贺晓龙 强亚勇 张斌病 宋红雄 勒永胜 周培清

【摘要】目的：比较单用α肾上腺受体阻滞剂与α肾上腺受体阻滞剂联合5α-还原酶抑制剂治疗良性前列腺增生（BPH）的疗效。方法：检索中/英文公开发表的随机对照试验（RCT）。计算机检索PubMed、EMbase、the Cochrane Central Register of Controlled Trials（CENTRAL）、CNKI、CBM、VIP、万方数据库。检索时间为建库至2015年6月30日。同时，手检纳入文献的参考文献。按纳入排除标准进行RCT的筛选、资料提取和质量评价后，采用RevMan 5.2软件进行Meta分析。结果：共纳入4个研究，403例患者。Meta分析结果显示：有效性方面，两组在降低IPSS评分[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]、减少残余尿量 [SMD=0.62，95%CI（-0.97，2.22）P=0.17]上无明显统计学差异；与单用药物相比，联合用药在减少前列腺体积上 [SMD=6.94，95%CI（2.06，11.81）P=0.005]效果更好，两组在出现不良反应（头晕[SMD=0.57，95%CI（0.16，1.98）P=0.38]、性功能减退 [SMD=0.57，95%CI（0.16，1.98）P=0.38]）上无明显统计学差异。结论：单用α肾上腺受体阻滞剂与α肾上腺受体阻滞剂联合5α-还原酶抑制剂相比，两者疗效相似，对于前列腺体积不大的患者，单用α肾上腺受体阻滞剂即可达到很好的疗效，避免了不必要的经济负担；对于前列腺体积较大的患者，则推荐联合用药。对于前列腺具体多大的体积才是单用α肾上腺受体阻滞剂与联合5α-还原酶抑制剂治疗的分界阈值，则需要更多高质量、大样本的RCT进一步论证。

【关键词】良性前列腺增生：α肾上腺受体阻滞剂；5α-还原酶抑制剂；随机对照试验

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）

【中图分类号】R697+.3【文献标志码】A

良性前列腺增生（BPH）是老年男性的常见疾病之一[1]，目前在临床上越来越受到关注。在流行病学方面研究中发现：BPH的发生率在40多岁以后随年龄的增大而显著增高，严重影响了患者的生活质量[2]。……