慢性前列腺炎/慢性盆底疼痛综合征(CP/CPPS)治疗有效性和安全性的系统评价(Meta分析)

Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta-analysis of randomized controlled trials (RCTs)

目的评价慢性前列腺炎/慢性盆底疼痛综合征(CP/CPPS)治疗的有效性与安全性。方法计算机检索MEDLINE(1966年1月—2007年6月)、EMBASE(1988年1月—2007年6月)及4家中文医学期刊文献数据库。纳入有效的随机对照试验(RCT)。由两位系统评价员独立进行文献筛查、质量评价和资料提取,意见不一致时通过讨论解决,或向专家咨询解决。采用RevMan4.2软件进行Meta分析。结果共初检出150篇文献,经筛选后最后纳入12篇原始研究(1051例)进行分析。Meta分析结果显示:α受体阻滞剂具有中等疗效(NIH-CPSI总分和疼痛评分的WMD分别为-4.10[95%CI:-6.92～-1.28]和-1.68[95%CI:-2.54～-0.82]);抗生素不能明显改善患者症状,其NIH-CPSI总分和疼痛评分的WMD分别为-2.71(95%CI:-4.78～-0.64)和-0.86(95%CI:-2.07～0.36);黄酮哌酯改善NIH-CPSI总分效果不明显,但缓解疼痛效果较好,其NIH-CPSI总分和疼痛评分的WMD分别为-2.96(95%CI:-5.17～-0.74)和-3.06(95%CI:-3.64～-2.48)。结论药物干预治疗能一定程度上改善CP患者总的NIH-CPSI评分和总体症状,但没有一种药物可以持续显著的改善CP患者所有症状。今后的临床研究需选择适宜样本量和最佳疗程,并进行随访。提高国内原始研究质量,开展高质量临床研究非常重要。

Objective To evaluate the efficacy and safety of the treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods The randomized controlled trials （RCTs） about the treatment for CP/CPPS all over the world were searched. MEDLINE（1966-2007.6）,EMBASE（1988-2007.06）, and four Chinese databases were electronically searched. The studies included in the references of eligible studies were additionally searched. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were settled by discussion or consulted by the expert. Meta-analysis was performed by using Rev Man 4.2 software. Results Twelve original studies involving 1051 participants met inclusion criteria. Compared with placebo, Alpha-blockers could improve the symptoms of CP/CPPS obviously with WMD of NIH-CPSI total score and pain score were -4.10, 95%CI： -6.92 to-1.28 and -1.68, 95%CI： -2.54 to -0.82. Antibiotics could not improve the symptoms obviously with WMD of NIH-CPSI total score and pain score were -2.71, 95%CI： -4.78 to -0.64） and -0.86, 95%CI： -2.07 to 0.36. Flavoxate could not improve the NIH-CPSI total score obviously, but could relieve the pain, with WMD of NIH-CPSI total score and painscore were -2.96, 95%CI： -5.17 to -0.74 and -3.06, 95%CI： -3.64 to-2.48. Prostat could improve the NIH-CPSI total score obviously, but could not relieve the pain, with WMD of NIH-CPSI total score and pain score were -7.60, 95%CI： -9.97 to -5. 23and -1.82, 95%CI： -2.58, to -1.05. Conelusion Drug interventions could improve NIH-CPSI and total symptoms of CP/ CPPS in some degree, but no universally effective treatment in this study showed to be benefit for all the symptoms of CP/CPPS. Appropriate sample size and optimal duration and follow-up of participants were essential for future RCT study. It is important to improve the quality of domestical original studies.