联合应用坦索罗辛和托特罗定治疗男性顽固性下尿路症状的临床研究

Combination of tamsulosin and tolterodine alleviates refractory lower urinary tract symptoms in male patients

目的:探讨及对比联合应用高选择性α受体阻滞剂(坦索罗辛)和M受体阻滞剂(托特罗定)及单用高选择性α受体阻滞剂治疗男性顽固性下尿路症状的临床疗效及安全性。方法:2009年4月至2009年12月期间收集我院184例顽固性下尿路症状(LUTS)的男性前列腺增生患者,病程4周至2年。所有患者均为应用高选择性α受体阻滞剂(坦索罗辛)0.2 mg,1次/d,治疗1周后LUTS症状无改善。入选病例随机分成2组,其中坦索罗辛组89例继续应用坦索罗辛0.2 mg,1次/d,治疗4周;联合治疗组95例联合应用高选择性α受体阻滞剂(坦索罗辛)和M受体阻滞剂(托特罗定),给予坦索罗辛0.2 mg 1次/d+托特罗定2 mg 2次/d,治疗4周。分组治疗前后分别进行国际前列腺症状储尿期症状评分(储尿期IPSS)、生活质量评分(QOL)和最大尿流率(Qmax)检测,评估治疗后LUTS症状的改善情况。结果:坦索罗辛组储尿期IPSS、QOL总体评分分别由治疗前的(13.23±4.39)、(4.23±1.27)分下降到治疗后的(12.21±4.07)、(3.53±0.9)分,Qmax由治疗前的(12.31±8.39)ml/s上升到治疗后的(14.12±8.62)ml/s,与治疗前相比差异均无显著性(P>0.05)。联合治疗组储尿期IPSS、QOL总体评分分别由治疗前的(14.45±5.31)、(4.45±0.79)分降到治疗后的(6.56±2.03)、(2.34±0.73)分,Qmax由治疗前的(11.41±9.21)ml/s上升到治疗后的(15.52±8.35)ml/s,与联合治疗前相比差异均有显著性(P<0.01)。184例患者均无严重并发症出现。结论:联合应用坦索罗辛和托特罗定能明显缓解男性顽固性下尿路症状,改善患者的生活质量。未见严重不良反应和急性尿潴留发生。

Objective：To evaluate and compare the clinical efficacy and safety of the highly selective α receptor antagonist tamsulosin and its combination with the M receptor antagonist tolterodine in the treatment of refractory lower urinary tract symptoms（LUTS） in patients with benign prostatic hyperplasia（BPH）.Methods：We included in this study 184 BPH patients with refractory LUTS with the disease course of 4 weeks to 2 years,whose LUTS were not alleviated after a week＇s treatment with tamsulosin.The patients were randomly divided into Groups A and B,the former（n = 89） treated with tamsulosin at 0.2 mg qd and the latter（n = 95） given tolterodine at 2 mg bid in addition to tamsulosin medication,both for 4 weeks.Scores on IPSS,QOL and Qmax were obtained before and after the treatment,and the improvement of LUTS evaluated after the medication.Results：The tamsulosin group showed no significant differences before and after the treatment in the scores on IPSS（13.23 ± 4.39 vs 12.21 ± 4.07）,QOL（4.23 ± 1.27 vs 3.53 ± 0.95） and Qmax（[12.3 ± 8.39] ml/s vs [14.1 ± 8.62] ml/s）（P〈0.05）,while the combination group exhibited significantly higher scores on IPSS and QOL and lower score on Qmax after the medication than before it（IPSS：14.45 ± 5.31 vs 6.56 ± 2.03,P〈0.05;QOL：4.45 ± 0.79 vs 2.34 ± 0.73,P〈0.05;Qmax：[11.4 ± 9.21] ml/s vs [15.5 ± 8.35] ml/s,P〈0.01）.No severe complications were found in any of the cases.Conclusion：Combination of tamsulosin and tolterodine can significantly alleviate refractory LUTS and improve QOL without causing serious adverse events in BPH patients.