單用α腎上腺受體阻滯劑與聯合5α—還原酶抑制劑治療良性前列腺增生療效的Meta分析

賀曉龍 強亞勇 張斌病 宋紅雄 勒永勝 周培清

【摘要】目的：比較單用α腎上腺受體阻滯劑與α腎上腺受體阻滯劑聯合5α-還原酶抑制劑治療良性前列腺增生（BPH）的療效。方法：檢索中/英文公開發表的隨機對照試驗（RCT）。計算機檢索PubMed、EMbase、the Cochrane Central Register of Controlled Trials（CENTRAL）、CNKI、CBM、VIP、萬方數據庫。檢索時間為建庫至2015年6月30日。同時，手檢納入文獻的參考文獻。按納入排除標準進行RCT的篩選、資料提取和質量評價后，采用RevMan 5.2軟件進行Meta分析。結果：共納入4個研究，403例患者。Meta分析結果顯示：有效性方面，兩組在降低IPSS評分[SMD=0.89，95%CI（-0.66，2.45）P=0.26]、提高最大尿流率[SMD=-3.67，95%CI（-8.88，1.54）P=0.17]、減少殘余尿量 [SMD=0.62，95%CI（-0.97，2.22）P=0.17]上無明顯統計學差異；與單用藥物相比，聯合用藥在減少前列腺體積上 [SMD=6.94，95%CI（2.06，11.81）P=0.005]效果更好，兩組在出現不良反應（頭暈[SMD=0.57，95%CI（0.16，1.98）P=0.38]、性功能減退 [SMD=0.57，95%CI（0.16，1.98）P=0.38]）上無明顯統計學差異。結論：單用α腎上腺受體阻滯劑與α腎上腺受體阻滯劑聯合5α-還原酶抑制劑相比，兩者療效相似，對于前列腺體積不大的患者，單用α腎上腺受體阻滯劑即可達到很好的療效，避免了不必要的經濟負擔；對于前列腺體積較大的患者，則推薦聯合用藥。對于前列腺具體多大的體積才是單用α腎上腺受體阻滯劑與聯合5α-還原酶抑制劑治療的分界閾值，則需要更多高質量、大樣本的RCT進一步論證。

【關鍵詞】良性前列腺增生：α腎上腺受體阻滯劑；5α-還原酶抑制劑；隨機對照試驗

Meta-analysis of the curative effect of alpha adrenal receptor blockers alone and combined 5 alpha reductase inhibitors for the treatment of benign prostatic hyperplasiaHE Xiaolong1， QIANG Yayong1， ZHANG Binbing1， SONG Hongxiong1， LE Yongsheng1， ZHOU Peiqing2△. 1 Department of Urology ， The Hospital Affliated to YanAn University，Yanan 716000，Shaanxi，China； 2 Department of General Surgery，Tongchuan Maternal and Children Health Care Hospital，Tongchuan 727000，Shaanxi，China

【Abstract】Objectives： To compare the curative effect of alpha adrenal receptor blockers alone and combined 5 alpha reductase inhibitors for the treatment of benign prostatic hyperplasia （BPH）. Methods： Chinese/English published randomized controlled trials （RCT） were retrieved. Computer retrieval PubMed， EMbase， theCochrane Central Register of Controlled Trials （Central）， VIP， CNKI， CBM and wanfang database was conducted. The retrieval time for library was until 30 June 2015. At the same time， literature references were also searched by hand. According to the inclusion standard， RevMan 5.2 software was adopted for Meta-analysis after RCT extraction and filtering， data quality evaluation. Results： A total of 403 patients were included in the four groups. In terms of effectiveness， the two groups had no significant statistical differences in reducing IPSS score [SMD = 0.89， 95% CI （-0.66， 2.45）P=0.26）]， raising the maximum urinary flow rate [SMD = 3.67， 95% CI （-8.88， 1.54）P=0.17）] and reducing the residual urine volume [SMD = 0.62， 95% CI （-0.97， 2.22） P=0.17]. Compared with medication alone， combined treatment had better effect on reducing prostate volume [SMD = 6.94， 95% CI （2.06， 11.81）， P = 0.005]， and there was no statistically significant difference in adverse reaction between the two groups （dizziness [SMD = 0.57， 95% CI （0.16， 1.98）， P = 0.38）， decreased sexual function [SMD = 0.57， 95% CI （0.16， 1.98）， P = 0.38]）. Conclusion： The effectiveness of the two treatment methods is similar. For patients with small prostate volume， using alpha adrenal receptor blockers alone is better with less cost， while for patients with large prostate volume， combined treatment is better. As for how to decide ones prostate volume is large or small， it needs further RCT with larger sample.

【Key words】Benign prostatic hyperplasia （BPH）； Alpha blockers； 5 alpha reductase inhibitors； Randomized controlled trial （RCT）

【中圖分類號】R697+.3【文獻標志碼】A

良性前列腺增生（BPH）是老年男性的常見疾病之一[1]，目前在臨床上越來越受到關注。在流行病學方面研究中發現：BPH的發生率在40多歲以后隨年齡的增大而顯著增高，嚴重影響了患者的生活質量[2]。……