非那雄胺对慢性心力衰竭合并良性前列腺增生老年男性患者的疗效

Effects of finasteride for elderly male patients with chronic congestive heart failure combined with benign prostatic hyperplasia

目的探讨非那雄胺对慢性心力衰竭(chronic heart failure,CHF)合并良性前列腺增生(benign prostatichyperplasia,BPH)的老年男性患者的疗效。方法 95例CHF合并BPH老年男性按数字表法随机分为治疗组及对照组,两组均根据患者的心功能情况规范使用抗心力衰竭治疗。治疗组使用非那雄胺,对照组使用安慰剂治疗2年。观察两组前列腺体积、国际前列腺症状评分表(IPSS)评分、BPH患者生活质量(QOL)评分、肌酐、血尿素氮、N末端脑钠肽前体、肌钙蛋白、左心室射血分数(LVEF)、急性尿潴留、需手术干预、心血管事件、心力衰竭再住院率、心功能的变化及主要副作用等指标,并进行比较。结果治疗组心血管事件发生率[23.25%(10/43)vs.47.61%(20/42),P<0.05]、心力衰竭再住院率[25.58%(11/43)vs.50.00%(21/42),P<0.05]、急性尿潴留率[13.95%(6/43)vs.42.85%(18/42),P<0.05]、需手术干预率[16.27%(7/43)vs.52.38%(22/42),P<0.05],明显低于对照组,差异有统计学意义。治疗组前列腺体积、国际前列腺症状评分表评分及肌酐、N末端脑钠肽前体浓度低于对照组,差异有统计学意义(P<0.05)。两组治疗2年后在勃起功能障碍、性欲减退、乳腺增大、乳腺疼痛的发生率比较,差异无统计学意义(P>0.05)。结论对于CHF合并BPH的患者在规范的治疗心力衰竭的基础上应尽早长期使用非那雄胺,可显著降低患者的主要心血管事件发生率、心力衰竭再次住院率、急性尿潴留率、需手术干预率,缩小前列腺体积,改善下尿道症状及患者生活质量,而无明显增加副作用。

Objectives To observe the effects of finasteride for elderly male patients with chronic congestive heart failure （CHF） combined with benign prostatic hyperplasia （BPH）. Methods A total of 95 BPH combined with CHF elderly male patients were randomly divided into treatment group and control group. Patients in both groups were treated with standard therapies according to their cardiac functions. Treatment group was treated with finasteride, and control group was treated with placebo for 2 years. Prostate volume, international prostate symptom score （IPSS）, quality of life （QOL） of BPH patients, assessment of creatinine （Cr）, urea nitrogen （BUN）, N-terminal pro-B type natriuretic peptide （NT-proBNP）, cardiac troponin, left ventricular ejection fraction （LVEF）, acute urinary retention, surgical intervention, cardiovascular events, heart failure readmission rate, changes in heart function, and major side effects indicators of the 2 groups were observed and compared. Results Incidence rate of cardiovascular events [23.25% （ 10/43 ） vs. 47.61% （20/42）, P〈0.05 ], heart failure readmission rate [ 25.58% （ 11/43） vs. 50.00% （21/42）, P〈 0.05], rate of acute urinary retention [13.95% （6/43） vs. 42.85% （18/42）, P〈0.05], surgical intervention rate [16.27% （7/43） vs. 52.38% （22/42）, P〈0.05] in theatment group were significantly lower than those in control group. Prostate volume, IPSS, concentrations of Cr and NT-proBNP in theatment group were significantly lower than those in control group （P〈0.05）. Incidence rates of erectile dysfunction, loss of libido, hyperplasia and breast pain between the 2 groups had no significant difference （P〉0.05）. Conclusions Long-term use of finasteride in patientswith CHF combined with BPH going with standard treatment for heart failure can significantly reduce cardiovascular events, heart failure readmission rate, rate of acute urinary retention and surgical intervention rate. It can reduce prostate volume, lower urinary tract symptoms and improve patients＇ quality of life without obvious increase in side effects.