萘哌地尔治疗输尿管远端结石有效性和安全性的Meta分析

Efficacy and safety of naftopidil for treatment of distal ureteral calculi: a systematic review and meta-analysis

目的系统评价高选择性α_(1D)受体阻滞药萘哌地尔治疗输尿管远端结石的有效性及安全性。方法计算机检索了Pubmed、Cochrane图书馆、中国期刊全文数据库、万方数据库和维普数据库,收集了萘哌地尔治疗输尿管远端结石的随机对照试验。由2名评价者共同评价纳入文献质量并提取资料,采用Review Manager 5.0完成资料分析。结果共纳入11个研究,包含983例患者。Meta分析结果显示:与观察等待组相比,萘哌地尔组的排石率明显提高(RR=1.63,95%CI 1.32~2.03,P<0.01),排石时间缩短(WMD=-2.83,95%CI-3.75^-1.92,P<0.01),差异均有统计学意义。与α_(1A)受体阻滞药组相比,二者排石率(RR=0.97,95%CI 0.78~1.20,P=0.76)和排石时间(WMD=0.15,95%CI 0.40~0.69,P=0.59)比较,差异均无统计学意义,但萘哌地尔组不良反应的发生率明显降低,差异有统计学意义(RR=0.52,95%CI 0.27~0.98,P=0.04)。结论萘哌地尔能有效促进输尿管远端结石排出,与α_(1A)受体阻滞药相比无明显差异,但不良反应发生率明显降低。

Objective To access the efficacy and safety of naftopidil in medical expulsive therapy of distal ureteral calculi.Methods A systematic search was performed in Pubmed,Cochrane Library,CNKI,Wanfang database and VIP database to identify RCTs that compared naftopidil and other therapy for distal ureteral calculi. Two authors independently assessed study quality and extracted data. All data were analyzed using Rev Man5. 0. Results 11 studies with a total of 983 patients met the inclusion criteria.There was a significant overall benefit for stone expulsion rate（ RR = 1. 63,95% CI 1. 32-2. 03,P〈0. 01） and stone expulsion time（ WMD =- 2. 83,95% CI- 3. 75-- 1. 92,P〈0. 01） in naftopidil group compared with watching waiting group. Compared with α1A adrenergic receptor blockers group,there was no statistically significant differences in expulsion rate（ RR = 0. 97,95% CI 0. 78-1. 20,P = 0. 76） and stone expulsion time（ WMD = 0. 15,95% CI-0. 40-0. 69,P = 0. 59）. But naftopidil provided a significantly lower side effects rate（ RR = 0. 52,95% CI 0. 27-0. 98,P = 0. 04）. Conclusions Naftopidil can effectively promote the expulsion of distal ureteral calculi. Compared with α1A-adrenergic receptor blockers,there are no statistically significant differences in expulsion rate and stone expulsion time,but with a significantly lower side effects rate.