中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
Chinese Journal of Urology
2015年
11期
847-853
,共7页
李冲%王娟%曹文娟%高彦俊%鲁克庆%王志平
李遲%王娟%曹文娟%高彥俊%魯剋慶%王誌平
리충%왕연%조문연%고언준%로극경%왕지평
坦索罗辛%硝苯地平%药物排石治疗%输尿管结石%荟萃分析
坦索囉辛%硝苯地平%藥物排石治療%輸尿管結石%薈萃分析
탄색라신%초분지평%약물배석치료%수뇨관결석%회췌분석
Tamsulosin%Nifedipine%Medical expulsive therapy%Ureteral stones%Meta-analysis
目的 系统评价坦索罗辛和硝苯地平治疗输尿管下段结石的疗效及安全性.方法 2015年6-7月计算机检索Pubmed、Cochrane Library、Embase、中国期刊全文数据库、中国生物医学文献数据库、万方数据库、维普中文科技期刊数据库,收集有关坦索罗辛与硝苯地平治疗输尿管下段结石的随机对照试验,检索时限均从建库至2015年7月.2位研究员按照Cochrane手册评价方法独立对纳入文献进行质量评价,并提取患者数量、结石大小、排石率、排石时间、药物不良反应、后期体外冲击波碎石术(ESWL)或输尿管镜碎石(ureteroscopy lithotripsy,URSL)治疗率以及镇痛药使用量等数据,采用RevMan5.2统计软件对药物排石率、后期ESWL或URSL治疗率和药物不良反应进行荟萃分析.结果 共纳入13个随机对照试验,包括4 831例患者,其中坦索罗辛治疗组2 423例,硝苯地平治疗组2 408例.坦索罗辛组和硝苯地平组的结石排出率分别为92％(2 221/2 423)和73％(1 748/2408),后期ESWL或URSL治疗率分别为8％ (27/333)和20％ (67/328),差异均有统计学意义(RR=1.24,95％ CI 1.13～1.37,P＜0.05;RR =0.40,95％CI0.27 ～0.60,P＜0.05).坦索罗辛组和硝苯地平组的轻度不良反应发生率分别为5％ (99/1 804)和7％(117/1 796),重度不良反应发生率均＜1％(1/1 804,3/1 796),差异均无统计学意义(RR =0.85,95％ CI0.65 ～1.10,P=0.21;RR =0.49,95％CI0.09 ～2.59,P=0.40).结论 与硝苯地平相比,坦索罗辛具有较高的排石率,能降低后期ESWL或URSL的应用率,且无明显不良反应,可以优先考虑作为药物排石的选择.
目的 繫統評價坦索囉辛和硝苯地平治療輸尿管下段結石的療效及安全性.方法 2015年6-7月計算機檢索Pubmed、Cochrane Library、Embase、中國期刊全文數據庫、中國生物醫學文獻數據庫、萬方數據庫、維普中文科技期刊數據庫,收集有關坦索囉辛與硝苯地平治療輸尿管下段結石的隨機對照試驗,檢索時限均從建庫至2015年7月.2位研究員按照Cochrane手冊評價方法獨立對納入文獻進行質量評價,併提取患者數量、結石大小、排石率、排石時間、藥物不良反應、後期體外遲擊波碎石術(ESWL)或輸尿管鏡碎石(ureteroscopy lithotripsy,URSL)治療率以及鎮痛藥使用量等數據,採用RevMan5.2統計軟件對藥物排石率、後期ESWL或URSL治療率和藥物不良反應進行薈萃分析.結果 共納入13箇隨機對照試驗,包括4 831例患者,其中坦索囉辛治療組2 423例,硝苯地平治療組2 408例.坦索囉辛組和硝苯地平組的結石排齣率分彆為92％(2 221/2 423)和73％(1 748/2408),後期ESWL或URSL治療率分彆為8％ (27/333)和20％ (67/328),差異均有統計學意義(RR=1.24,95％ CI 1.13～1.37,P＜0.05;RR =0.40,95％CI0.27 ～0.60,P＜0.05).坦索囉辛組和硝苯地平組的輕度不良反應髮生率分彆為5％ (99/1 804)和7％(117/1 796),重度不良反應髮生率均＜1％(1/1 804,3/1 796),差異均無統計學意義(RR =0.85,95％ CI0.65 ～1.10,P=0.21;RR =0.49,95％CI0.09 ～2.59,P=0.40).結論 與硝苯地平相比,坦索囉辛具有較高的排石率,能降低後期ESWL或URSL的應用率,且無明顯不良反應,可以優先攷慮作為藥物排石的選擇.
