CAJ | 학술논문

目的探讨α1受体阻滞剂治疗BPH/膀胱过度活动症(OAB)疗效欠佳者,加用M受体阻滞剂治疗的疗效及安全性. 方法 2010年8月至2012年4月,对145例临床表现为OAB症状≥3个月、OAB症状评分(OABSS)≥3分、IPSS≥8分、QOL≥4分、Qmax≥5 ml/s,膀胱残余尿(PVR)≤100 ml的BPH患者,采用α1受体阻滞剂治疗2周,对OABSS仍≥3分者行尿动力学检测,选择合并膀胱逼尿肌过度活动(DO)、最大逼尿肌压力(Pdet)≥40 cm H2O的患者,加用M受体阻滞剂治疗2周,再次评估. 结果 α1受体阻滞剂治疗2周后,OABSS＜3分者48例(33％),≥3分者97例(67％),符合加用M受体阻滞剂条件94例并完成后续2周治疗.患者治疗前(基线值)、单用α1受体阻滞剂治疗2周后、加用M受体阻滞剂治疗2周后,OABSS评分分别为(7.0±1.3)、(5.2±0.8)、(3.1±0.8)分,IPSS评分分别为(17.0±1.7)、(14.2±1.9)、(11.1±1.9)分,QOL评分分别为(5.0±0.7)、(4.0±0.8)、(3.1±0.7)分,Qmax分别为(8.8±2.5)、(11.4±2.4)、( 10.8±2.4) ml/s,PVR分别为(86.0±16.5)、(67.9±12.9)、(71.8±11.9)ml.与基线值比较,单用α1受体阻滞剂、加用M受体阻滞剂后的OABSS、IPSS、QOL、Qmax、PVR值比较差异有统计学意义(P＜0.01)；加用M受体阻滞剂后OABSS、IPSS、QOL值与单用α1受体阻滞剂值比较差异有统计学意义(P＜0.05),加用M受体阻滞剂前后Qmax、PVR值的差异无统计学意义(P＞0.05). 结论 α1受体阻滞剂单用或加用M受体阻滞剂均能改善BPH/OAB症状.α1受体阻滞剂加用M受体阻滞剂疗效更佳、风险更小.
목적 탐토α1수체조체제치료BPH/방광과도활동증(OAB)료효흠가자,가용M수체조체제치료적료효급안전성. 방법 2010년8월지2012년4월,대145례림상표현위OAB증상≥3개월、OAB증상평분(OABSS)≥3분、IPSS≥8분、QOL≥4분、Qmax≥5 ml/s,방광잔여뇨(PVR)≤100 ml적BPH환자,채용α1수체조체제치료2주,대OABSS잉≥3분자행뇨동역학검측,선택합병방광핍뇨기과도활동(DO)、최대핍뇨기압력(Pdet)≥40 cm H2O적환자,가용M수체조체제치료2주,재차평고. 결과 α1수체조체제치료2주후,OABSS＜3분자48례(33％),≥3분자97례(67％),부합가용M수체조체제조건94례병완성후속2주치료.환자치료전(기선치)、단용α1수체조체제치료2주후、가용M수체조체제치료2주후,OABSS평분분별위(7.0±1.3)、(5.2±0.8)、(3.1±0.8)분,IPSS평분분별위(17.0±1.7)、(14.2±1.9)、(11.1±1.9)분,QOL평분분별위(5.0±0.7)、(4.0±0.8)、(3.1±0.7)분,Qmax분별위(8.8±2.5)、(11.4±2.4)、( 10.8±2.4) ml/s,PVR분별위(86.0±16.5)、(67.9±12.9)、(71.8±11.9)ml.여기선치비교,단용α1수체조체제、가용M수체조체제후적OABSS、IPSS、QOL、Qmax、PVR치비교차이유통계학의의(P＜0.01)；가용M수체조체제후OABSS、IPSS、QOL치여단용α1수체조체제치비교차이유통계학의의(P＜0.05),가용M수체조체제전후Qmax、PVR치적차이무통계학의의(P＞0.05). 결론 α1수체조체제단용혹가용M수체조체제균능개선BPH/OAB증상.α1수체조체제가용M수체조체제료효경가、풍험경소.
Objective Detrusor overactivity (DO) is one known cause of overactive bladder (OAB) symptoms in benign prostatic hyperplasia (BPH).In this study,OAB symptoms suggestive of DO in BPH were treated with α1-blocker monotherapy or α1-blocker and antimuscarinics add-on therapy,and the efficacy and safety were assessed.Methods BPH patients who suffered from OAB symptoms for at least 3 month were enrolled in a prospective self-control study from August 2010 to April 2012.The inclusion criteria are total international prostate symptom score (IPSS) ≥8,OAB Symptom Score (OABSS) ≥3,OABSS urgency score ≥2,Postvoid residual volume (PVR) ＜ 100 ml,and maximum urinary flow rate (Qmax) ≥ 5 ml/s.All the patients who met the inclusion criteria were treated with α1-blocker ( tamsulosin 0.2 mg/day or doxazosin 4 mg/day) for 2 weeks.After 2 weeks,patients with no symptomatic improvement ( OABSS≥3) underwent pressure-flow test,and those whose Pdet≥ 40 cm H2O and DO presented more than one time were added antimuscarinics (solifenacin 5 mg/day or tolterodine 4 mg/day) for an additional 2 weeks.OABSS,IPSS,QOL,Qmax and PVR were re-evaluated every 2 weeks.Results Ninety-four cases of BPH/OAB patients met the inclusion criteria and completed 4 weeks treatment.The baseline of total OABSS was 7.0 ± 1.3,IPSS was 17.0 ± 1.7,QOL was 5.0 ±0.7,Qmax was (8.8 ±2.5) ml/s and PVR was (86.0 ± 16.5) ml.After 2 weeks treatment with α1-blocker alone,OABSS was 5.2 ± 0.8,IPSS was 14.2 ± 1.9,QOLwas4.O±0.8,Qmaxwas (11.4±2.4) ml/s and PVR was (67.9±12.9) ml.After another2 weeks treatment with α1-blocker plus antimuscarinics,OABSS was 3.1 ± 0.8,IPSS was 11.1 ± 1.9,QOL was 3.1 ± 0.7,Qmax was ( 10.8 ± 2.4) ml/s and PVR was (71.8 ± 11.9 ) ml.Compared with baseline values,OABSS,IPSS,QOL,Qmax and PVR significantly improved (P ＜ 0.01 ) in α1-blocker monotherapy group and α1-blocker plus antimuscarinic group.The improvement of OABSS,IPSS,QOL scores of α1-blocker plus antimuscarinic group were greater than α1-blocker monotherapy group (p ＜ 0.05 ),while Qmax and PVR showed no differences between the two groups.No acute urinary retention (AUR) was deteted.Conclusion Both of α1-blocker monotherapy and α1-blocker with antimuscarinics add-on therapy can improve OAB symptoms.