5α-还原酶抑制剂与良性前列腺增生患者性功能障碍相关性的Meta分析

Association between 5α-reductase inhibitors and sexual dysfunction in subjects with benign prostatic hyperplasia:a meta-analysis

目的系统评价5α-还原酶抑制剂(5ARIs)与良性前列腺增生(BPH)患者性功能障碍发生风险之间的关联。方法计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、CNKI、WanFang Data、VIP和CBM数据库,搜集关于5ARIs与BPH患者性功能障碍发生相关性的研究,检索时限均为建库至2020年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入15个研究,包括17774例患者。Meta分析结果显示:与安慰剂组相比,5ARIs可增加BPH患者勃起功能障碍[RR=1.52,95%CI(1.36,1.69),P<0.0001]、性欲减退[RR=1.79,95%CI(1.37,2.32),P<0.0001]及射精功能障碍的发生风险[RR=2.97,95%CI(1.82,4.83),P<0.0001]。不同5ARIs类型、干预期、研究发表年份和样本量的亚组分析结果均显示5ARIs造成性功能障碍的发生风险高于安慰剂。结论当前证据表明,5ARIs可增加BPH患者勃起功能障碍、性欲减退和射精功能障碍的发生风险。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究予以验证。

Objective To systematically review the association between 5α-reductase inhibitors(5 ARIs) and risk of sexual dysfunction in subjects with benign prostatic hyperplasia(BPH). Methods Pub Med, Web of Science, The Cochrane Library, EMbase, CNKI, Wan Fang Data, VIP and CBM databases were electronically searched to collect studies on the association between 5 ARIs and risk of sexual dysfunction in subjects with BPH from inception to October 2020.Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Metaanalysis was then performed by using Stata 12.0 software. Results A total of 15 studies involving 17 774 subjects were included. The results of the meta-analysis showed that compared with the placebo group, 5 ARIs could significantly increase risk of erectile dysfunction(RR=1.52, 95%CI 1.36 to 1.69, P<0.000 1), while decrease libido(RR=1.79, 95%CI 1.37 to 2.32, P<0.000 1) and ejaculation disorder(RR=2.97, 95%CI 1.82 to 4.83, P<0.000 1) in subjects with BPH. Subgroup analysis of the type of 5 ARIs, intervention period, publication year and sample size showed that the 5 ARIs had a higher risk of sexual dysfunction than the placebo group. Conclusions Current evidence shows that 5 ARIs can increase risk of erectile dysfunction, decrease libido and ejaculation disorder in subjects with BPH. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.