目的 系统评价高选择性α1D受体阻滞药萘哌地尔治疗输尿管远端结石的有效性及安全性。方法 计算机检索了Pubmed、Cochrane图书馆、中国期刊全文数据库、万方数据库和维普数据库,收集了萘哌地尔治疗输尿管远端结石的随机对照试验。由2名评价者共同评价纳入文献质量并提取资料,采用Review Manager 5.0完成资料分析。结果 共纳入11个研究,包含983例患者。Meta分析结果显示:与观察等待组相比,萘哌地尔组的排石率明显提高(RR=1.63,95% CI 1.32~2.03,P<0.01),排石时间缩短(WMD=-2.83,95% CI -3.75~-1.92,P<0.01),差异均有统计学意义。与α1A受体阻滞药组相比,二者排石率(RR=0.97,95% CI 0.78~1.20,P=0.76)和排石时间(WMD=0.15,95% CI 0.40~0.69,P=0.59)比较,差异均无统计学意义,但萘哌地尔组不良反应的发生率明显降低,差异有统计学意义(RR=0.52,95% CI 0.27~0.98,P=0.04)。结论 萘哌地尔能有效促进输尿管远端结石排出,与α1A受体阻滞药相比无明显差异,但不良反应发生率明显降低。
Abstract
Objective To access the efficacy and safety of naftopidil in medical expulsive therapy of distal ureteral calculi. Methods A systematic search was performed in Pubmed, Cochrane Library, CNKI, Wanfang database and VIP database to identify RCTs that compared naftopidil and other therapy for distal ureteral calculi. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan5.0. Results 11 studies with a total of 983 patients met the inclusion criteria. There was a significant overall benefit for stone expulsion rate(RR=1.63, 95%CI 1.32-2.03, P＜0.01)and stone expulsion time(WMD=-2.83, 95% CI -3.75--1.92, P＜ 0.01)in naftopidil group compared with watching waiting group. Compared with α1A adrenergic receptor blockers group, there was no statistically significant differences in expulsion rate(RR=0.97, 95% CI 0.78-1.20, P=0.76)and stone expulsion time(WMD=0.15, 95%CI -0.40-0.69, P=0.59). But naftopidil provided a significantly lower side effects rate(RR=0.52, 95%CI 0.27-0.98, P=0.04). Conclusions Naftopidil can effectively promote the expulsion of distal ureteral calculi. Compared with α1A-adrenergic receptor blockers, there are no statistically significant differences in expulsion rate and stone expulsion time, but with a significantly lower side effects rate.
关键词
输尿管远端结石 /
萘哌地尔 /
高选择性α1D受体阻滞药 /
药物排石 /
Meta分析
Key words
distal ureteral calculi /
naftopidil /
α1D adrenergic receptor blockers /
medical expulsive therapy /
Meta-analysis
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参考文献
[1] 刘志华, 周祥福. 输尿管下段结石的治疗进展[J]. 中华腔镜泌尿外科杂志(电子版),2010, 4(1):76-78.
[2] Wook K D, Gorbachinsky I, Gutierrez J. Medical expulsive therapy [J]. Indian J Urol, 2014, 30(1): 60-64.
[3] Jadal A R, Moore R A,Carroll D,et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
[4] Lu J L, Tang Q L, De L F,et al. Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study[J]. Urol Res, 2012, 40(6): 757-762.
[5] Lv J L,Tang Q L.Comparative evaluation of efficacy of use of naftopidil and/or celecoxib for medical treatment of distal ureteral stones[J]. Urolithiasis, 2014,42(6): 541-547.
[6] Kumar S, Kurdia K C,Ganesamoni R,et al. Randomized controlled trial to compare the safety and efficacy of naftopidil and tamsulosin as medical expulsive therapy in combination with prednisolone for distal ureteral stones [J]. Korean J Urol, 2013, 54(5):311-315.
[7] Tsuzaka Y, Matsushima H,Kaneko T,et al. Naftopidil vs silodosin in medical expulsive therapy for ureteral stones: a randomized controlled study in Japanese male patients[J]. Int J Urol, 2011,18(11): 792-795.
[8] Zhou S G, Lu J L, and Hui J H.Comparing efficacy of alpha1D-receptor antagonist naftopidil and alpha1A/D-receptor antagonist tamsulosin in management of distal ureteral stones[J]. World J Urol, 2011, 29(6): 767-771.
[9] 王浩敏,王 芳,李永生,等.萘哌地尔治疗输尿管下段结石的疗效观察[J].药物与临床,2010,17(31):51-52.
[10] 张忠林,李火金,史 明,等.萘哌地尔治疗输尿管下段结石的疗效观察[J].深圳中西医结合杂志,2009,19(1):34-36.
[11] 金晓华,王 竞,范 波,等.萘哌地尔治疗输尿管下段结石的临床研究[J].现代中西医结合杂志, 2012, 21(30): 3369-3371.
[12] Kohjimoto Y, Hagino K, Ogawa T,et al. Naftopidil versus flopropione as medical expulsive therapy for distal ureteral stones: results of a randomized, multicenter, doubleblind, controlled trial [J]. 2015, 33(12): 2125-2129.
[13] Sun X Z, Lei H, Wei H G,et al. Efficacy of selective 1D-blocker naftopidil as medical expulsive therapy for distal ureteral stones [J]. J Urol, 2009,181(4):1716-1720.
[14] 冉 清,窦 科,熊 伟.萘哌地尔治疗输尿管下段结石的临床评价[J].四川医学, 2008, 29(5): 540-541.
[15] Malin J M, Deane R F, Boyarsky S. Characterisation of adrenergic receptors in human ureter [J]. Br J Urol, 1970, 42(2): 171-174.
[16] Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medicalmanagement of juxtavesical ureteral stones [J]. J Urol, 2003, 170(6pt1): 2202-2205.
[17] Itoh Y, Kojima Y, Yasui T, et al. Examination of alpha 1 adrenoceptor subtypes in the human ureter [J]. Int J Urol, 2007, 14(8):749-753.
[18] Takei R, Ikegaki I, Shibata K,et al. Naftopidil, a novel alpha1-adrenoceptor antagonist, displays selective inhibition of canine prostatic pressure and high affinity binding to cloned human alpha1-adrenoceptors [J]. Jpn J Pharmacol, 1999, 79(4): 447-454.
[19] Ohgaki K, Horiuchi K, Hikima N,et al. Facilitation of expulsion of ureteral stones by addition of α1-blockers to conservative therapy [J].Scand J Urol Nephrol, 2010,44(6):420-424.
[20] Sasaki S, Tomiyama Y, Kobayashi S,et al. Characterization of α1-adrenoceptor subtypes mediating contraction in human isolated ureters [J]. Urology, 2011,77(3):762.e13-17.
[21] Tatemichi S, Kobayashi K, Maezawa A,et al. Alpha1-adrenoceptor subtype selectivity and organ specificity of silodosin(KMD-3213)[J]. Yakugaku zasshi, 2006,126: 209-216.
[22] Take H, Shibata K, Awaji T,et al. Vascular alpha1-adrenoceptor subtype selectivity and alpha1-blocker-induced orthostatic hypotension [J]. Jpn J Pharmacol,1998, 77(1): 61-70.
[23] Bozkurt O, Demir O, Sen V,et al. Silodosin causes impaired ejaculation andenlargement of seminal vesicles in sexually active men treated for lower urinary tract symptoms suggestive of benign prostatic hyperplasia[J]. Urology, 2015, 85(5):1085-1089.
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