坦索罗辛和特拉唑嗪治疗BPH的系统评价

Comparison of Tamsulosin and Terazosin in treating benign prostatic hyperplasia:a systematic review

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 Man 4．2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。

Objective： To systematically review and evaluate the effectiveness of two α-antagonists, terazosin and tamsulosin, for treating benign prostatic hyperplasia （BPH） comparatively. Methods： Both English and Chinese studies were sought and included in the review if they were RCTs （randomized controlled trials）, or CCTs （clinical controlled trials） involved men with BPH, compared terazosin with tamsulosin and revealed the effectiveness comparatively in the outcomes. Data were processed by RevMan 4.2. Results： Eight studies involving 806 men, met the inclusion criteria, i.e. 6 randomized trials, 2 non-randomized trials, among whom, 763 men were included in the Meta analysis. The baseline of patients＇ characteristics were comparable in all the studies. The studies＇ duration were 4～20 weeks. By comparing the six common criteria, including IPSS, MFR, AFR, residual volume, QOL, volume of the prostate, we found that tamsulosin is better than terazosin at improving IPSS[Z=2.09 （ P=0.04）, WMD=0.75（0.07,1.43）]and at improving QOL. Tamsulosin seemed having better efficacy than terazosin in long term therapy, but due to the heterogeneity of the studies, this was not certain. No other different aspect in efficacy between the two drugs was found. Conclusions：The available evidence indicates that tamsulosin is better than terazosin at improving IPSS and there is evidence showing that tamsulosin seemed to have better efficacy than terazosin in long term therapy at improving QOL. More high quality trials with large sample and longer follow up are proposed.