单一用药及联合用药治疗良性前列腺增生合并膀胱过度活动症的疗效分析

Efficacy analysis of the single versus combination drug therapies for benign prostatic hyperplasia with overactive bladder

目的观察按前列腺体积分组进行单一用药和联合用药治疗良性前列腺增生（BPH）合并膀胱过度活动症（OAB）患者的药物疗效。方法本次研究采用开放式连续队列研究。收集2012年3月至2015年10月门诊BPH合并OAB患者471例，均符合纳入排除标准。根据前列腺体积的大小将患者分为两组进行治疗：单一用药组采用α受体阻滞剂治疗（前列腺体积〈30ml）4周，罔际前列腺症状评分（IPSS）评分改变小于30％的患者继续治疗8周。联合药物组患者（前列腺体积≥30ml）先服用5α还原酶受体阻滞剂治疗12周，IPSS评分改变小于30％的患者添加α受体阻滞剂进行治疗4周。分别比较两组患者治疗前后残余尿量（PVR）、前列腺体积（PV）、最大尿流率（Qmax）、罔际前列腺症状评分（IPSS）、过度活动症评分（OABSS）、生活质量评分（QOL），储尿期症状评分和排尿期症状评分的改善情况。结果BPH合并OAB患者进行单一药物组和联合用药组治疗后，两组IPSS、OABSS、QOL、尿急症状、储尿期症状和排尿期症状等指标较治疗前改善（P≤0．05）。联合用药组患者PVR和Qmax的改善不明显。BPH合并0AB患者单用药物治疗后OAB的缓解率为70．5％（206／292），治疗12周后OAB的缓解率为78．6％（165／210）；联合用药组患者治疗12周后OAB的缓解率为54．5％（64／122），治疗16周后OAB症状的缓解率为67．1％（53／79）。结论根据患者前列腺体积进行分组治疗后，单用α受体阻滞剂和联合使用5a还原酶抑制剂治疗BPH合并OAB均具有较好的疗效；单用α受体阻滞剂可改善BPH合并OAB患者PVR和Qmax；联合用药可改善BPH合并OAB患者PV。

Objective To explore the efficacy of the single versus combination drug therapies for benign prostatic hyperplasia（BPH）combined with overactive bladder（OAB）. Methods A total of 471 outpatients with BPH and OAB meeting the inclusion/exclusion criteria were enrolled in this prospective cohort study from March 2012 to October 2015. Patients were divided into two groups：（1） the single alpha-blocker treatment group（prostate volume 〈30 ml）,and（2）the 5-alpha reductase inhibitors（,5 ARIs）plus alpha-blocker combination treatment group（prostate volume ≥ 30 ml）. The 318 patients were treated with alpha-blockers for 4 weeks,and then received a continuing alpha-blocker treatment for 8 weeks if IPSS score changes were less than 30% （i. e. single alpha-blocker treatment group）. And 153 patients were treated with 5 ARIs for 12 weeks, then received 5 ARIs plus alphablocker combination treatment for another 4 weeks（a total of 16 weeks）if IPSS score changes were less than 30 % （i. e. combination treatment group）. The improvements of post-voiding residual（PVR）, PV, maximum urinary flow rate（Qmax）, international prostate symptom score（IPSS）, overactive bladder symptom score （ OABSS）, quality of life （ QOL）, urine storage period symptom score （USPSS） and voiding symptom score（VSS）were compared between the two groups. Results The values of IPSS, OABSS,QOL,USPSS and VSS index in the two groups were improved after treatment as compared with pre-treatment（all P≤0.05）. Patients in combination treatment group had little improvement in PVR and Qmax after treatment. The OAB symptom remission rates of BPH patients with OAB in single alpha-blocker treatment group were 70. 5% （206/292）and 78.6% （165/210）after 4 and 12 weeks of treatment respectively. The OAB symptoms remission rates of BPH patients with OAB in combination treatment group were 54. 5%（64/122）and 67.1% （53/79）after 12 and 16 weeks of treatment respectively. Conclusions Both single alpha-blocker treatment and alpha-blocker plus SARIs combination treatment, which identification was based on prostate volume,have good effects on BPH patients with OAB. The single alpha-blocker treatment can improve PVR and Qmax, and the alpha-blockers plus SARIs combination treatment can improve the prostate volume in BPH patients with OAB.