목적 계통평개탄색라신화초분지평치료수뇨관하단결석적료효급안전성.방법 2015년6-7월계산궤검색Pubmed、Cochrane Library、Embase、중국기간전문수거고、중국생물의학문헌수거고、만방수거고、유보중문과기기간수거고,수집유관탄색라신여초분지평치료수뇨관하단결석적수궤대조시험,검색시한균종건고지2015년7월.2위연구원안조Cochrane수책평개방법독립대납입문헌진행질량평개,병제취환자수량、결석대소、배석솔、배석시간、약물불량반응、후기체외충격파쇄석술(ESWL)혹수뇨관경쇄석(ureteroscopy lithotripsy,URSL)치료솔이급진통약사용량등수거,채용RevMan5.2통계연건대약물배석솔、후기ESWL혹URSL치료솔화약물불량반응진행회췌분석.결과 공납입13개수궤대조시험,포괄4 831례환자,기중탄색라신치료조2 423례,초분지평치료조2 408례.탄색라신조화초분지평조적결석배출솔분별위92％(2 221/2 423)화73％(1 748/2408),후기ESWL혹URSL치료솔분별위8％ (27/333)화20％ (67/328),차이균유통계학의의(RR=1.24,95％ CI 1.13～1.37,P＜0.05;RR =0.40,95％CI0.27 ～0.60,P＜0.05).탄색라신조화초분지평조적경도불량반응발생솔분별위5％ (99/1 804)화7％(117/1 796),중도불량반응발생솔균＜1％(1/1 804,3/1 796),차이균무통계학의의(RR =0.85,95％ CI0.65 ～1.10,P=0.21;RR =0.49,95％CI0.09 ～2.59,P=0.40).결론 여초분지평상비,탄색라신구유교고적배석솔,능강저후기ESWL혹URSL적응용솔,차무명현불량반응,가이우선고필작위약물배석적선택.
Objective To compare the efficacy and safety of tamsulosin with nifedipine for medical expulsive therapy (MET) in patients with lower ureteral stones (LUS).Methods Randomized controlled trials(RCTs) in comparison of tamsulosin and nifedipine in treatment of LUS published in Pubmed, Cochrane Library,Embase,CNKI,CBM, Wanfang and VIP from databases establishment to July 2015 were retrieved.According to Cochrane handbook, the quality of included RCTs were assessed, and the relevant data including the number of participants, stone size, stone expulsion rate, time to stone expulsion, drug-related side effect,the incidence of ESWL or ureteroscopy lithotripsy (URSL) after MET and analgesic dose were extracted by two reviewers independently.The statistical software RevMan 5.2 was used for meta-analysis with regard to the stone expulsion rate, the incidence of ESWL or URSL and adverse effects.This study lasted more than one month from June to July 2015.Results A total of 13 RCTs with 4 831 patients were eligible.The results showed that the stone expulsion rate and the incidence rate of ESWL or URSL after MET were 92％ (2 221/2 423) and 8％ (27/333) in the tamsulosin group,and 73％ (1 748/2 408) and 20％ (67/328) in the nifedipine group.There are statistically significant differences (RR =1.24,95 ％ CI 1.13-1.37, P ＜ 0.05;RR =0.40,95 ％ CI 0.27-0.60, P ＜ 0.05, respectively).The subgroup analysis indicated no statistically significant differences in drug-related adverse effects between tamsulosin and nifedipine with 5％ (99/1 804)and 7％ (117/1 796) minor adverse effects respectively and less than 1％ severe adverse effects in both groups (RR =0.85,95％ CI 0.65-1.10, P =0.21;RR =0.49,95 ％ CI 0.09-2.59, P =0.40).Conclusion Compared to nifedipine, tamsulosin has higher stone expulsion rate and lower incidence rates for ESWL or URSL.Since there was no obvious adverse effects, tamsulosin could be considered as a preferable option for patients with LUS.
