硝苯地平和坦索罗新治疗下段输尿管结石的meta分析

Efficacy of nifedipin versus tamsulosin in treatment of lower ureteral stones: a meta-analysis

目的比较硝苯地平与坦索罗新两种药物在药物排石治疗中的疗效及安全性。方法计算机检索Pubmed、Cochrane和Embase等数据库,查找所有比较硝苯地平与坦索罗新治疗下段输尿管结石的临床随机对照试验（RCT）,检索时限为建库至2014年1月16日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价后,采用Rev Man 5.2软件进行meta分析,并采用证据质量分级和推荐强度（GRADE）系统进行证据质量评价。结果共纳入5个研究,3 708例患者。meta分析结果显示：1在有效性方面：5个研究均比较了排石率,坦索罗新组排石率高于硝苯地平组,差异有统计学意义（RR为0.77,95%CI为0.75-0.80,P=0.02）。4个研究比较了排石时间（d）,其中1个研究显示两者差异无统计学意义（P=0.2）,另外3个研究均显示两者差异有统计学意义（均P〈0.01）,坦索罗新组排石时间较硝苯地平组短。5个研究均比较了镇痛效果,其中1个研究显示两者双氯芬酸使用剂量差异无统计学意义（P〉0.05）,另外4个研究均显示两者治疗双氯芬酸使用剂量差异有统计学意义（P〈0.01）。2在安全性方面：两组在轻微不良反应发生率和严重不良反应发生率上差异均无统计学意义（RR为1.61,95%CI为0.59-4.38,P=0.35;RR为0.43,95%CI为0.06-2.89,P=0.38）。结论硝苯地平跟坦索罗新相比,坦索罗新组排石率高于硝苯地平组,而两者不良反应发生率相似;此外,坦索罗新组在缩短排石时间和减少镇痛剂使用量方面优于硝苯地平组。下段输尿管结石的药物治疗首选坦索罗新。

[Objective]To compare the efficacy and safety of nifedipin versus tamsulosin in medical expulsive therapy（ MET） of lower ureteral stones. [Methods]The randomized controlled trials（ RCTs） published from databases establishment to January 16,2014,which compared the efficacy and safety between nifedipin and tamsulosin in treatment of lower ureteral stones,were searched in the databases,such as Pub Med,Cochrane and Embase. Meanwhile,the references of these RCTs were also searched by hand.According to the inclusion and exclusion criteria in this analysis,two authors independently carry out the RCTs selection,data extraction and quality assessment,and a meta-analysis was performed by using the Rev Man 5. 2 software. GRADE system was used to conduct the evidence quality assessment. [Results]The results of meta-analysis showed that： 1 efficacy indicators： The efficacy was investigated in all of five trials,the lithagogue rate of tamsulosin was significantly higher than that of nifedipin（ RR was 0. 77,95% CI： 0. 75-0. 80,P = 0. 02）. In four trials,the information was available for the stone expulsion time（ d）,one trial showed that there was no significant difference between nifedipine group and tamsulosin group,while other three trials showed the opposite results（ all P〈0.01）,which indicated tamsulosin group had shorter stone expulsion time than nifedipine group. In all of these five trials,the information was available for the analgesic effect,one trial showed that there was no significant difference in dose of diclofenac between nifedipine group and tamsulosin group（ P〈0.05）,while other four trials showed the opposite results（ all P〈0.01）. 2 safety indicators： There were no significant differences in the incidence rates of slight and severe adverse reactions between two groups（ RR was 1. 61,95% CI： 0. 59-4. 38,P = 0. 35; RR was 0. 43,95% CI： 0. 06-2. 89,P = 0. 38）.[Conclusion]The effective rate of tamsulosin is higher than that of nifedipine,but the incidence rate of adverse reactions of tamsulosin is similar to that of nifedipine. Moreover,tamsulosin has the better effect than nifedipine on shortening the stone expulsion time and reducing the analgesic dose. Tamsulosin is the first choice in MET for lower ureteral stones.