摘要
目的系统评价α1肾上腺素受体阻滞剂坦索罗辛治疗输尿管结石的疗效。方法计算机检索PubMed、EMbase、BIOSIS和International Pharmaceutical Abstracts(IPA)数据库,Cochrane图书馆(2006年第3期),中国期刊全文数据库(1995.1～2006.9)及重要学术会议论文集,系统收集坦索罗辛治疗输尿管结石的随机对照试验。由2名评价者共同评价纳入研究质量并提取资料,合并同质研究进行Meta分析,采用STATA9.0完成定量资料分析。结果共纳入16个随机对照试验,包括1521例输尿管下段结石患者。Meta分析结果显示:①坦索罗辛组比仅使用饮水和镇痛药的保守疗法结石排出率高[RR1.50,95%CI(1.20,1.87)],缩短排石时间[SMD–1.29,95%CI(–2.27,–0.31)],并降低后期ESWL或输尿管镜治疗率[RR0.40,95%CI(0.27,0.59)],差异有统计学意义(P<0.05)。②坦索罗辛/地夫可特联用组比保守疗法排石率高[RR1.59,95%CI(1.31,1.93)],缩短排石时间[SMD–0.8,95%CI(–1.18,–0.42)],明显减少后期ESWL或输尿管镜治疗率[RR0.13,95%CI(0.06,0.31)],差异有统计学意义(P<0.05)。③坦索罗辛与地夫可特联用组与单用地夫可特组在结石排出率方面没有差异[RR1.31,95%CI(0.78,2.23),P=0.31],但能明显减少镇痛药剂量[SMD15.20,95%CI(14.98,15.52)]和后期输尿管镜治疗率[RR0.09,95%CI(0.02,0.47)],差异有统计学意义。④坦索罗辛与地夫可特联用组比硝苯地平与地夫可特联用组结石排出率高[RR1.20,95%CI(1.07,1.35),P=0.002],而排石时间[SMD–1.34,95%CI(–3.47,0.79)]和后期ESWL或输尿管镜治疗率[RR0.34,95%CI(0.05,2.22)]无差异(P>0.05)。⑤以坦索罗辛为主的干预组和保守疗法在药物副作用方面没有差异(P均>0.05)。结论目前的证据支持:坦索罗辛对输尿管下段和膀胱壁间段结石具有较高的促排石率,能缩短排石时间和降低后期侵入性治疗率。0.4mg/d坦索罗辛对下段输尿管结石治疗安全有效。有限证据支持坦索罗辛与地夫可特联用有助于提高排石率,但需要大样本的研究结果予以支持。
Objective To assess the efficacy of medical expulsive therapy for ureteral calculi with tamsulosin. Methods We searched PubMed, MEDLINE, EMBASE, BIOSIS, International Pharmaceutical Abstracts （IPA） Database, The Cochrane Library and Chinese Journal Full-text Database from 1995 to September 2006, as well as the proceedings of urological scientificconferences from 2000 to 2006. Randomized controlled trials（RCTs） comparing tamsulosin and other therapies for ureteral calculi among adults were included. Data were extracted by two reviewers independently and synthesized by STATA 9.0 software. Results A total of 16 studies involving 1 521 patients with distal or juxtavesical ureteral calculi were included. Compared with conservative therapy, tamsulosin showed higher expulsion rate [RR 1.50, 95%CI （1.20 to 1.87）, P〈0.000 1], shorter expulsion time [SMD -1.29, 95%CI （-2.27, -0.31 ）] and fewer patients requiring ESWL or ureteroscopy [RR 0.40, 95%CI （0.27, 0.59）, P〈0.05]. Compared with conservative therapy, the combination of tamsulosin plus deflazacort also showed higher expulsion rate [RR 1.59, 95%CI （1.31, 1.93）], shorter expulsion time [SMD -0.8, 95%CI （-1.18, -0.42）] and fewer patients requiring ESWL or ureteroscopy [RR 0.13,95%CI （0.06, 0.31）, P〈0.05]. Compared with deflazacort alone the combination of tamsulosin plus deflazacort demonstrated similar expulsion rate [RR 1.31, 95%CI （0.78, 2.23）, P=0.31] but significantly reduced the dosage of analgesics [SMD 15.20, 95%CI （14.98, 15.52）] and decreased the proportion of patients requiring ESWL or ureteroscopy [RR 0.09, 95%CI （0.02, 0.47）, P〈0.05]. Compared with deflazacort plus nifedipine, the combination of tamsulosin plus deflazacort showed higher expulsion rate [RR 1.20, 95%CI （1.07, 1.35）, P=0.002], but similar expulsion time [SMD -1.34, 95%CI （- 3.47, 0.79）] and proportion of patients requiring ESWL or ureteroscopy [RR 0.34, 95%CI （0.05, 2.22）, P〉0.05]. As for side effects,tamsulosin-based treatment and conservative therapy were comparable （P〉0.05）. Conclusions Tamsulosin has a beneficial effect on the expulsion of ureteral calculi, especially for distal and juxtavesical ureteral calculi. Tamsulosin- based medical expulsive therapy at the dosage of 0.4mg daily is effective and safe for patients with distal ureteral calculi. More large-scale studies are required to define the efficacy of combination therapy of tamsulosin plus deflazacort.
出处
《中国循证医学杂志》
CSCD
2007年第7期506-515,共10页
Chinese Journal of Evidence-based Medicine
