非那雄胺治療經尿道前列腺切除術中出血的Meta分析_《中國循證醫學雜志》

作者：

朱育春 ¹ , 鐘玲 ² , 魏強 ¹

1. 四川大學華西醫院泌尿外科（成都 610041） 2. 四川大學華西臨床醫學院;

關鍵詞：

非那雄胺經尿道前列腺切除術出血良性前列腺增生（癥） Meta分析

DOI：

10.7507/1672-2531.20080104

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目的　評價非那雄胺治療經尿道前列腺切除術中出血的效果。
方法　按Cochrane 協作網工作手冊的要求，制定相應的納入/ 排除標準及檢索策略。檢索MEDLINE（1966～2005）、EMbase（1984～2004）、CBM（1980～2005）、Cochrane 圖書館（2005 年第4期）以及相關雜志和學位論文，收集非那雄胺治療經尿道前列腺切除術中出血的隨機和非隨機對照試驗。對納入的試驗進行方法學質量評價。采用統一的表格由兩名評價員獨立進行資料提取，用RevMan4.2 軟件進行數據處理和分析。
結果　最終納入5篇文獻：4 個為隨機對照試驗，1個為非隨機對照試驗。3個隨機對照試驗的質量等級均為C級。Meta分析結果顯示，兩組年齡、下尿路癥狀評分、前列腺特異抗體水平及術前前列腺體積、術中切除組織量均可比（P gt;0.05）的情況下，非那雄胺組術中出血量［WMD –85.44，95%CI（–117.31，–53.58）］、每克切除前列腺組織出血量［WMD –3.5，95%CI（–6.34，–0.58）］，術前術后血色素降低量［WMD – 1.61，95%CI（–1.96，–1.26）］均少于對照組。
結論　現有證據表明，行經尿道前列腺切術前服用非那雄胺能有效減少術中出血。

引用本文： 朱育春,鐘玲,魏強. 非那雄胺治療經尿道前列腺切除術中出血的Meta分析. 中國循證醫學雜志, 2008, 08(6): 456-460. doi: 10.7507/1672-2531.20080104 復制

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11.	Gormley GJ, Stoner E, Bruskewitz RC, et al. For the Finasteride Study Group: The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med, 1992, 327: 1185-1191.
12.	Marshall S, Narayan P. Treatment of prostatic bleeding: suppression of angiogenesis by androgen deprivation. J Urol, 1993, 149: 1553-1554 .
13.	Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
14.	Hochberg DA, Basillote JB, Armenakas NA, et al. Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia. J Urol, 2002, 167: 1731-1733.
15.	Luke M, Kvist E, Anderson F, et al. Reduc postoperative bleeding after transurethral resectioprostate by local instillation of fibrin adhesive. BeBr J Urol, 1986, 58: 672-675.
16.	Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU Int, 2000, 85(1): 70-73.
17.	Szewczyk W. Blood loss during transurethral resection of the prostate injected with phenol solution. Int Urol Nephrol, 1991, 23: 155-159.
18.	Levine AC, Liu XH, Greenberg PD, et al. Androgens induce the expression of vascular endothel ial growth factors in human fetal prostatic fibroblasts. Endocrinology, 1998, 139: 4672-4678 .
19.	Franck-Lissbrant I, Haggestrom S, Damber JE, et al. Testosterone stimulates angiogenesis and vascular regrowth in the ventral prostate in castrated adult rats. Endocrinology, 1998, 139: 451-456.
20.	Buttyan R, Ghafar MA, Shabsigh A. The effects ofandrogen deprivation on the prostate gland: cell death mediated by vascular regression. Curr Opin Urol, 2000, 10: 415-420.
21.	Weingartner K, Ben-Sasson S, Stewart R, et al. Endothel ial cell prol iferation activity in benign prostatic hyperplasia and prostate cancer: an in vitro model for assessment. J Urol, 1998, 159: 465-470.
22.	Senger DR, Gall i SJ, Dvorak AM, et al. Tumor cells secrete a vascular permeabil ity factor that promotes accumulation of ascites fluid. Science, 1983, 219(4587): 983-985.
23.	Moon SY, Moon WC, Hak R, et al. Finasteride inhibits angiogenesis and expression of VEGF in human BPH. J Urol, 1998, 159(suppl): 332, abstract 1276.
24.	Miller MI, Puchner PJ. Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up. Urology, 1998, 51: 237-240.

