secretion and the analgesic effect ofβ-endorphin (β-EP). Specific COX-2 inhibitors can significantly reduce the pain of CPPS. We have conjectured that the possible treatment mechanism of Qianlietongyu-tang may be achieved by the way of decreasing the concentration of PGE2 of the prostate tissue. The topic made use of animal experiments to observe the intervention of Qianlietongyu-tang on cytokine such as PGE2, etc, and revealed its possible mechanism of treatment of CPPS.Object The project made the experimental CPPS rat model by using SC purified prostate protein twice with immune adjuvant, observed the influence of Qianlietongyu-tang on morphological peculiarities of experimental rats prostate tissue, and evaluated its efficacy. The project observed the change of pain factor—PGE2, and the other cytokines as IL-1, COX-2 andβ2-EP that were closely related with PGE2, to explore the possible mechanism of treatment by Qianlietongyu-tang. The project also summarized the patterns of prescription and the characteristics of the drug to provide ideas for guiding reasonable choice of effective medicines and prescriptions in clinic.Methods Selection of 62 male, 3-month-old, weight 180-220g Wistar rats, randomly divided into two groups: a control group, 10 rats and a model group, 52 rats. The model group was made by DPT vaccine in peritoneal injection, and rat prostatein purification of FCA emulsion multiple intra-dermal injections. The injected rats were again randomly divided into a control group, a model group, a celecoxib group and a group of low, middle and high dose of Qianlietongyu-tang. The low, middle and high dose group was given dose according to standards of 32,16,8g crude drug/kg respectively. The Celecoxib group administrates the dose of 0.04/kg. The control group and the model group were given the same dose of distilled water. The above groups were successively administrated oral for 30days, qd. All animals were killed 30d after treatment, and prostate glands were obtained to observe the histomorphological changes and detect the contents of IL-1β, COX-2, PGE2 andβ-endorphin in prostate-homogenate by enzyme linked immunosorbent assay.Results①pathological findings: the model group shows chronic inflammation of prostate glandular tissue. The glandular organ of prostate gland adheres to the surrounding tissue, kermesinus or yellow, slightly hard in quality, or obviously indurate. Under microscope, infiltration of lymph and mononuclear cells, interstitial edema and fibroplasias, damage, atrophia, or ablate of prostate gland endepidermis, accrementition or damage of prostatid ducts can be seen. According to statistical analysis on classified pathological sections of prostate gland, the difference between model group and normal group has statistical significance. The above results indicate that the model building is successful.②In the high dose group of Qianlietongyu-tang and Celecoxib group, the epithelial tissues recover, the architecture of epithelial tissues are integrated, and the interstitial edemas disappear. In the mid and low dose group, the damage of prostate gland tissues recover slightly. According to classified statistical analysis, the differences among each group of the Qianlietongyu-tang and the Celecoxib group had statistical significance. The difference between the low dose group of Qianlietongyu-tang and normal group had statistical significance, whereas the differences among the other groups had not.③Compared to the model group, the level of PGE2, IL-1βand COX-2 of prostate glandular tissues reduced in each group of Qianlietongyu-tang and Celecoxib, whereasβ-EP increased obviously. The difference between high dose group of Qianlietongyu-tang and Celecoxib group had no statistical significance.Conclusion①Using the way of autoimmune reaction to induce the CPPS animal model, the change in pathology of the animal's prostate tissue is most similar to that of patients, and pathogenesis is relatively consistent with patients. It is a relatively satisfied way to induce CPPS animal model.②Qianlietongyu-tang can reduce or eliminate inflammation of the model rat prostate tissue, improve its organizational structure damage, it has an anti-fibrosis effect, and so plays a significant role in the protection of prostate issue.③Qianlietongyu-tang can dramatically reduce the levels of IL-1β, COX-2, PGE2 of prostate tissue of the model rat, which can reduce inflammation reaction and pain of reproductive pelvic. The content ofβ-endorphin was dramatically increased in the high dose Qianlietongyu-tang group and celecoxib group, which can strengthen the effectiveness of topo-inhibition pain. Those two groups showed no significant difference in all parameters.The research demonstrated that the possible mechanism of treatment of Qianlietongyu Tang on CPPS is closely related to the effect of adjusting the prostate tissue cytokine levels, reduce prostate inflammation and protect prostate tissue.
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