5α还原酶和α受体阻断剂联合治疗对良性前列腺增生患者中央区腺体增生的效果评价  

Efficacy of combination therapy with 5 alpha-reductase inhibitor and alpha-receptor blocker for the treatment of intravesical prostatic profusion in patients with benign prostatic hyperplasia

作　　者：康健[1] 齐隽[1] 黄涛[1] 朱云开[2] 

机构地区：[1]上海交通大学医学院附属新华医院泌尿外科,200092 [2]上海交通大学医学院附属新华医院超声科,200092

出　　处：《中华老年医学杂志》2013年第4期372-374,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨非那雄胺和多沙唑嗪联合治疗前列腺增生（BPH）合并下尿路症候群（LUTS），对不同程度中央区腺体增生（前列腺膀胱内突出部分）（IPP）的效果。方法本次研究入组322例患者，存在前列腺体积增大以及显著的LUTS症状，所有患者采用非那雄胺5mg和多沙唑嗪4mg每天1次联合治疗，6个月为观察终点。根据超声检查提示的IPP的程度，患者分成4组：〉10mm33例，5～10mm46例，〈5mm65例；没有IPP的BPH患者178例作为对照组。组内分析比较药物治疗前后国际前列腺症状评分（IPSS），前列腺特异抗原（PSA）以及超声检查数据的变化，COX回归分析上述因素与IPP的相关关系。结果本次研究的患者在药物联合治疗6个月后，三组的IPP程度和最大尿流率在治疗后没有明显变化（P〉0．05），同时，第一组患者的IPSS分数也没有明显改善（P〉0．05）；而其余患者的PSA，IPSS，前列腺体积（TPV），前列腺移行区体积（TZV）和残余尿量（PVR）则在治疗前后比较明显减少（P〈0．05）。COX回归分析结果提示，残余尿量和最大尿流率与IPP分别呈正相关和负相关（Pd0．001和P=0．024）。结论BPH／LUTS患者6个月的联合治疗可以明显改善症状，缩小体积，但是对于BPH合并IPP的患者，联合治疗并不能有效缓解IPP的程度。Objective To evaluate the efficacy of combination therapy with finasteride and doxazosin in benign prostatic hyperplasia/ lower urinary tract symptoms （BPH/LUTS） patients with intravesical prostatic profusion （IPP）. Methods A total of 322 BPH/LUTS patients who accepted combination therapy with finasteride and doxazosin were enrolled in this study. Patients were divided into 4 groups according to the degree of IPP： group I（IPP〉10 mm ）, group 2 （IPP between 5 mm and 10 mm）, group 3 （IPP〈5 mm）, control group （without IPP）. All patients were received inasteride 5 mg once per day and doxazosin 4 mg once per day for 6 months. International prostate symptom score （IPSS）, prostatic specific antigen（PSA）, ultrasonographic and urodynamic evaluation were compared before and after treatment. The correlations between the above factors and IPP were estimated by Logistic regression analysis. Results After 6 month of treament, the changes of IPP degree and the maximal urinary flow rate （Qmax） had no significant differences in group 1, group 2 and group 3 as compared with before treatment （all P〉0.05）. The IPSS in group 1 was not significantly different before and after treatment （P〉0.05）. There were significant differences in the PSA level, IPSS, total prostate volume （TPV）, transition zone volume （TZV）, residual urine volume （PVR） in the 4 groups before and after treatment （all P〈0.05）. Logistic regression analysis showed that PVR and Qmax had positive and negative correlations with IPP （P〈0. 001 and P= 0. 024）, respectively. Conclusions Combination therapy with finasteride and doxazosin can significantly improve the symptoms of LUST and reduce the total prostate volume in patients with BPH/LUTS, but for BPH patients with IPP, the combination therapy can not effectively alleviate the degree of IPP.The increase of residual urine volume and decrease of Qmax may enhance the risk of bladder outlet obstruction in BPH patients with IPP.

关 键 词：睾酮5-α还原酶 前列腺增生 多沙唑嗪 

分 类 号：R6[医药卫生—外科学]