| ObjectivesBenign prostatic hyperplasia(BPH)is a common urinary system disease in middle-aged and elderly men.The main clinical manifestations are frequent urination,increased nocturia and progressive dysuria.The incidence of BPH gradually increases with age.The incidence of BPH is 50%-75%in patients over 50 years old,and it increases to 80%in patients over 80 years old.There is no name for benign prostatic hyperplasia(BPH)in traditional Chinese medicine(TCM).The main clinical manifestations of BPH are frequency and hesitation of urination,thinning urine stream,increased frequency of nocturia,and lower urinary tract symptoms such as posturination dribbling and endless urination.In addition,the Longshu syndrome and lymphatic syndrome were used for syndrome differentiation and treatment.Studies have shown that traditional Chinese medicine has a good effect on BPH.Domestic traditional Chinese medicine treatment mainly includes traditional Chinese medicine,acupuncture,moxibustion,massage and so on.The studies on the treatment of BPH with TCM external treatment techniques were sorted out.All the studies involved abdominal meridians,acupoints or related operations,and abdominal meridians were the main points.This study intends to conduct a meta-analysis of the clinical trials of abdominal manipulation of TCM external treatment techniques in the treatment of BPH at home and abroad,make a systematic review of abdominal manipulation related TCM external treatment techniques in the treatment of BPH,analyze and evaluate its efficacy,and further analyze the treatment principle of abdominal manipulation as the main operation site for the treatment of BPH.To provide a basis for further promoting the external treatment of traditional Chinese medicine in the treatment of BPH.Professor Fu Guobing,a famous TCM doctor in Beijing,has been engaged in clinical practice for more than 40 years.He is good at using Abdominal vibratory therapy to treat a variety of diseases such as internal medicine,gynecology,children,andrology and so on.Serum sex hormones and inflammatory factors play an important role in the pathogenesis of BPH.In order to verify the curative effect of abdominal vibration on BPH and explore the internal mechanism of abdominal vibration in the treatment of BPH,this study explored the effects of abdominal vibration on prostate histomorphology,serum sex hormone and inflammatory factor levels in BPH rats from the serum levels of sex hormones and inflammatory factors.To further provide theoretical support for the clinical application of vibrating abdomen method in the treatment of BPH.MethodsStudy I:Meta-analysis of the efficacy of abdominal manipulation with TCM external treatment for BPHThe databases of China National Knowledge Infrastructure(CNKI),VIP,Wanfang Data,Sinomed,PubMed and Cochrane Library were searched by computer,and the journals related to urology and andrology were searched manually.We collected randomized controlled trials(RCTS)about the treatment of BPH with external abdominal treatments.The experimental group was an abdominal external treatment,which did not cooperate with the operation sites outside the abdomen,with or without the drugs used in the control group.The control group was treated with conventional western medicine.The search time was from the establishment of the database to June 2022.Two researchers independently screened the literature and extracted the data according to the inclusion and exclusion criteria.RevMan 5.3 software was used for Meta-analysis.Study II:Effects of abdominal vibration on serum sex hormones and inflammatory factors in BPH model ratsTwenty-one 6-week-old SPF SD male rats were randomly divided into control group,model group and vibration abdominal treatment group,with 7 rats in each group.The model group and the vibrating abdomen treatment group were treated with subcutaneous injection of non-castrated testosterone propionate to establish the model,and the vibrating abdomen treatment group was treated with vibrating abdomen intervention after successful modeling.The changes in body weight of rats were recorded during the experiment.At the end of the intervention,2%sodium pentobarbital was injected intraperitoneally for anesthesia,and abdominal aortic blood was collected for determination of the concentrations of sex hormones T,E2,and DHT,and the expression levels of inflammatory factors TNF-α,IL-2,IL-4,IL-6,and IL-17 by ELISA,and the E2/T ratio was calculated.The weight of the prostate tissue was measured,the wet mass index of the prostate was calculated,and the histomorphological changes of the prostate tissue were observed by HE staining.ResultsStudy Ⅰ:Meta-analysis of the efficacy of abdominal manipulation with TCM external treatment for BPHTwelve studies involving 813 patients were included.Meta-analysis results showed that:1.The clinical effective rate of the experimental group was higher than that of the control group[OR=3.70,95%CI(2.38,5.75),P<0.00001].The clinical effective rate of BPH treated by external abdominal treatment combined with conventional western medicine was higher than that of conventional western medicine[OR=4.96,95%CI(2.18,11.26),P=0.0001].The clinical efficacy of simple external abdominal therapy in the treatment of BPH was higher than that of conventional western medicine[OR=3.27,95%CI(1.94,5.52),P<0.00001].2.The IPSS of the experimental group was lower than that of the control group[MD=-2.43,95%CI(-3.35,-1.50),P<0.00001].There was no significant difference in IPSS between the external abdominal treatment combined with conventional western medicine and conventional western medicine in the treatment of BPH[MD=-1.31,95%CI(-2.94,0.32),P=0.12].The IPSS of simple external abdominal therapy for BPH was lower than that of conventional