α_1受体阻滞剂治疗女性下尿路症状有效性与安全性的系统评价  

Adrenergic alpha-1 receptor antagonists in the treatment of lower urinary tract symptoms(LUTS) in women:a systematic review

作　　者：王晓明[1] 魏强[1] 韩平[1] 

机构地区：[1]四川大学华西医院泌尿外科,四川成都610041

出　　处：《现代泌尿外科杂志》2015年第9期617-622,627,共7页Journal of Modern Urology

基　　金：国家自然科学基金(No.81270841)

摘　　要：目的采用循证医学方法评价α1受体阻滞剂治疗女性下尿路症状群(LUTS)的有效性和安全性。方法制定高敏感检索策略,检索截止2014年11月的α1受体阻滞剂治疗女性下尿路症状的临床研究文献,运用改良后Jadad量表评价纳入文献质量并提取有效数据进行Meta分析,用RevMan 5.3软件完成统计和系统评价,对不能进行数据合成的研究采用定性分析的评价方式。结果共包含1 198例患者的10篇文献符合纳入标准,其中7篇纳入定性分析,3篇纳入Meta分析。Meta分析结果显示,相较于安慰剂组,α1-受体阻滞剂能显著改善国际前列腺症状评分(IPSS)[MD=-2.26,95%CI(-2.60,-1.92),P<0.001]和平均尿流率(AFR)[MD=1.41,95%CI(0.67,2.14),P=0.000 2],但Qmax[MD=0.41,95%CI(-0.96,1.79),P=0.56]改善不显著。定性分析结果显示,α1受体阻滞剂与M受体拮抗剂联合治疗女性下尿路症状能显著改善患者症状评分及尿流动力学指标,疗效优于单药治疗效果。α1受体阻滞剂分别与ExMI、生物反馈疗法联合的新型治疗方式也取得了令人满意的效果。10篇文献均报道了不良反应,未见严重不良反应发生。结论α1受体阻滞剂单药治疗能够缓解女性LUTS症状,并能一定程度改善尿流动力学指标。α1受体阻滞剂与M受体拮抗剂联合治疗女性LUTS效果优于单药治疗。α1受体阻滞剂的安全性好,总体不良反应率较低。Objective To evaluate the efficacy and safety of alpha‐1‐blockers in the treatment of female lower urinary tract symptoms （LUTS） .Methods Randomized or controlled clinical trials comparing alpha‐1‐blockers monotherapy with cotherapy of antimuscarinics and alpha‐1‐blockers ,placebo and other types of therapy in the treatment of female LUTS were i‐dentified by electronic and manual retrieval and analysis .The methodological quality of the included trials was assessed by mod‐ified Jadad scoring system and Meta‐analysis was performed with Revman 5.3 software .Results Altogether 10 eligible ran‐domized controlled trials （n=1198） were included in this systematic review ,of which 7 were included for qualitative analysis and 3 for quantitative analysis .Meta‐analysis showed that there were significant improvements on international prostate symp‐tom score [mean difference （MD） = -2 .26 ,95% CI （-2 .60 ,-1 .92） ,P〈0 .001） and average flow rate （MD=1 .41 ,95%CI （0 .67 ,2 .14） ,P=0 .000 2] .There was no significant difference regarding maximum flow rate （MD= 0 .41 ,95% CI （-0.96 ,1 .79） ,P=0 .56） .Qualitative analysis indicated combined therapy with antimuscarinics and alpha‐1‐blockers was more ef‐fective ,which could significantly improved both symptoms and subjective urodynamic parameters .Combined with extracorporeal magnetic innervations or uroflowmetry biofeedback ,alpha‐1‐blockers could obtain significant therapeutic effects as well .All 10 articles reported side effects but no serious adverse events were reported .Conclusions Monotherapy of alpha‐1‐blockers may ameliorate lower urinary tract symptoms and improve urodynamic parameters in women .Combined therapy was more effica‐cious than monotherapy .Alpha‐1‐blockers were well tolerated and the overall incidence of adverse events was low .Due to lim‐ited number of the included studies ,the above mentioned conclusions still need to be verified with more data .

关 键 词：Α1肾上腺素能受体阻滞剂 女性下尿路症状 系统评价 META分析 

分 类 号：R691.5[医药卫生—泌尿科学]