坦索羅辛用于輸尿管結石排石治療隨機對照試驗的Meta分析_《中國循證醫學雜志》

作者：

熊瑋 ¹² , 王坤杰 ¹ , 王莉 ³ , 王佳 ¹ , 魏強 ¹ ,  李虹 ¹

1. 四川大學華西醫院泌尿外科（成都 610041）2. 四川省醫學科學院?四川省人民醫院器官移植科（成都610072）3. 四川大學華西醫院中國循證醫學中心;

關鍵詞：

坦索羅辛 α1腎上腺素受體阻滯劑輸尿管結石 Meta分析排石治療隨機對照試驗

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目的　系統評價α1腎上腺素受體阻滯劑坦索羅辛治療輸尿管結石的療效。
方法　計算機檢索PubMed、EMbase、BIOSIS和International Pharmaceutical Abstracts（IPA）數據庫，Cochrane圖書館（2006年第3期），中國期刊全文數據庫（1995.1～2006.9）及重要學術會議論文集，系統收集坦索羅辛治療輸尿管結石的隨機對照試驗。由2名評價者共同評價納入研究質量并提取資料，合并同質研究進行Meta分析，采用STATA9.0完成定量資料分析。
結果　共納入16個隨機對照試驗，包括1521例輸尿管下段結石患者。Meta分析結果顯示：① 坦索羅辛組比僅使用飲水和鎮痛藥的保守療法結石排出率高［RR 1.50，95%CI（1.20，1.87）］，縮短排石時間［SMD –1.29，95%CI（–2.27，–0.31）］，并降低后期ESWL或輸尿管鏡治療率［RR 0.40，95%CI（0.27，0.59）］，差異有統計學意義（P lt;0.05）。② 坦索羅辛/地夫可特聯用組比保守療法排石率高[RR 1.59，95％CI（1.31，1.93）］，縮短排石時間［SMD –0.8，95％CI（–1.18，–0.42）］，明顯減少后期ESWL或輸尿管鏡治療率［RR 0.13，95％CI（0.06，0.31）］，差異有統計學意義（P lt;0.05）。③ 坦索羅辛與地夫可特聯用組與單用地夫可特組在結石排出率方面沒有差異［RR 1.31，95％CI（0.78，2.23），P=0.31］，但能明顯減少鎮痛藥劑量［SMD 15.20，95%CI（14.98，15.52）］和后期輸尿管鏡治療率［RR 0.09，95%CI（0.02，0.47）］，差異有統計學意義。④ 坦索羅辛與地夫可特聯用組比硝苯地平與地夫可特聯用組結石排出率高［RR 1.20，95%CI（1.07，1.35），P=0.002］，而排石時間［SMD –1.34，95%CI（–3.47，0.79）］和后期ESWL或輸尿管鏡治療率［RR 0.34，95%CI（0.05，2.22）］無差異（P gt;0.05）。⑤以坦索羅辛為主的干預組和保守療法在藥物副作用方面沒有差異（P均 gt;0.05）。
結論　目前的證據支持：坦索羅辛對輸尿管下段和膀胱壁間段結石具有較高的促排石率，能縮短排石時間和降低后期侵入性治療率。0.4mg/d坦索羅辛對下段輸尿管結石治療安全有效。有限證據支持坦索羅辛與地夫可特聯用有助于提高排石率，但需要大樣本的研究結果予以支持。

引用本文： 熊瑋,王坤杰,王莉,王佳,魏強,李虹. 坦索羅辛用于輸尿管結石排石治療隨機對照試驗的Meta分析. 中國循證醫學雜志, 2007, 07(7): 506-515. doi: 復制

