右旋酮洛芬氨丁三醇在慢性前列腺炎/慢性骨盆疼痛综合征治疗中的应用

目的:评价右旋酮洛芬氨丁三醇在治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)中的疗效和安全性。方法:115例CP/CPPS患者被随机分为3组,右旋酮洛芬氨丁三醇组40例,口服右旋酮洛芬氨丁三醇25mg,3次/d,特拉唑嗪2mg,1次/晚;吲哚美辛组40例,口服吲哚美辛25mg,3次/d,特拉唑嗪2mg,1次/晚;特拉唑嗪组35例,口服特拉唑嗪2mg,1次/晚,分别连续药物治疗4周。治疗前后分别进行NIH-CPSI评分,比较各组的疗效和不良反应发生率。结果:治疗后各组NIH-CPSI评分较治疗前有明显改善,右旋酮洛芬氨丁三醇组和吲哚美辛组疗效均优于特拉唑嗪组(P<0.05),但其两组之间疗效相比差异无显著性(P>0.05)。右旋酮洛芬氨丁三醇组、吲哚美辛组和特拉唑嗪组不良反应发生率分别为10.00%、27.50%、8.57%,右旋酮洛芬氨丁三醇组、特拉唑嗪组不良反应发生率分别与吲哚美辛组相比差异有显著性(P<0.05)。结论:右旋酮洛芬氨丁三醇联合特拉唑嗪能有效改善CP/CPPS症状,其疗效优于单用特拉唑嗪,耐受性优于吲哚美辛。     

宁泌泰胶囊缓解良性前列腺增生下尿路症状的短期临床对照观察

目的:观察中成药宁泌泰胶囊缓解良性前列腺增生(BPH)患者下尿路症状(LUTS)的临床疗效和安全性。方法:筛选门诊BPH患者40例,随机分为对照组和试验组。对照组口服盐酸特拉唑嗪片每日1次,每次2 mg;试验组口服宁泌泰胶囊,每日3次,每次4粒。两组患者均连续服药14 d,分别于治疗前(门诊当日)、治疗7 d和治疗14 d时观察并记录患者的国际前列腺症状评分(IPSS)、生活质量评分(Qo L)和最大尿流率(Qmax),并检测患者的血常规、尿常规和肝肾功能。结果:宁泌泰胶囊和特拉唑嗪都能改善BPH患者IPSS总分、储尿期和排尿期IPSS,提高Qmax、增加排尿量并减少残余尿,提高患者生活质量。宁泌泰胶囊和特拉唑嗪主要差异在于服用宁泌泰胶囊的患者尿不尽感缓解更明显(IPSS问题1),服用特拉唑嗪的患者尿线变细问题缓解更明显(IPSS问题5)。特拉唑嗪减少残余尿量优于宁泌泰胶囊,而宁泌泰胶囊对Qo L的改善作用略优于特拉唑嗪,且总体不良反应发生率较少。结论:宁泌泰胶囊缓解BPH症状有一定疗效,安全性较好。宁泌泰胶囊和特拉唑嗪对尿路刺激和尿路梗阻症状的缓解各有侧重。     

多沙唑嗪治疗良性前列腺肥大合并下尿路症状患者的疗效优于阿夫唑嗪

为比较多沙唑嗪和阿夫唑嗪应用于治疗中到重度下尿路症状(LUTS)并提示膀胱流出道梗阻时的疗效,de Reijke TM等进行了一项14周多中心、随机、双盲、基线对照、剂量可调的临床研究。共入选210名有LUTS的良性前列腺肥大(BPE)患者,随机接受多沙唑嗪1～8mg,1次/d或阿夫唑嗪5～10mg,2～3次/d。应用国际前列腺症状评分IPSS和最大尿流率评估疗效。研究结束时,平均剂量多沙唑嗪6．1mg/d,阿夫唑嗪8．8mg/d。多沙唑嗪和阿夫唑嗪分别与基线比较,总IPSS评分改善的最小二乘方平均值为-9．23和-7．45(两组均P＜0．001),刺激症状分别改善为-3．5和-2．8(两组均P＜0．001)。多沙唑嗪在统计学意义上显著好于阿夫唑嗪(组间比较,总IPSS,P=0．036；刺激性症状,P=0．049)。在残尿量上,多沙唑嗪也显著优于阿夫唑嗪(-29．19 mL vs 9．59 mL,P=0．002)。两组改善在平均尿流率和最大尿流率方面接近,分别为 1．5、 1．2和 2．8、 2．5mL/s。两种药物耐受性良好,大多数不良事件为轻到中度。由此得出结论,多沙唑嗪和阿夫唑嗪的平均剂量效力并不等同,对于中、重度LUTS男性患者,多沙唑嗪6．1mg/d较阿夫唑嗪8．8 mg/d在改善总IPSS评分、刺激症状和残余尿量方面疗效更好,而两者改善平均尿流率和最大尿流率的疗效接近,同时多沙唑嗪和阿夫唑嗪均具有良好的耐受性。     

