前立腺疾患における蓄尿障害に対する牛車腎気丸の効果 : 漢方治療の基礎研究と今後の方向性について (第57回日本泌尿器科学会中部総会)

Abstract

内服治療で頻尿症状の改善が不十分であった前立腺疾患患者25例(平均72.6歳)に対し牛車腎気丸を投与した。疾患は前立腺肥大症22例, 前立腺炎3例で, 既往内服薬は塩酸タムスロシン13例, ナフトピジル9例, 酢酸クロルマジノン1例, 塩酸プロピベリン10例であった。牛車腎気丸投与による副作用は便秘, 胃部不快, 動悸を各1例に認めた。昼間排尿回数は投与前7.8回, 投与4週後7.0回, 8週後6.6回, 夜間排尿回数は順に4.4回, 3.1回, 2.7回と有意な減少を認めた。尿流測定による最大尿流量率, 平均尿流量率, 残量量も有意に改善した。国際前立腺症状スコア(IPSS)合計とQOLスコアも有意に改善し, IPSSの項目別では残尿感, 排尿間隔, 尿線途絶, 排尿の我慢, 夜間頻尿回数で改善を認めた。実虚証判定ソフトにより判定した実証例と虚証例とで頻尿改善効果に有意差はなかった。

At present, patients with lower urinary tract symptoms, including storage symptoms, caused by prostatic disease are predominantly treated with alpha1-adrenoceptor antagonist and anticholinergic agents. However, some patients are not improved by this treatment. We investigated the efficacy of Goshajinkigan in 25 patients with prostatic disease in whom pollakisuria was not improved by treatment with drugs for lower urinary tract symptoms. The urinary frequency was significantly improved both in the daytime and at night. The parameters of uroflowmetry, the residual urine volume, the international prostate symptom score and QOL score were also improved after therapy. It was considered that the pollakisuria was improved by Goshajinkigan induced activation of spinal kappa-opioid receptors, which inhibited the micturition reflex via blunting of bladder sensation. The inhibition of C-fiber and the down regulation of Fos protein in the pontine micturition center were also suggested to be related with improvement ofpollakisuria. Chinese herbal medicine therapy is different in various aspects from Western medicine. Clarification of the mechanisms of Chinese herbal medicine and Sho (patient status in Chinese herbal medicine) is awaited.