特拉唑嗪治疗慢性前列腺炎/慢性盆腔疼痛综合征的系统评价

Terazosin for chronic prostatitis/chronic pelvic pain syndrome:A systematic review of efficacy and adverse effects

目的评价特拉唑嗪治疗慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)的疗效与安全性。方法采用Cochrane系统评价方法,电子检索Embase、Pubmed等国内、外数据库。纳入特拉唑嗪与安慰剂或其他疗法比较治疗CP/CPPS男性患者的随机对照试验(RCT)。由两名评价员独立评价文献质量和提取资料,用Stata9.2软件进行Meta分析。结果检索结果获得9个随机对照实验,其中只有4个RCTs(369例)被纳入。本系统评价的meta分析结果显示特拉唑嗪治疗CP/CPPS的疗效优于安慰剂,能有效地改善CP/CPPS患者的NIH症状指数总评分、生活质量、疼痛及排尿症状,但其不良反应也高于安慰剂。结论根据现有的证据,可以认为特拉唑嗪有改善CP/CPPS症状的作用。但鉴于目前评价其疗效和安全性的随机对照试验及病例数较少,研究质量普遍不高,有必要进一步开展高质量、大样本随机对照试验评价其疗效和安全性。

Objective To examine the effectiveness and adverse effects of terazosin in the treatment of CP/CPPS. Methods Trials were identified from an electronic database search （Pubmed, Embase） for published and unpublished randomized controlled trials in any language comparing terazosin with placebo or other interventions for CP/CPPS,then extracted and evaluated independently by two authors;and reviewed in a meta-analysis. Men who met the National Institutes of Health （NIH） criteria for CP/CPPS were eligible for inclusion in this review. Exclusion criteria included ： non RCTs studies ; no blinded studies ; previous treatment with antibiotics, terazosin or other alpha blockers ;evidence of bacterial prostatitis or urinary tract infection;trials with treatment duration less than 2 weeks;and a total patients number less than 10 patients. Results We identified 9 randomized placebo-controlled trials, and only 4 （ including 369 men） met our inclusion criteria. The recta-analysis was taken using Stata version 9.2, and results were expressed as standardized mean difference （ SMD and 95% CI） for continuous data ,and RR with 95% CI for dichotomous data. Meta-analysis results of this systematic review of randomized controlled trials showed a statistically significant difference in favor of terazosin in post-treatment total score, quality of life score ; pain and urinary symptoms score domains. For overall side effect, there was a statistically significant effect in favor of placebo compared with terazosin. Conclusions Available evidence shows modest effect of terazosin in reducing NIH-CPSI total score, pain symptoms, and improving quality of life of patients with CP/CPPS. There is a need for more well-designed trials, with larger patient groups and longer duration treatment to further determine the efficacy and adverse effects of terazosin in men with CP/CPPS.