M受体阻滞剂联合α受体阻滞剂治疗膀胱过度活动症合并膀胱出口梗阻的Meta分析  

Clinical effectiveness and safety of combined therapy with alpha-blocker and an anticholinergic drug for bladder outlet obstruction with overactive bladder： a Meta-analysis of outcomes

作　　者：刘秉乾[1] 李建华[1] 王义昆[1] 武玉东[1] 

机构地区：[1]郑州大学第一附属医院泌尿外科,河南省泌尿外科研究所,450052

出　　处：《中华外科杂志》2014年第5期376-380,共5页Chinese Journal of Surgery

摘　　要：目的 评价M受体阻滞剂联合α受体阻滞剂治疗膀胱过度活动症（OAB）合并膀胱出口梗阻（BOO）患者的疗效及安全性.方法 检索PubMed、EMBase、Ovid、万方数据知识服务平台和中国期刊全文数据库;检索时间范围均为建库至2013年10月.收集比较M受体阻滞剂联合α受体阻滞剂与α受体阻滞剂单药治疗BOO ＋OAB患者的随机对照试验.由2名研究者按Cochrane系统评价方法来筛选文献、评价质量、提取资料,并用RevMan 5.2软件进行Meta分析.结果 共纳入7个随机对照试验,其中1737例患者接受联合治疗,1 721例患者接受单药治疗.Meta分析结果显示,联合组总IPSS和储尿期IPSS的改善优于单药组（RR=-0.23,95％ CI：-0.44～-0.02,P=0.03;RR=-0.69,95％ CI：-0.88 ～-0.51,P＜0.01）,两组间排尿期IPSS及Qmax的差别无统计学意义（P=0.86、0.89）.联合组的口干（OR =2.53）、便秘（OR=3.74）、头晕（OR=0.73）以及尿潴留（OR=0.26）等不良反应的发生率高于单药组（P＜0.05）,但是总体发生率低,表现轻微.结论 M受体阻滞剂联合α受体阻滞剂治疗BOO＋OAB的整体疗效优于单用α受体阻滞剂,不良反应能为患者所耐受.Objective To compare the clinical effectiveness and safety of alpha-blocker alone and combined tamsulosin with an anticholinergic drug for bladder outlet obstruction （BOO） with overactive bladder （OAB）. Methods Literature search was performed using PubMed, EMBASE, Ovid, Wanfang, and CNKI from inception to October 2013 for comparative studies assessing alpha-blocker alone and combined alpha-blocker with an anticholinergic drug for BOO ＋ OAB. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for systematic reviews. Meta-analyses were conducted using RevMan 5.2. Results A total of 7 studies involving 3 458 patients were included for the analysis. The values of total IPSS and storage IPSS reduced significantly after treatment in combination group （RR= -0.23,95%CI： -0.44- -0.02, P=0.03;RR= -0.69,95%CI： -0.88--0.51,P〈0.01） . There were no significant differences between the two groups in voiding IPSS and Qmax （ P = 0. 86 and 0. 89）. The incidences of dry mouth （ OR = 2. 53 ）, constipation （ OR = 3.74 ）, dizziness （ OR = 0. 73 ）, and urinary retention （ OR = 0. 26 ） were higher in combination group than in alpha-blocker alone group （P 〈 0.05）. But most adverse events were mild in degree. Conclusion Alpha-blocker combined with an antieholinergic drug in the treatment of BOO ＋ OAB was better than that of alpha-blocker alone, and was safe and well tolerated.

关 键 词：膀胱 过度活动性 膀胱颈梗阻 肾上腺素能Α拮抗剂 胆碱能拮抗剂 META分析 

分 类 号：R694[医药卫生—泌尿科学]