坦索罗辛治疗输尿管上段结石疗效的meta分析

Efficacy of tamsulosin in treatment of upper ureteral calculi: a meta-analysis

目的系统评价坦索罗辛治疗上段输尿管结石的有效性及安全性。方法计算机检索PubMed、Cochranelibrary、EMBASE、万方数据库、中国知网全文数据库(CNKI)、维普在线数据库,纳入坦索罗辛治疗上段输尿管结石的随机对照试验,对纳入的研究进行质量评价,并提取有效数据,采用RevMan 5.0软件进行meta分析。结果共纳入5个随机对照试验,涉及输尿管上段结石患者480例。Meta分析结果表明,与经保守治疗的对照组比较,经坦索罗辛辅助治疗的试验组患者:(1)结石清除率提高(RR=1.25,95%CI:1.12～1.40,P<0.000 1);(2)平均结石排出时间缩短了2.99d(95%CI:-3.61～-2.37,P<0.000 01);(3)肾绞痛发生率及平均视觉模拟疼痛评分降低(RR=0.39,95%CI:0.26～0.57,P<0.000 01;WMD=-10.94,95%CI:-21.30～-0.58,P=0.04)。结论坦索罗辛治疗输尿管上段结石,能提高结石清除率、缩短平均结石排出时间、降低肾绞痛发生率及平均视觉模拟疼痛评分。

Objective To systematically revise the efficacy and safety of tamsulosin in treatment of proximal ureteral calculi. Methods Electronic search was conducted with PubMed, Cochrane library, EMBASE, Wanfang database, CNKI and VIP to collect randomized controlled trials（RCTs） involving the application of tamsulosin in treatment of upper ureteral calculi. The quality of the included trials was assessed; the data were extracted and analyzed with RevMan 5.0 software. Results Five RCTs involving 480 patients were identified. The results of recta-analysis showed that, compared with the control group, patients in the tamsulosin group had （1） a remarkably higher stone clearance rate （RR = 1. 25,95% CI： 1. 12-1. 40, P 0. 000 1）, （2） shorter mean time of calculi expulsion （shortened by 2.99 days, 95%0CI： -3.61--2.37, P〈0. 000 01）, and （3） decreased incidence of renal colic episodes and mean visual analogue scale pain score （RR=0.39,95%CI：0.26-0.57, P〈 0.000 01; WMD=--10. 94,95GCI： -21.30 -0.58, P=0.04）.Conclusion Our results show that tamsulosin can improve the stone clearance, shorten the mean time for calculi expulsion, decrease the incidence of renal colic episodes and the mean visual analogue scale pain score in patients with proximal ureteral calculi.