氨氯地平联合特拉唑嗪治疗老年性高血压疗效观察

目的探讨氨氯地平联合特拉唑嗪治疗老年性高血压的疗效。方法选择88例老年性高血压患者,随机为治疗组（氨氯地平联合特拉唑嗪）与对照组（氨氯地平）,二组治疗均为4周或血压降至正常范围。治疗前后监测血压、肝肾功能、血脂、血糖等。结果治疗组显效32例、有效9例、无效3例,总有效率为93.2%;对照组显效23例、有效11例、无效10例,总有效率为77.3%。治疗组疗效与对照组相比差异有统计学意义（P〈0.05）,治疗组与对照组治疗前后组间血压比较差异有统计学意义（P〈0.01）,两组治疗前后血常规、尿常规、肝肾功能、血糖、血脂等指标无明显变化。结论氨氯地平联合特拉唑嗪治疗老年原发性高血压疗效优于单用氨氯地平组,耐受性较好,未见明显不良反应。     

中药灌肠联合特拉唑嗪治疗Ⅲ_B型前列腺炎疗效观察

目的 观察中药灌肠联合特拉唑嗪治疗ⅢB型前列腺炎的临床疗效.方法 90例ⅢB型前列腺炎患者随机分成两组,对照组45例仅口服特托唑嗪2mg,1次/d,治疗14d:治疗组在口服特拉唑嗪基础上给予中药保留灌肠,1次/d,治疗14d.结果 对照组病例全部完成临床观察,治疗组有4例病例未完成临床观察,全部病例无不良事件发生.两组NIH-CPSI评分治疗后每个变量与治疗前比较差异均有统计学意义(P<0.05或P<0.01):治疗后治疗组NIH-CPSI评分与对照组相比具有统计学差异(P<0.05):两组NIH-CPSI评分治疗前后差值(d)相比,具有显著差异(P<0.05或P<0.01).结论 中药灌肠联合特拉唑嗪可显著提高ⅢB型前列腺炎疗效.     

特拉唑嗪联合氯美扎酮治疗慢性前列腺炎/慢性骨盆疼痛综合征的回顾性分析

目的:探讨α肾上腺素能受体(α-AR)阻滞剂特拉唑嗪联合氯美扎酮治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)的疗效和安全性。方法:将168例CP/CPPS患者随机分成3组:特拉唑嗪组58例、氯美扎酮组38例和特拉唑嗪+氯美扎酮组72例,每组患者均接受药物治疗4周。采用美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)评分作为疗效指标,分别评价各组患者的疗效和药物不良反应。结果:159例完成了4周的治疗并接受最终评估,其中特拉唑嗪组55例、氯美扎酮组35例、特拉唑嗪+氯美扎酮组69例。3组患者的NIH-CPSI总分治疗前后平均分别下降7.90、5.92、8.92分,与治疗前相比均有显著性差异(P<0.05)。特拉唑嗪+氯美扎酮组较特拉唑嗪组和氯美扎酮组总分下降均有显著性差异(P<0.05)。药物不良反应包括体位性低血压(特拉唑嗪组17.1%,特拉唑嗪+氯美扎酮组15.4%)、射精障碍(仅特拉唑嗪组3.4%)和倦怠、疲乏和厌食等(氯美扎酮组18.5%,特拉唑嗪+氯美扎酮组12.6%)。因不良事件终止治疗的共9例,其中特拉唑嗪组3例(5.2%)、氯美扎酮组3例(7.9%)、特拉唑嗪+氯美扎酮组3例(4.2%)。结论:特拉唑嗪、氯美扎酮均能有效缓解CP/CPPS患者的症状,改善患者的生活质量,两者联合治疗疗效优于单一治疗。     