1.	Zhang XZ, Zhu X. The effect of tamsulosin and doxazosin in treatment for distal ureteral calculi-a randomized controlled trial. [in Chinese], in Association CU: The 13th annual meeting of Chinese Urological Association. SHENYANG, Chinese Urological Association, 2006: 577.
2.	Lv JJ, Wei LJ, Zhang H, et al. Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones. [Chinese]. Chinese J of Urol, 2006, 27(9): 612-614.
3.	Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol, 2006, 16(2): 71-76.
4.	Dal Moro F, Abate A, Lanckriet GR, et al. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines. Kidney Int, 2006, 69(1): 157-160.
5.	Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med, 2004, 350(7): 684-693.
6.	Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol, 2002, 34(1): 25-29.
7.	Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology, 2005, 66(4): 712-715.
8.	Resim S, Ekerbicer HC, Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology, 2005, 66(5): 945-948.
9.	Kupeli B, Irkilata L, Gurocak S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology, 2004, 64(6): 1111-1115.
10.	Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg, 2000, 87(11): 1448-1454.
11.	Coll DM, Varanelli MJ, Smith RC. Relationship of Spontaneous Passage of Ureteral Calculi to Stone Size and Location as Revealed by Unenhanced Helical CT. Am J Roentgenol, 2002, 178(1): 101-103.
12.	Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315: 629-634.
13.	Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol, 2003, 170(6 Pt 1): 2202-2205.
14.	Porpiglia F, Ghignone G, Fiori C, et al. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol, 2004, 172(2): 568-571.
15.	Autorino R, De Sio M, Damiano R, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res, 2005, 33(6): 460-464.
16.	Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol, 2005, 174(1): 167-172.
17.	Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol, 2005, 12(7): 615-620.
18.	Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
19.	De Sio M, Autorino R, Di Lorenzo G, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol, 2006, 20(1): 12-16.
20.	Porpiglia F, Vaccino D, Billia M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol, 2006, 50(2): 339-344.
21.	Taghavi R, Mahdavi R, Darabi MR, et al. The effect of tamsulosin in the passage of juxtavesical stones. Int J Urol, 2006, 13 (Suppl 1): A39.
22.	Hong Y, Lee Y, Lee J, et al. Medical Therapy for Lower Ureteral Lithiasis: Prospective Study Using Tamsulosin in Combination with Furosemide. Int J Urol, 2006, 13(Suppl 1): A6.
23.	Puthenveetil R, Deka P, Barua S, et al. Role of tamsulosin in the management of patients with pre-vesical ureteral calculi. Urology, 2006, 68(Suppl 1): 81-81.
24.	張選志, 朱煊. 兩種不同α1受體阻滯劑——坦索羅辛和多沙唑嗪在治療輸尿管下段結石上的應用. 見: 第十三屆全國泌尿外科學術會議暨第八屆全球華人泌尿外科學術會議. 沈陽: 中華醫學會泌尿外科學分會; 2006: 577.
25.	呂家駒, 尉立京, 張輝, 等. 坦索羅辛和硝苯地平在輸尿管下段結石輔助排石中作用的比較. 中華泌尿外科雜志, 2006, 27(9): 612-614.
26.	Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn, 2005, 24(2): 142-148.
27.	Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol, 2001, 40(4): 362-371.
28.	Yucel S, Baskin LS. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol, 2003, 170(3): 945-948.
29.	Hollingsworth JM, Rogers MAM, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet, 2006, 368(9542): 1171-1179.
30.	Tekin A, Alkan E, Beysel M, et al. Alpha-1 receptor blocking therapy for lower ureteral stones: a randomized prospective trial (abstract). J Urol, 2004, 171(suppl): 304.
31.	Porpiglia F, Destefanis P, Fiori C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology, 2000, 56(4): 579-582.
32.	Porpiglia F, Destefanis P, Fiori C, et al. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology, 2002, 59(6): 835-838.
33.	Roehrborn CG. Are all alpha-blockers created equal? An update. Urology, 2002, 59(2 Suppl 1): 3-6.
34.	Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol, 2004, 171(3): 1029-1035.