western medicine[MD=-3.11,95%CI(-4.49,-1.73),P<0.0001].3.Qmax of the experimental group was higher than that of the control group[MD=1.28,95%CI(0.10,2.46),P=0.03].4.The PVR of the experimental group was lower than that of the control group[MD=-6.47,95%CI(-9.19,-3.76),P<0.00001].The PVR of BPH treated with external abdominal therapy combined with conventional western medicine was lower than that of conventional western medicine[MD=-5.97,95%CI(-8.41,-3.52),P<0.00001].The PVR of BPH treated with external abdominal therapy was lower than that of conventional western medicine[MD=-6.32,95%CI(-10.03,-2.61),P=0.0008].5.The PV of the experimental group was lower than that of the control group[MD=-3.74,95%CI(-5.73,-1.76),P=0.0002].The PV of BPH treated with external abdominal treatment combined with conventional western medicine was lower than that of conventional western medicine[MD=-2.52,95%CI(-4.07,-0.98),P=0.001].The PV of BPH patients treated with external abdominal therapy was lower than that of conventional western medicine[MD=-4.37,95%CI(-7.22,-1.52),P=0.003].6.The QOL of the experimental group was lower than that of the control group[MD=-1.25,95%CI(-1.68,-0.82),P<0.00001].The QOL of BPH patients treated with external abdominal therapy combined with conventional western medicine was lower than that of conventional western medicine[MD=-0.96,95%CI(-1.16,-0.75),P<0.00001].The QOL of BPH patients treated with external abdominal therapy was lower than that of conventional western medicine[MD=-1.41,95%CI(-2.02,-0.79),P<0.00001].7.There were no obvious adverse reactions in the two groups.8.The sensitivity analysis of IPSS,PVR,PV and QOL showed that the change effect model had no significant effect on the combined results.After excluding one study,it was found that in the subgroup analysis of IPSS,the subgroup of BPH treated by external abdominal treatment combined with conventional western medicine was statistically significant compared with that treated by conventional western medicine after excluding one study.In the subgroup analysis of PVR,after excluding one study,the subgroup of BPH treated by external abdominal therapy was compared with conventional western medicine treatment,and the heterogeneity test results were more homogeneous.The funnel plot of clinical effective rate,IPSS,PVR,PV and QOL was analyzed.The funnel plot of clinical effective rate,IPSS,PVR,PV and QOL was symmetrical on both sides.Study Ⅱ:Effects of abdominal vibration on serum sex hormones and inflammatory factors in BPH model rats1.The body weight and prostate weight of rats:the body weight of rats in the model group and the vibration-abdominal treatment group was higher than that in the blank group on the 28th day of modeling(P<0.05),but there was no significant difference between the model group and the vibration-abdominal treatment group(P>0.05).There was no significant difference in body weight between the abdominal vibration treatment group and the model group(P>0.05),but the growth rate of body weight in the abdominal vibration treatment group was significantly lower than that in the model group(P<0.05).Compared with the blank group,the prostate weight of the model group was significantly increased(P<0.05),and the prostate weight of the vibration abdominal group was significantly increased(P<0.05).Compared with the model group,the prostate weight of the vibration abdominal group was significantly reduced(P<0.05).Compared with the blank group,the wet mass index of the prostate in the model group was significantly increased(P<0.05),and the wet mass index of the prostate in the vibration group was increased(P<0.05).Compared with the model group,the prostate wet mass index of the vibration abdominal group was significantly decreased(P<0.05).2.Histological morphology of prostate:in the blank group,the prostatic epithelial cells were arranged neatly,cuboidal or columnar,the inner surface of glandular cavity was regular and smooth,and there was almost no papillary inward protrusion.In the model group,the prostate epithelium showed papillary protrusion,hyperplasia and concave to the glandular cavity,and the area of the glandular cavity was significantly reduced.Compared with the model group,there was a small amount of interstitium in the prostate gland of the vibration abdominal treatment group,and the glandular cavity area was increased,and the papillary inward protrusion was reduced.3.Serum sex hormone levels:compared with the blank group,the levels of serum T,E2,DHT and E2/T in the model group and the vibration-abdominal treatment group were significantly increased(P<0.05);Compared with the model group,the levels of serum T,E2,DHT and E2/T in the Zhenabdominal treatment group were significantly decreased(P<0.05).4.Serum levels of inflammatory factors:compared with the blank group,the serum levels of TNF-α,IL-2,IL-4,IL-6 and IL-17 in the model group and the vibration-abdomen treatment group were significantly increased(P<0.05).Compared with the model group,the serum levels of TNF-α,IL-2,IL-4 and IL-6 in the Zhenabdominal treatment group were significantly decreased(P<0.05),and there was no significant difference in the level of IL-17(P>0.05).Conclusions1.Based on the current clinical evidence,the clinical effective rate and Qmax of the external abdominal treatment for BPH are higher than those of the control group,and the IPSS,PVR,PV,and QOL are lower than those of the control group.2.BPH rat model can be successfully induced by subcutaneous injection of testosterone propionate.The abdominal vibration method can effectively slow down the growth rate of body weight,reduce the prostate wet mass index of BPH rats,regulate the levels of sex hormones and inflammatory factors. |
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