特拉唑嗪治疗良性前列腺增生及下尿路症状有效性和安全性的前瞻性多中心研究

目的 研究特拉唑嗪4 mg/d治疗良性前列腺增生(BPH)及下尿路症状(LUTS)的疗效和安全性.方法临床诊断为BPH患者120例,随机分为2组,每组60例,分别给予特拉唑嗪2 mg/d或4 mg/d治疗2个月,比较2组患者治疗前后血压和IPSS、最大尿流率的变化,以及各种不良反应发生率.结果 2 mg和4 mg组完成治疗分别为46例和54例.2组年龄和治疗前基础血压、IPSS评分和最大尿流率比较差异无统计学意义.2组最大尿流率改善＞30%者分别为11例(23.9%)和25例(46.3%)(P=0.02).2组患者总体耐受性均良好,不良反应发生率低且程度轻微.结论 特拉唑嗪4 mg/d治疗BPH/LUTS在症状评分和最大尿流率改善效果优于2 mg/d,患者不良反应发生率低,总体耐受良好.

Abstract：

Objective To compare the efficacy and safety of 2 mg/d and 4 mg/d of terazosin in the treatment of benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS).Methods A total of 120 BPH patients were randomly divided into 2 groups receiving 2 mg or 4 mg terazosin per day for 2 months. Arterial blood pressure, International Prostatic Symptom Score (IPSS) and peak flow rate (Qmax) before and after treatment were compared while side effects were estimated. Results Forty-six patients receiving 2 mg and 54 patients receiving 4 mg terazosin completed this study. Patients' age and pre-treatment blood pressure, IPSS and Qmax had no difference between the 2 groups. The improvement of IPSS (including obstructive score, irritating score and total IPSS) and Qmax was significantly better in 4 mg group. The percentage of patients experiencing greater than 30% improvement in Qmax in the 4 mg treatment groups was significantly higher than that of the 2 mg group (46.3% vs 23.9%, P=0.02). Side effects were rare and mild in both groups.Conclusion The improvements of IPSS and Qmax are significantly greater in 4 mg treatment of terazosin than that of 2 mg with no obvious increase of side effects.     

α1受体阻滞剂(特拉唑嗪)在输尿管下段结石促排石的疗效观察

目的 评价α1受体阻滞剂(特拉唑嗪)治疗输尿管下段结石的疗效.方法 90例诊断为输尿管下段结石患者随机分为2组(每组45例).组1为对照组,给予双氯芬酸钠缓释片75mg/d,每天1次.组2为特拉唑嗪治疗组,在组1基础上加用特拉唑嗪2mg/d.结果 组1有18例排出结石,排石率40%,组2有39例排出结石,排石率86.6...     

坦索罗辛和特拉唑嗪治疗BPH的系统评价

目的:系统评价坦索罗辛(tamsulosin)和特拉唑嗪(terazosin)对照治疗BPH的疗效。方法:搜集世界范围内运用坦索罗辛和特拉唑嗪两种药物对比治疗BPH的随机对照试验(Randomized controlled trials,RCTs)和半随机临床对照试验(Clinical controlled trials,CCTs)的英文及中文文献,并追查已纳入文献的参考文献。由至少两位系统评价员做独立文献筛查、质量评价和资料提取,并交叉核对,不同意见请第三者裁决。使用统计软件Rev Man4.2完成Meta分析。结果:经筛选,最后纳入8篇文献,其中6篇RCT,2篇CCT,包括受试患者806例,排除失访人数,实际纳入763例进行Meta分析,其基线情况具有可比性。随访时间4~20周不等。通过比较用药前后6个判效指标,即国际前列腺症状评分(IPSS)、最大尿流率(MFR)、平均尿流率(AFR)、剩余尿量、生活质量(QOL)、前列腺体积的改善程度,发现在改善IPSS方面,坦索罗辛优于特拉唑嗪Z=2.09(P=0.04),WMD=0.75(0.07,1.43)。有证据支持在长期治疗后,坦素罗辛在改善QOL方面优于特拉唑嗪。除此之外,两者的疗效均无明显差异。结论:在改善IPSS方面,坦索罗辛效果优于特拉唑嗪;经长期治疗后,坦索罗辛在改善QOL方面优于特拉唑嗪。除此之外,二者差别无统计学意义。建议进行大样本、长期随访的高质量临床试验,提供更佳循证证据。     