1. Zhang XZ, Zhu X. The effect of tamsulosin and doxazosin in treatment for distal ureteral calculi-a randomized controlled trial. [in Chinese], in Association CU: The 13th annual meeting of Chinese Urological Association. SHENYANG, Chinese Urological Association, 2006: 577.
2. Lv JJ, Wei LJ, Zhang H, et al. Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones. [Chinese]. Chinese J of Urol, 2006, 27(9): 612-614.
3. Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol, 2006, 16(2): 71-76.
4. Dal Moro F, Abate A, Lanckriet GR, et al. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines. Kidney Int, 2006, 69(1): 157-160.
5. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med, 2004, 350(7): 684-693.
6. Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol, 2002, 34(1): 25-29.
7. Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology, 2005, 66(4): 712-715.
8. Resim S, Ekerbicer HC, Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology, 2005, 66(5): 945-948.
9. Kupeli B, Irkilata L, Gurocak S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology, 2004, 64(6): 1111-1115.
10. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg, 2000, 87(11): 1448-1454.
11. Coll DM, Varanelli MJ, Smith RC. Relationship of Spontaneous Passage of Ureteral Calculi to Stone Size and Location as Revealed by Unenhanced Helical CT. Am J Roentgenol, 2002, 178(1): 101-103.
12. Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315: 629-634.
13. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol, 2003, 170(6 Pt 1): 2202-2205.
14. Porpiglia F, Ghignone G, Fiori C, et al. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol, 2004, 172(2): 568-571.
15. Autorino R, De Sio M, Damiano R, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res, 2005, 33(6): 460-464.
16. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol, 2005, 174(1): 167-172.
17. Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol, 2005, 12(7): 615-620.
18. Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
19. De Sio M, Autorino R, Di Lorenzo G, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol, 2006, 20(1): 12-16.
20. Porpiglia F, Vaccino D, Billia M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol, 2006, 50(2): 339-344.
21. Taghavi R, Mahdavi R, Darabi MR, et al. The effect of tamsulosin in the passage of juxtavesical stones. Int J Urol, 2006, 13 (Suppl 1): A39.
22. Hong Y, Lee Y, Lee J, et al. Medical Therapy for Lower Ureteral Lithiasis: Prospective Study Using Tamsulosin in Combination with Furosemide. Int J Urol, 2006, 13(Suppl 1): A6.
23. Puthenveetil R, Deka P, Barua S, et al. Role of tamsulosin in the management of patients with pre-vesical ureteral calculi. Urology, 2006, 68(Suppl 1): 81-81.
24. 張選志, 朱煊. 兩種不同α1受體阻滯劑——坦索羅辛和多沙唑嗪在治療輸尿管下段結石上的應用. 見: 第十三屆全國泌尿外科學術會議暨第八屆全球華人泌尿外科學術會議. 沈陽: 中華醫學會泌尿外科學分會; 2006: 577.
25. 呂家駒, 尉立京, 張輝, 等. 坦索羅辛和硝苯地平在輸尿管下段結石輔助排石中作用的比較. 中華泌尿外科雜志, 2006, 27(9): 612-614.
26. Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn, 2005, 24(2): 142-148.
27. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol, 2001, 40(4): 362-371.
28. Yucel S, Baskin LS. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol, 2003, 170(3): 945-948.
29. Hollingsworth JM, Rogers MAM, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet, 2006, 368(9542): 1171-1179.
30. Tekin A, Alkan E, Beysel M, et al. Alpha-1 receptor blocking therapy for lower ureteral stones: a randomized prospective trial (abstract). J Urol, 2004, 171(suppl): 304.
31. Porpiglia F, Destefanis P, Fiori C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology, 2000, 56(4): 579-582.
32. Porpiglia F, Destefanis P, Fiori C, et al. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology, 2002, 59(6): 835-838.
33. Roehrborn CG. Are all alpha-blockers created equal? An update. Urology, 2002, 59(2 Suppl 1): 3-6.
34. Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol, 2004, 171(3): 1029-1035.

《中國循證醫學雜志》

坦索羅辛用于輸尿管結石排石治療隨機對照試驗的Meta分析

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《中國循證醫學雜志》

坦索羅辛用于輸尿管結石排石治療隨機對照試驗的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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