补肾活血类中药复方治疗前列腺增生症的系统评价

【作者】 周仕轶；

【导师】 张蜀武； 王久源；

【作者基本信息】 成都中医药大学 ， 中西医结合临床， 2004， 硕士

【摘要】 目的：系统分析补肾活血类中药复方治疗前列腺增生症(benign prostatic hyperplmsia，BPH)的疗效和不良反应，以期做出客观、可信的评价，指导临床用药。提出中医临床研究中存在的问题，拟采取的对策。 方法：采用循证医学的方法，全面检索国内1978年-2003年2月中医药治疗BPH的临床研究文献，按照文献可靠性的分级、试验分配的隐藏方案和JADAD量表评价文献的质量。对符合纳入标准的文献进行META分析，用Revman 4.2软件进行统计和系统评价。评价指标包括有效率，前列腺体积，最大尿流率(MFR)，膀胱残余尿量(PVR)，前列腺症状评分(I-PSS)及生活质量评分(QOL)。其中二分变量资料以比数比(OR)，相对危险度(RR)和率差(RD)来评价；连续变量资料以加权均数差(WMD)来评价。总体异质性卡方检验P＞0.05采用固定效应模型分析，反之P＜0.05采用随机效应模型分析。 结果：补肾活血类中药复方治疗BPH比前列康更为有效；与保列治相比无统计学差异；补肾活血类中药复方合用外科治疗与单纯外科治疗的疗效也无统计学差异。但补肾活血类中药复方就缓解患者症状来看在短期使用中有效，并表现出优于保列治及单纯外科治疗的趋势，补肾活血类中药复方对BPH的长期治疗作用从本文纳入的文献中无法判断。本文纳入的所有文献均报道了阳性试验结果，存在发表偏倚。 结论：应该进行随机、双盲、安慰剂对照、多中心、大样本的中药临床试验，从客观指标的改善来研究中医药治疗BPH的更成都中医药大学2001级硕士论文有效方法并客观评价其不良反应，以求更大程度改善患者症状，提高生活质量，减少药物不良反应，以便临床推广应用。更多还原

【Abstract】 Purpose: To make the system review of "Bushenhouxue" compound Chinese medicine treating benign prostatic hyperplasia (BPH) and their side effect so that clinical treating decision can be made based on objective, believable evaluation of the treatment to BPH by this method, to find out the problems in the clinical trials of traditional Chinese medicine and the methods to solve them.Method:All the articles about the research work of Chinese medicine treating BPH from 1978 to Feb. 2003 were searched based on the methods of Evidence-based Medicine (EBM). All the articles were evaluated based on reliability classification, concealment of research allocation and JADAD standard. The total effective rate, volume of the prostate, maximal flow rate of urine(MFR), post-voiding residual volume(PVR), international prostatic symptom score(I-PSS) and quality of life(QOL) in all the articles were involved to analyze with META-analysis using Revman 4.2 software. The odds ratio(OR), relative risk(RR) and risk difference(RD) were used to evaluate the dichotomous files and the weighed mean difference(WMD) was used to evaluate the continuous files. Fixed model evaluation was used if the probability of the test for heterogeneity is above 0.05 and random model evaluation was used if it is below 0.05.Result: The efficacy of "Bushenhouxue" compound Chinese medicine treating BPH is better than that of Qianliekang but no statistical difference is showed when compared with finasteride. The combining use of it with surgical treatment also shows no statistical difference with using surgical treatment only. If used in short periodfor treatment "Bushenhouxue" compound Chinese medicine is effective to alleviate the symptoms which has a better tendency than that of fmasteride and surgical treatment only. As for the long period effect no conclusion can be made from all these articles analyzed. There is a publication bias because all the articles reported positive results of their clinical trials.Conclusion: Massive, randomized, multi-center, double blind, and placenbo controlled clinical trials should be conducted to find out more effective method to treat BPH objectively with Chinese medicine in order to alleviate the symptoms, improve quality of life of BPH patients, and popularize the use of Chinese medicine.更多还原