特拉唑嗪联合前列舒通胶囊治疗前列腺增生的临床效果分析

目的研究良性前列腺增生运用特拉唑嗪联合前列舒通胶囊治疗的临床效果。方法将80例前列腺增生患者随机分为两组各40例,对照组患者单纯服用特拉唑嗪4 mg/次,1次/d,晚睡前服用进行治疗,观察组患者在此治疗基础上联合应用前列舒通胶囊进行治疗,3粒/次,3次/d,连续治疗3个月,对两组患者治疗前后的前列腺症状进行评分(IPSS)、最大尿流率(Qmax)、前列腺体积、残余尿量,同时记录不良事件的发生率。结果治疗后观察组患者的IPSS评分、前列腺体积变化比对照组显著,两组间差异有统计学意义(P0.05);两组患者的Qmax、残余尿量相比差异无统计学意义(P0.05)。结论前列腺增生运用特拉唑嗪联合前列舒通胶囊治疗的临床效果显著,有效改善前列腺增生的症状,缩小前列腺的体积,提高最大尿流速度,效果较好。     

Influence of hypertension on lower urinary tract symptoms in benign prostatic hyperplasia

AIM: To clarify the influence of hypertension on lower urinary tract symptoms (LUTS) we examined the relationship between blood pressure, LUTS, and the effect of terazosin on LUTS in patients with benign prostatic hyperplasia (BPH). METHODS: The subjects were patients who had LUTS and BPH. They were treated with terazosin (1 mg, twice-a-day) for 12 weeks. Calculation of the International Prostate Symptom Score (IPSS), measurement of blood pressure, and uroflowmetry were performed before and after 12 weeks of therapy. Patients were divided into a normotensive (NT) group and a hypertensive (HT) group at the time of first examination. RESULTS: The IPSS for urinary frequency and nocturia in BPH-HT patients (n = 21; mean age, 71 years) were significantly higher than those in the BPH-NT patients (n = 21; mean age, 69 years) before the administration of terazosin. The total IPSS the BPH-HT patients was also significantly higher than that of the BPH-NT patients. There were no differences of uroflowmetric parameters between the two groups. After 12 weeks of therapy, systolic and diastolic blood pressure decreased in the BPH-HT patients, but not in the BPH-NT patients. However, the systolic pressure of the BPH-HT patients was still significantly higher than that of the BPH-NT patients. The score for each IPSS parameter decreased in both groups, but the difference of the score between the two groups increased. CONCLUSION: Hypertension may worsen LUTS and may decrease the improvement of symptoms by terazosin.     

Amlodipine alone or combined with terazosin improves lower urinary tract disorder in rat models of benign prostatic hyperplasia or detrusor instability: focus on detrusor overactivity

OBJECTIVE

To investigate the effects of amlodipine, a dihydropyridine calcium‐channel blocker, alone or combined with terazosin, on urodynamics in rats with benign prostatic hyperplasia (BPH) and in female rats with detrusor instability (DI).

MATERIALS AND METHODS

The rat model of BPH was induced by subcutaneous injection of testosterone (0.5 mg per rat for 21 days). The female rat model of DI was induced by partial bladder outlet ligation for 6 weeks. The rats were intragastrically administered with assigned drugs (amlodipine, terazosin or both combined) for 14 days in three experiments. Continuous cystometry was assessed in rats under urethane anaesthesia.

