肉毒素膀胱逼尿肌多点注射治疗膀胱过度活动症的Meta分析  

A meta-analysis of botulinum toxin A injection in the treatment of overactive bladder

作　　者：毛全宗[1] 杨瑜[1] 李汉忠[1] 纪志刚[1] 刘广华[1] 肖河[1] 黄钟明[1] 荣石[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院泌尿外科,100730

出　　处：《北京医学》2014年第2期106-110,共5页Beijing Medical Journal

摘　　要：目的系统评价A型肉毒素(BT-A)膀胱逼尿肌多点注射治疗膀胱过度活动症(OAB)的疗效及安全性。方法检索PubMed、Science Direct及中国生物医学文献数据库(CBM)关于BT-A膀胱逼尿肌多点注射治疗OAB的随机对照试验。对符合条件的研究结果应用RevMan 4.2统计软件进行数据分析。以BT-A组相对于安慰剂组在排尿症状、尿动力检查及生活质量评分等方面的加权均数差(WMD)为指标进行疗效评价,以两组在不良事件的相对危险度(RR)为指标进行安全性评价。结果共纳入9项研究,Meta分析结果显示,BT-A组相对于安慰剂组在改善症状(急迫性尿失禁,尿急、尿频,尿痛)方面WMD分别为-0.31(P<0.00001)、-7.92(P<0.00001)、-3.87(P=0.14);尿动力学检查方面[最大膀胱容量(MCC)、最大逼尿肌压力(MDP)]WMD分别为205.99(P<0.00001)、-42.82(P<0.00001);生活质量评分方面(IIQ-7、UDI-6评分)WMD分别为-22.06(P=0.16)、-12.48(P=0.14)。BT-A组相对于安慰剂组在泌尿系感染和尿潴留的RR值分别为1.25(P=0.008)和5.96(P<0.00001)。结论 BT-A对缓解尿急、尿频、尿痛及急迫性尿失禁等症状有明确作用;BT-A可以提高膀胱容量、降低逼尿肌压力;但是,BT-A有发生泌尿系感染及尿潴留的危险。Objective To analyze the efficacy and safety of botulinum toxin A （BT-A） injection in treating overactive bladder （OAB） based on the published randomized clinical trials. Methods Randomized clinical trials of BT-A in treating OAB were searched from PubMed, Science Direct and CBM. A recta-analysis of the included clinical trials was statistically aualyzed with RevMan 4.2 software. Efficacy was assessed with the weighted mean differeo.ee （WMD） （~f voiding symptoms, urodynamic study and quality of life scores.Safety and tolerability were assessed with the relative risk （RR） of the adverse events （AE）. Results A total of 9 clinical trials were included in the meta-analysis. Overall WMD were -0.31 （P 〈 0.00001） for urgent incontinence; -7.92 （P 〈 0.00001） for urgency and -3.87 （P = 0.14） for frequency in voiding symptoms; 205.99（P 〈 0.00001） for MCC and -42.82 （P 〈 0.00001） for MDP in urodynamic study; -22.06（P = 0.16） for I- 1Q-7 scores and -12.48 （P = 0.14） for UDI-6 scores in quality of life evaluation. The overall relative risk of BT-A versus placebo was 1.25 （P = 0.008） for urinary tract infection and 5.96 （P 〈 0.00001） for urinary retention. Conclusion BT-A injection is effective in relieving OAB symptoms, such as urgent incontinence and urgency. BT-A can improve MCC and decrease MDP; while BT-A can cause adverse events such as urinary tract infection and urinary retention.

关 键 词：A型肉毒素 膀胱过度活动症 META分析 

分 类 号：R694[医药卫生—泌尿科学]