M受体阻滞剂联合非药物方式治疗成年女性膀胱过度活动症的系统评价

Muscarinic antagonists combined with non drug therapy for overactive bladder in adult female:a systematic review

目的:系统评价M受体阻滞剂联合非药物方式治疗成年女性膀胱过度活动症(overactive bladder,OAB)的疗效及临床价值。方法:检索2015年1月前在Pub Med、Embase、Web of Science以及中国期刊全文数据库(CNKI)和中国生物医学文献数据库(CBWMDisc)等已公开发表的关于M受体阻滞剂联合非药物与单用M受体阻滞剂相比治疗成年女性膀胱过度活动症(OAB)的随机对照试验,通过纳入标准和排除标准筛选文献。按照Jadad量表评价纳入研究的质量,采用Revman5.3进行meta分析。结果:共有7篇文献(共610例)符合纳入标准。其中M受体阻滞剂联合电刺激4篇,联合行为训练2篇,联合电刺激加行为训练1篇。Meta分析结果显示:(1)与对照组(单用M受体阻滞剂组)相比,M受体阻滞剂联合电刺激在降低日平均排尿次数(WMD=-0.60,95%CI=-1.23~0.03,P=0.06)、尿失禁次数(SMD=-4.45,95%CI=-12.77~3.86,P=0.29)方面疗效无统计学差异;但在降低尿急次数(WMD=-1.09,95%CI=-2.15^-0.03,P=0.04),提高临床总有效率(RR=1.24,95%CI=1.06~1.44,P=0.007)方面,M受体阻滞剂联合电刺激疗效优于对照组。(2)M受体阻滞剂联合行为训练在降低日平均排尿次数方面疗效优于对照组(WMD=-0.67,95%CI=-1.14^-0.20,P=0.005)。结论:M受体阻滞剂联合非药物治疗方式较单用M受体阻滞剂能够更好地改善成年女性OAB患者的部分排尿症状,提高临床总有效率。

Objective：To assess the therapeutic effects of muscarinic antagonists combined with non drug therapy or overactive bladder（OAB）in adult female. Methods：Published randomized controlled trials（RCTs）on muscarinic antagonists combined with non drug therapy and muscarinic antagonists therapy in the treatment of overactive bladder（OAB）in adult female were searched from Pub Med,Embase,Web of Science,CNKI,CBWMDisc,Wanfang,VIP and other databases before January 2015 according to pre-specified standard. Studies were qualified according to Jadad scale,and were analyzed using Revman5.3. Results：Totally 7 articles（610 patients）,including 4 articles about muscarinic antagonists combined with electrical stimulation,2 articles about muscarinic antagonists combined with behavior training,1 article about muscarinic antagonists combined with both above. The meta-analysis showed that：1There was no difference in the average daily frequency of urination（WMD=-0.60,95%CI=-1.23 to 0.03,P=0.06）and frequency of urinary incontinence（SMD=-4.45,95%CI=-12.77 to 3.86,P=0.29）. Frequency of urgency（WMD=-1.09,95%CI=-2.15 to-0.03,P=0.04）significantly decreased and total clinical efficiency（RR=1.24,95%CI=1.06 to 1.44,P=0.007）improved obviously in the muscarinic antagonists combined with electrical stimulation group compared with those of control group. 2Efficacy of muscarinic antagonists combined with behavior training group was better than control group in reducing the average daily frequency of urination（WMD=-0.67,95%CI=-1.14 to-0.20,P=0.005）. Conclusion：Compared with single muscarinic antagonists therapy,the muscarinic antagonists combined with non drug therapy can better improve the partial urinary symptoms in adult female patients with OAB,and improve the total clinical efficiency.