RESULTS

Amlodipine at 0.5, 1 and 3 mg/kg significantly decreased the bladder index (BI), threshold pressure (TP), and micturition pressure (MP), and significantly increased intermicturition duration (IMD) in BPH rats. Moreover, amlodipine 0.5 mg/kg plus terazosin 0.4 mg/kg gave the greatest improvements in all urodynamic variables, with a greater decrease in BI, TP, MP and greater increase in IMD than with either of the drugs used alone in BPH and DI rats, and had a similar efficacy to terazosin 1 mg/kg. The combined treatment also gave a greater decrease in nonvoiding bladder contractions in DI rats.

CONCLUSIONS

Amlodipine alone or combined with terazosin might have the potential to alleviate lower urinary tract symptoms (LUTS). The combined therapy appears to be more suitable for LUTS with predominantly irritative symptoms.     

alpha-blocker monotherapy in the treatment of nocturia in men with lower urinary tract symptoms: a prospective study of response prediction

OBJECTIVE: To determine the efficacy of an alpha-adrenoceptor antagonist, terazosin, in reducing nocturia in men with lower urinary tract symptoms (LUTS), and to identify the factors predicting treatment outcome. PATIENTS AND METHODS: In all, 100 patients were treated with 2 mg of terazosin once daily for the first 7 days, and continued to receive 4 mg of terazosin once daily for the following 3 weeks. The men were assessed at baseline and at the end of treatment using uroflowmetry, the International Prostate Symptom Score (IPSS), and the degree of nocturia estimated from a frequency-volume chart (FVC) and objectively. RESULTS: On the FVC, 27 patients reported that the terazosin treatment reduced their nocturia by more than half, and 14 reported a reduction of 25-49%. On the IPSS, 31 patients reported that the treatment reduced their nocturia by more than half and 27 reported a reduction of 25-49%. On multivariate regression analysis, only the actual number of nightly voids on the FVC was associated with a 2.1-fold chance of an improvement of >25% in objective nocturia (P = 0.016). Using a comparable model, a greater nocturia score on the IPSS was associated with a higher likelihood of improvement in subjective nocturia (odds ratio, 1.653; 95% confidence interval, 1.079-2.533; P = 0.021). CONCLUSION: Treatment with terazosin can reduce patients' episodes of nocturia both subjectively and objectively in some men with LUTS. Our results suggest that both subjective and objective numbers of nocturia episodes are associated with improvements in subjective and objective nocturnal frequencies, respectively.     

A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

INTRODUCTION: Benign prostatic hyperplasia (BPH) is associated with bothersome lower urinary tract symptoms (LUTS) and reduced patient quality of life (QoL). Phosphodiesterase (type) 5 (PDE5) inhibitors such as vardenafil are commonly used for the treatment of erectile dysfunction (ED), but have also been shown to improve the symptoms of BPH. This randomised, double-blind, placebo-controlled study investigated the effects of vardenafil on LUTS and QoL in men with BPH/LUTS, with or without concomitant ED. METHODS: Men aged 45-64 yr with BPH/LUTS and an International Prostate Symptom Score (IPSS) > or =12 were randomised to receive either 10mg vardenafil or placebo twice daily. LUTS were assessed with the use of two primary efficacy parameters, IPSS score and maximum urinary flow rate (Qmax), as well as postvoid residual (PVR) urine volume; ED was measured with the use of the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-EF); and QoL was assessed with the Urolifetrade mark QoL-9 questionnaire. RESULTS: After 8 wk of treatment, there was a significant improvement in the IPSS total score in the vardenafil group compared with placebo (-5.9 and -3.6, respectively; p=0.0013). Nominally significant improvements in irritative and obstructive IPSS subscores (p=0.0017 and p=0.0081, respectively), EF (p=0.0001), and Urolife QoL-9 (p<0.0001) were also associated with vardenafil treatment. Qmax and PVR urine volume did not change significantly with treatment, although baseline values were already considered close to normal. Vardenafil was generally well tolerated, with most adverse events considered mild or moderate in severity. CONCLUSIONS: Vardenafil treatment significantly improved LUTS, EF, and QoL in men with BPH/LUTS. Vardenafil may be considered a promising treatment option for men with symptoms secondary to BPH.     

