低能量冲击波治疗勃起功能障碍疗效及安全性:随机对照试验的meta分析

目的:依据现有临床证据评价低能量冲击波(LI-ESWT)治疗勃起功能障碍(ED)的临床疗效及安全性。方法:通过计算机检索PubMed、Medline、EMBASE、Cochrane图书馆和CNKI、VIP、CBM、万方数据库建库至2018年6月有关LI-ESWT治疗ED的随机对照试验(RCT),由2名研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价,并采用RevMan 5.3软件进行meta分析。结果:共纳入来自8项随机双盲对照研究的595例ED患者,其中LI-ESWT治疗组362例,对照组233例。meta分析结果显示,与对照组相比较,LI-ESWT治疗可显著提高ED患者的IIEF评分WMD=1.70, 95%CI (0.44, 2.96),P=0.008]和勃起硬度分级(EHS)RR=11.72, 95%CI (5.13, 26.80),P<0.01]。进一步分析表明LI-ESWT治疗后随访4周和24周ED患者的IIEF评分均显著提高WMD=1.43, 95%CI (0.10, 2.75),P=0.03; WMD=3.09, 95%CI (1.49, 4.68),P=0.000 2];LI-ESWT治疗10～12次ED患者的IIEF评分显著提高,而治疗5～6次IIEF评分并未显示出明显增加WMD=1.81, 95%CI (0.31, 3.31),P=0.02; WMD=1.88,95%CI (-2.10, 5.86),P=0.35];基线IIEF≥12分ED患者LI-ESWT治疗后IIEF评分明显增加而基线IIEF≤11分治疗后IIEF评分并未显示出明显增加WMD=2.13, 95%CI (0.51, 3.75),P=0.01; WMD=1.04, 95%CI (-0.96, 3.03),P=0.31]。8项研究报告了LI-ESWT治疗后均无明显不良反应发生。结论:LI-ESWT作为一种非侵入性治疗手段,其可明显改善ED患者的IIEF评分和EHS分级,临床应用安全有效。

Efficacy and safety of low-intensity extracorporeal shock wave therapy in the treatment of ED: A meta-analysis of randomized controlled trials

MO Dun-sheng;ZHAN Xu-xin;SHI Hong-wei;CAI Hong-cai;MENG Jun;ZHAO Jing;SHANG Xue-jun(Department of Urology, Liuzhou Workers’ Hospital/The Fourth Affiliated Hospital of Guangxi Medical University,Linzhou, Guangxi 545005 , China;Department of Reproductive Medicine,Xi’an No.4 Hospital,Xi'an , Shaanxi 710004, China;Department of Traditional Chinese Medicine, Xi’an No.4 Hospital,Xi'an , Shaanxi 710004;Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology,Wuhan, Hubei 430030, China;Deshengchang Clinic of Traditional Chinese Medicine, Xianyang, Shaanxi 712000, China;Department of Andrology, Jinling Hospital Affiliated to Nanjing University School of Medicine, Nanjing, Jiangsu 210002 , China;Department of Andrology, Nanjing School of Clinical Medicine, Southern Medical University / General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002 , China)