经皮胫神经电刺激与M受体阻滞剂治疗膀胱过度活动症疗效和安全性的Meta分析  

The efficacy and safety of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder:a meta-analysis and systemic review

作　　者：李浩冉 陈敏[1] 钟贺 陈佳炜 彭景涛 Li Haoran;Chen Min;Zhong He;Chen Jiawei;Peng Jingtao(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430000

出　　处：《中华泌尿外科杂志》2022年第3期212-216,共5页Chinese Journal of Urology

摘　　要：目的系统评价经皮胫神经电刺激与M受体阻滞剂治疗非神经源性膀胱过度活动症(OAB)的疗效与安全性。方法计算机检索Pubmed、Cochrane Library、Embase、Medline、中国知网、维普数据库、万方数据库,检索年限为从建库至2021年2月。由两名研究者独立筛选文献并进行文献质量评价,筛选有关经皮胫神经电刺激与M受体阻滞剂治疗的随机对照实验,分析其安全性和有效性。采用Review Manager 5.4软件进行Meta分析。结果经过筛选后纳入11项临床研究,包括10项随机对照试验,1项随机对照交叉试验,共纳入患者605例,其中经皮胫神经电刺激组309例,M受体阻滞剂组296例。Meta分析结果显示:经皮胫神经电刺激与M受体阻滞剂治疗非神经源性OAB,在24 h排尿次数(MD=-0.06,95%CI-1.67~1.54)、24h急迫性尿失禁次数(MD=0.04,95%CI-0.46~0.54)、膀胱过度活动问卷简表的症状评分(MD=0.37,95%CI-0.02~0.76)、生活质量评分(SMD=0.32,95%CI-0.06~0.69)改善方面差异均无统计学意义(P>0.05);但经皮胫神经电刺激较M受体阻滞剂有更高的疗效满意率(OR=1.97,95%CI 1.16~3.36,P<0.05)、更低的不良反应发生率(OR=0.24,95%CI 0.12~0.48,P<0.0001)。结论经皮胫神经电刺激与M受体阻滞剂在改善非神经源性OAB患者症状和提高生活质量方面疗效相当,但经皮胫神经电刺激有更高的疗效满意率和更低的不良反应发生率。该结论尚需更多高质量研究进一步验证。Objective To systematically review the efficacy and safety of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder.Methods The literature search was conducted using the PubMed,The Cochrane Library,EMbase,Medline,CNKI,CQVIP,Wanfang databases.The retrieval period was from the establishment of the database to February 2021.Literature was screened and evaluated independently by two investigators to compare the safety and efficacy of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder.Meta-analysis was performed using Review Manager 5.4 software.Results A total of 11 clinical trials,including 10 randomized controlled trials and 1 cross-over study were included,involving 605 patients,including 309 in the experimental group(nerve stimulation group)and 296 in the control group(antimuscarinic drugs group).The results of meta-analysis showed as follow.For patients with non-neurogenetic overactive bladder,there was no statistically significant differences between electrostimulation of the posterior tibial nerve therapy and antimuscarinic drugs in the improvement of 24h urination frequency(MD=-0.06,95%CI-1.67-1.54,P>0.05),24h urge incontinence frequency(MD=0.04,95%CI-0.46-0.54,P>0.05),symptoms scores of OAB-q questionnaire(MD=0.37,95%CI-0.02-0.76,P>0.05)and quality of life scores(SMD=0.32,95%CI-0.06-0.69,P>0.05).However,compared with antimuscarinic drugs,posterior tibial nerve stimulation had better efficacy satisfaction rate(OR=1.97,95%CI 1.16-3.36,P<0.05)and lower side effect rate(OR=0.24,95%CI 0.12-0.48,P<0.0001).And the results have significant statistical differences.Conclusions Electrostimulation of the posterior tibial nerve was almost as effective as antimuscarinic drugs in improving symptoms and quality of life in patients with non-neurogenic OAB.However,compared with antimuscarinic drugs,electrostimulation of the posterior tibial nerve had a higher efficacy satisfaction rate and a lower incidence

关 键 词：META分析 膀胱过度活动症 经皮胫神经电刺激 M受体阻滞剂 系统评价 

分 类 号：R694.5[医药卫生—泌尿科学]