硝苯地平辅助治疗输尿管结石的有效性和安全性Meta分析

Efficacy and safety Meta analysis of nifedipine in the adjunctive expulsive therapy of ureteral stones

目的分析硝苯地平辅助输尿管结石排出的有效性和安全性。方法计算机检索Pubmed、Embase、Cochrane、CNKI、VIP、CBM、万方数据库,纳入关于硝苯地平治疗输尿管结石的随机对照试验,检索时间均为建库至2016年6月。由两位研究者按照纳入与排除标准独立进行文献筛选、资料提取和方法学质量评价,对纳入研究进行Meta分析。结果共纳入11项研究,5468例患者。系统评价结果显示:硝苯地平组排石率高于标准治疗组〔RR=1.52,95%CI(1.10,2.10),P=0.01〕,低于坦索罗辛组〔RR=0.83,95%CI(0.75,0.92),P<0.01〕;硝苯地平组排石时间短于标准治疗组〔WMD=-2.45,95%CI(-3.41,-1.48),P<0.01〕,长于坦索罗辛组〔WMD=2.48,95%CI(2.40,2.57),P<0.01〕;3个研究比较了硝苯地平组与标准治疗组的镇痛剂使用量,显示硝苯地平组镇痛剂使用量低于标准治疗组(P<0.05);7个研究比较了硝苯地平与坦索罗辛的镇痛剂用量,其中2个研究显示两者差异无统计学意义(P>0.05),另外5个研究显示硝苯地平组使用量明显高于坦索罗辛组(P<0.05);硝苯地平组轻中度不良反应发生率高于标准治疗组和坦索罗辛组〔RR=2.71,95%CI(1.59,4.60),P<0.01;RR=1.28,95%CI(1.02,1.61),P<0.05〕,严重不良反应发生率间无差异(P>0.05)。结论硝苯地平能够有效的辅助输尿管结石排出,但疗效不如坦索罗辛,二者严重不良反应率间无明显差异。

Objective To compare the efficacy and safety of nifedipine in the adjunctive expulsive therapy of patients with ureteral stones. Methods Databases including pubmed,embase,cochrane,CNKI,VIP,CBM,Wanfang were electronically searched for the randomized controlled trials on nifedipine in the adjnnctive expulsive therapy of patients with ureteral stones from inception to June 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality. Then,Meta analysis was performed. Results A total of 11 studies involving 5468 cases of patients with ureteral stones were finally included. Compared with standard therapy or tamsulosin respectively,nifedipine showed higher or lower expulsion rate 〔RR = 1. 52,95% CI（ 1. 10,2. 10）,P = 0. 01; RR = 0. 83,95%CI（ 0. 75,0. 92）,P 〈0. 01〕,shorter or longer expulsion time 〔WMD =-2. 45,95% CI（-3. 41,-1. 48）,P 〈0. 01;WMD = 2. 48,95% CI（ 2. 40,2. 57）,P 〈0. 01〕. The information was available for analgesic dosage in three trials（ nifedipine vs standard therapy） or 7 trials（ nifedipine vs tamsulosin）. Nifedipine showed lower analgesic dosage than standard therapy in three trials（ P 〈0. 05）. Two trials showed that there was no significant difference between nifedipine and tamsulosin group（ P 〈0. 05）,while other five trials showed the opposite results（ P 〈0. 05）. Conclusion Nifedipine has a beneficial effect on the expulsion of ureteral stones,but the effective rate is lower than tamsulosin. Meanwhile,the rate of severe adverse reaction is similar between nifedipine and tamsulosin.