赛洛多辛治疗输尿管下段结石的有效性和安全性的Meta分析

The efficacy and safety of silodosinin in the treatment of distal ureteral calculi

目的采用Meta分析的方法,评价赛洛多辛治疗输尿管下段结石的有效性和安全性。方法检索PubMed、Cochrane图书馆、Embase,将赛洛多辛与安慰剂、坦索罗辛治疗输尿管下段结石的随机对照研究(RCT)纳入分析。结果纳入9个RCT,包括1 048例患者,分别比较了赛洛多辛与安慰剂、赛洛多辛与坦索罗辛治疗输尿管下段结石的排石率、排石时间和主要不良反应。结果显示:与安慰剂相比,赛洛多辛对输尿管下段的排石率(OR=2.82,95%CI=1.70~4.67,P<0.000 1)显著增加、排石时间(SMD=-4.71,95%CI=-6.60^-2.83,P<0.000 01)显著缩短。与坦索罗辛相比,赛洛多辛对输尿管下段的排石率(OR=2.54,95%CI=1.70~3.78,P<0.000 01)也明显增加、排石时间(SMD=-2.64,95%CI=-3.64^-1.64,P<0.00001)明显缩短、肾绞痛发作频次(P<0.000 01)明显下降。但与坦索罗辛相比,赛洛多辛射精异常的发生率显著增加,而在其他并发症方面,两者无明显差异(OR=1.00,95%CI=0.58~1.74,P=1.00)。结论与安慰剂和坦索罗辛相比,赛洛多辛治疗输尿管下段结石、缓解肾绞痛更有效。赛洛多辛除了逆向射精发生率较高外,在安全性方面与坦索罗辛相当。

Objective To evaluate the efficacy and safety of silodosin in the treatment of distal ureteral stones.Methods Randomized controlled trials（RCT）on the efficacy and safety of silodosin in the treatment of distal ureteral stones compared with placebo or tamsulosin were retrieved from PubMed,Cochrane Library,and Embase.Results Together 9RCTs involving a total of 1 048 participants were included for the meta-analysis.Compared with placebo,silodosin produced higher expulsion rate of distal ureteral stones（OR=2.82,95%CI=1.70～4.67,P〈0.000 1）,and needed shorter expulsion time（days）（SMD=-4.71,95%CI=-6.60～-2.83,P〈0.000 01）.Compared with tamsulosin,silodosin produced higher expulsion rate（OR=2.54,95%CI=1.70～3.78,P〈0.000 01）,needed shorter expulsion time（days）（SMD=-2.64,95%CI=-3.64 ～-1.64,P〈0.000 01）,caused less pain（P〈0.000 01,but caused higher rate of abnormal ejaculation.There was no significant difference for complications（OR=1.00,95%CI=0.58～1.74,P=1.00）.Conclusion Silodosin is more effective than placebo and tamsulosin in the treatment of distal ureteral calculi with better control of pain,and it is as safe as tamsulosin though abnormal ejaculation is more common in silodosin use.