摘要
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.
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.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2015年第11期847-853,共7页
Chinese Journal of Urology
作者简介
通信作者：王志平，Email：erywzp@lzu．edu．cn
