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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 姜秉均 | Silodosin在血管粥狀硬化引起膀胱缺血(非膀胱出口阻塞)之老鼠實驗模式對於血流與膀胱功能之影響 | 2015/1/25 下午 05:20:03 | 0 |
| 原 文 | 題 目 | Effects of Silodosin, a Selective alfa-1A-Adrenoceptor Antagonist, on Bladder Blood Flow and Bladder Function in a Rat Model of Atherosclerosis Induced Chronic Bladder Ischemia without Bladder Outlet Obstruction |
| 作 者 | Yoshiaki Goi, Yoshitaka Tomiyama, Masanori Nomiya, Koji Sagawa, Ken Aikawa | |
| 出 處 | Journal of Urology Vol. 190, 1116-1122, | |
| 出版日期 | September 2013 | |
| 評 論 |
Silodosin (商品名為Urief) 為一種選擇性alfa-1A-adrenergic receptor阻斷劑。其健保適應症為前列腺肥大症伴隨排尿障礙之患者, 常見的副作用為射精功能障礙, 依照仿單標示, 約有17%的患者使用之後會產生此副作用, 因男性高潮時輸精管與儲精囊需要藉由alfa-1A-adrenergic receptor的作用而將精液往前推送, Silodosin之藥理機轉會抑制精液之emission的動作, 故某些患者會抱怨有高潮的感覺, 但無精液射出。 在過去的研究證實Silodosin可以減輕膀胱出口阻塞引起之排尿障礙, 但仍有1/3的男性罹患排尿障礙之患者並非膀胱出口阻塞引起, 有一部分的原因是骨盆腔血管因為粥狀動脈硬化狹窄導致膀胱產生慢性缺血性傷害, 在尿路動力學上發現, 這些患者可能產生逼尿肌不穩定與逼尿肌收縮力不足的情況, 在臨床上使用Alfa-blocker包括Silodosin來治療這類的排尿障礙的患者, 仍有一定的療效, 本篇文章利用老鼠建立骨盆腔血管慢性缺血模式, 發現在骨盆腔血管受傷導致血管狹窄的老鼠, 較容易產生逼尿肌不穩定,頻尿,組織自由基較高的情況, 經過Silodosin治療之後, 對於慢性缺血性膀胱傷害, 回復膀胱血流, 膀胱功能, 清除自由基方面皆有一定的效果, 在膀胱肌肉層之微血管內, 含有alfa-1A,B,D三種alfa receptor, 由於 Silodosin 為一高度Alfa-1A特異性之阻斷劑, 其藥理機轉可能透過改善膀胱微循環特別是alfa-1A receptor,來改善膀胱功能, 故可能可以解釋為何使用alfa-blocker仍然可以改善並無膀胱出口阻塞之排尿障礙。 |
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| abstract |
Purpose: We investigated the effects of the ive alfa-1A-adrenoceptor antagonist silodosin on bladder blood flow and bladder function in a rat model of atherosclerosis induced chronic bladder ischemia without bladder outlet obstruction. Materials and Methods: The chronic bladder ischemia model was prepared by creating balloon endothelial injury of the bilateral iliac arteries in male rats. Using an osmotic pump, chronic bladder ischemia rats received silodosin subcutaneously at a rate of 0.1 or 0.3 mg/kg per day, or vehicle for 8 weeks. All groups received a 2% cholesterol diet throughout the experiment. For each alfa-1-adrenoceptor subtype mRNA expression in bladder microvessels was examined by in situ hybridization. Bladder blood flow was measured using a laser speckle blood flow imager. Malondialdehyde in bladder tissue and 8-hydroxy-2-deoxyguanosine in urine were measured as markers of oxidative stress. A metabolic cage study and cystometry were performed in conscious rats. Results: The expression of all 1-adrenoceptor subtype mRNA was observed in rat bladder microvessels. Silodosin abrogated the decreased bladder blood flow in the empty bladder and during bladder distention that were evident in rats with chronic bladder ischemia. Levels of oxidative stress markers in these rats were significantly decreased by silodosin administration. Silodosin ameliorated bladder dysfunction in rats with chronic bladder ischemia in the metabolic cage study and on cystometry. Conclusions: Results suggest that in ischemic conditions alfa-1-adrenoceptor antagonists such as silodosin may improve bladder function by restoring bladder blood flow. |
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