【摘要】 目的 :系统评价坦索罗辛单用或联合抗胆碱能药物治疗输尿管支架相关症状(SRSs)的疗效,为临床治疗提供循证参考。方法:计算机检索Pub Med、Embase、Cochrane图书馆、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、万方数据库,检索时限均为各数据库自建库起至2019年10月,收集坦索罗辛单药(单用组)或联合抗胆碱能药物(联用组)对比安慰剂或空白对照(对照组)治疗SRSs的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取后,采用Cochrane协作网系统评价手册5.1.0进行质量评价,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入9项RCT,合计932例患者。Meta分析结果显示,在支架置入术后,单用组患者尿路症状评分[MD=-4.23,95%CI(-5.96,-2.51),P<0.000 01]、躯体疼痛评分[MD=-4.20,95%C(I-5.30,-3.10),P<0.000 01]、总体健康评分[MD=-1.36,95%C(I-1.75,-0.98),P<0.000 01]均显著低于对照组,差异均有统计学意义;两组患者工作能力评分[MD=0.19,95%CI(-0.99,1.37),P=0.76]、性生活质量评分[MD=-0.31,95%CI(-0.68,0.05),P=0.09]比较,差异均无统计学意义。支架取出后4周,单用组患者躯体疼痛评分[MD=-0.64,95%CI(-0.84,-0.43),P<0.000 01]、总体健康评分[MD=-0.28,95%CI(-0.41,-0.15),P<0.000 1]、尿路症状评分[MD=-1.46,95%C(I-2.60,-0.32),P=0.01]均显著低于对照组,差异均有统计学意义;而两组患者工作能力评分[MD=0.31,95%CI(-0.22,0.84),P=0.25]、性生活质量评分[MD=-0.15,95%C(I-0.41,0.10),P=0.23]比较,差异无统计学意义。单用组患者尿路症状评分[MD=5.93,95%CI(2.83,9.02),P=0.000 2]、躯体疼痛评分[MD=3.49,95%CI(1.39,5.60),P=0.001]、总体健康评分[MD=2.96,95%CI(1.44,4.49),P=0.000 1]均显著高于联用组;两组患者工作能力评分[MD=1.53,95%CI(-0.12,3.18),P=0.07]、性生活质量评分[MD=0.46,95%CI(-1.03,1.96),P=0.54]比较,差异均无统计学意义。结论:坦索罗辛对SRSs有较好的治疗作用,联合抗胆碱能药物能获得更好的治疗效果。更多还原

【Abstract】 OBJECTIVE:To systematically review the efficacy of tamsulosin alone or combined with antimuscarinic drugs in the treatment of ureteral stent-related symptom(SRSs), and to provide evidence-based reference for the clinical treatment.METHODS:Retrieved from Pub Med,Embase,Cochrane Library,CJFD,CBM,VIP and Wanfang database,from the inception to Oct. 2019,RCTs about tamsulosin alone(monotherapy group) or combined with antimuscarinic drugs(combination group)versus placebo or blank control(control group)in the treatment of SRSs were collected. After data extraction of included clinical studies met inclusion criteria,their quality was evaluated with Cochrane collaborative network system evaluation manual 5.1.0,and Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS:A total of 9 RCTs were included,involving932 patients. Meta-analysis results showed that after stent placement,the urinary symptoms score [MD=-4.23,95%CI(-5.96,-2.51),P<0.000 01],body pain score [MD=-4.20,95%CI(-5.30,-3.10),P<0.000 01],general health score [MD=-1.36, 95% CI(-1.75,-0.98), P<0.000 01] in monotherapy group were significantly lower than control group with statistical significance; there was no significantly difference in the work performance score [MD=0.19,95% CI(-0.99,1.37),P=0.76],sexual matters score [MD=-0.31,95%CI(-0.68,0.05),P=0.09] in 2 groups. 4 weeks after thestent was removed,the body pain score [MD=-0.64,95% CI(-0.84,-0.43),P<0.000 01],general health score [MD=-0.28,95%CI(-0.41,-0.15),P<0.000 01],urinary symptoms score [MD=-0.64,95%CI(-0.84,-0.43),P<0.000 01]in monotherapy group were significantly lower than control group after stent placement,with statistical significance;there was no significantly difference in the work performance score [MD=0.31,95%CI(-0.22,0.84),P=0.25] or sexual matters score [MD=-0.31,95%CI=(-0.68,0.05),P=0.09] in 2 groups. The urinary symptoms score [MD=5.93,95%CI(2.83,9.02),P=0.000 2],body pain score [MD=3.49,95%CI(1.39,5.60),P=0.001] and general health score [MD=2.96,95%CI(1.44,4.49),P=0.000 1]in the monotherapy group were higher than the combination group;there was no significantly difference in the work performance score [MD=1.53,95%CI(-0.12,3.18),P=0.07] or sexual matters score [MD=0.46,95%CI(-1.03,1.96),P=0.54] in 2 groups.CONCLUSIONS:Tamsulosin has a good therapeutic effect on SRSs;its combination with antimuscarinic drugs can achieve better therapeutic efficacty.更多还原