Terazosin and doxazosin in the treatment of BPH: results of a randomized study with crossover in non-responders

OBJECTIVE: To compare the effects of the doxazosin and terazosin on total International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in treating patients with lower urinary tract symptoms (LUTS) and compare this effectivity by switching the drugs in the patients who did not benefit from either the first or the second drug. METHODS: This is a prospective randomized study of the patients with LUTS suggestive of benign prostatic hyperplasia (BPH). Fifty male patients (mean age 59.4 +/- 7.6 years) received either doxazosin (n = 25) or terazosin (n = 25) once daily every night. The patients were evaluated in the 1st, 2nd and 3rd months of treatment. Minimum 20% improvement in IPSS and Qmax in the 3rd month was considered as improvement. The patients with no improvement in any of the parameters switched the drugs, and they were followed up in the next 3 months. The patients whose only one parameter improved were excluded from the study. RESULTS: Eleven (44%) out of 25 patients using doxazosin and 10 (40%) out of 25 patients using terazosin showed improvement in both IPSS and Qmax at the end of the 3rd month and continued using the drug. After 3 months of treatment, increase in Qmax (p < 0.001) and decrease in IPSS (p < 0.01) was significant for both doxazosin and terazosin. Nineteen patients, who did not show improvement in any of the parameters, switched the drug. Of the patients who switched the drug, 2 (4%) showed improvement both in IPSS and in Qmax, while 2 (4%) showed improvement only in IPSS but not in Qmax. The remaining 15 (30%) patients did not show improvement in any of the parameters. CONCLUSION: The results of the study suggest that alpha-blockade with either doxazosin or terazosin is effective in males with LUTS. The two alpha-blocking drugs showed equal effectiveness in the treatment of LUTS. If one of the drugs is ineffective in the treatment of LUTS, then the other drug will probably be ineffective.     

锯叶棕果实提取物治疗BPH引起的下尿路症状疗效观察

目的:探讨锯叶棕果实提取物治疗BPH引起的下尿路症状的疗效。方法:采用锯叶棕果实提取物单药治疗30例前列腺增生伴下尿路症状患者8周,分别比较患者治疗前后的最大尿流率、前列腺体积、剩余尿量、IPSS评分及QOL评分的变化情况。结果:治疗8周后,患者的最大尿流率、剩余尿量、IPSS评分及QOL评分均有明显改善,前列腺体积则无明显变化。所有患者均无明显不良反应。结论:锯叶棕果实提取物能有效改善BPH患者的下尿路症状。     

Effects of three types of alpha‐1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia

Objectives: The aim of the present study was to explore the effects of three different types of alpha‐1 adrenoceptor blockers (α1‐blocker) on lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and ejaculatory dysfunction (EjD) in patients with benign prostatic hyperplasia. Methods: A total of 136 male LUTS patients aged 50–80 years with International Prostate Symptom Score (IPSS) ≥8 were enrolled. They were divided into three groups. Group S received silodosin at 4 mg twice a day; group T received tamsulosin at 0.2 mg once a day; and group N received naftopidil at 50 mg once a day. Assessment included IPSS, quality of life indexes (QOL), International Index of Erectile Function (IIEF‐5), an ejaculation questionnaire, Qmax and post‐void residual urine volume (PVR). These parameters were recorded at baseline, and at 1 and 3 months after treatment had ended. Results: Mean IPSS and Qmax significantly improved after treatment in all groups without any significant difference among them. As for the IIEF‐5 score, only group N significantly improved at 1 and 3 months. After treatment, 2.6 and 2.4% of patients complained of a de novo reduced volume of ejaculation in both groups T and N, respectively. Ten out of 41 patients (24.4%) complained of a total absence of antegrade ejaculation in group S after treatment. Conclusions: All three types of α1‐blockers provided an objective and subjective improvement of LUTS in the present study population. However, erectile function only improved in patients treated with naftopidil and a higher rate of EjD was observed in those receiving silodosin. Because of their variable effects, we should consider the sexual dimension when prescribing α1‐blockers for LUTS.