1. Dull P, Reagan RW Jr, Bahnson RR, et al. Managing Benign ProstaticHyperplasia. Am Fam Physician, 2002, 66(1): 77-84.
2. Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
3. Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6[updated month year]. The Cochrane Library, Issue 4, 2006. Chichester: Wiley. Updated quarterly.
4. 李幼平, 劉鳴. 循證醫學—21世紀的臨床醫學. 實用醫學雜志, 2000, 16: 517-521.
5. Peter Juni, Anne Witschi, Ralph Bloch T, et al. he hazards of scoring the qual ity of cl inical trials for meta-analysis. JAMA, 2000, 282: 1054-1060.
6. Crea G, Sanfil i ppo G, Anastasi G, et al. Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia. Urologia Internationalis, 2005, 74(1): 51-53.
7. Donohue JF, Sharma H, Abraham R, et al. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of role of finasteride for decreasing operative blood loss. J Urol, 2002, 168: 2024-2026.
8. 李恭會, 何正富, 余大敏, 等. 非那雄胺對經尿道前列腺切除術中出血和沖洗液吸收影響的定量性研究. 浙江大學學報 (醫學版), 2004, 33(3): 258-260.
9. 劉孝東, 楊宇如, 盧一平, 等. 非那雄胺減少TURP術中出血的機理研究. 中華泌尿外科雜志, 2003, 10(24): 694-696.
10. Ozdal OL, Ozden C, Benl i K, et al. Effect of short-term finasteride therapy on reoperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study. Prostate Cancer Prostatic Dis, 2005, 8(3): 215-218.
11. Gormley GJ, Stoner E, Bruskewitz RC, et al. For the Finasteride Study Group: The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med, 1992, 327: 1185-1191.
12. Marshall S, Narayan P. Treatment of prostatic bleeding: suppression of angiogenesis by androgen deprivation. J Urol, 1993, 149: 1553-1554 .
13. Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
14. Hochberg DA, Basillote JB, Armenakas NA, et al. Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia. J Urol, 2002, 167: 1731-1733.
15. Luke M, Kvist E, Anderson F, et al. Reduc postoperative bleeding after transurethral resectioprostate by local instillation of fibrin adhesive. BeBr J Urol, 1986, 58: 672-675.
16. Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU Int, 2000, 85(1): 70-73.
17. Szewczyk W. Blood loss during transurethral resection of the prostate injected with phenol solution. Int Urol Nephrol, 1991, 23: 155-159.
18. Levine AC, Liu XH, Greenberg PD, et al. Androgens induce the expression of vascular endothel ial growth factors in human fetal prostatic fibroblasts. Endocrinology, 1998, 139: 4672-4678 .
19. Franck-Lissbrant I, Haggestrom S, Damber JE, et al. Testosterone stimulates angiogenesis and vascular regrowth in the ventral prostate in castrated adult rats. Endocrinology, 1998, 139: 451-456.
20. Buttyan R, Ghafar MA, Shabsigh A. The effects ofandrogen deprivation on the prostate gland: cell death mediated by vascular regression. Curr Opin Urol, 2000, 10: 415-420.
21. Weingartner K, Ben-Sasson S, Stewart R, et al. Endothel ial cell prol iferation activity in benign prostatic hyperplasia and prostate cancer: an in vitro model for assessment. J Urol, 1998, 159: 465-470.
22. Senger DR, Gall i SJ, Dvorak AM, et al. Tumor cells secrete a vascular permeabil ity factor that promotes accumulation of ascites fluid. Science, 1983, 219(4587): 983-985.
23. Moon SY, Moon WC, Hak R, et al. Finasteride inhibits angiogenesis and expression of VEGF in human BPH. J Urol, 1998, 159(suppl): 332, abstract 1276.
24. Miller MI, Puchner PJ. Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up. Urology, 1998, 51: 237-240.

《中國循證醫學雜志》

非那雄胺治療經尿道前列腺切除術中出血的Meta分析

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《中國循證醫學雜志》

非那雄胺治療經尿道前列腺切除術中出血的Meta分析

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