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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 第五型磷酸二酯酶抑制劑對治療攝護腺肥大相關的下泌尿道症狀是確實有效嗎? | 2015/12/31 下午 02:06:55 | 0 |
| 原 文 | 題 目 | Are phosphodiesterase type 5 inhibitors effective for the management of lower urinary symptoms suggestive of benign prostatic hyperplasia? |
| 作 者 | Li Tao Zhang, Jong Kwan Park | |
| 出 處 | World Journal of Nephrology | |
| 出版日期 | 4(1):138-147, 2015 | |
| 評 論 |
傳統上對於攝護腺肥大的藥物治療，甲型交感神經接受體阻斷劑(Alpha-blockers) 及5 Alpha還原酶抑制劑(5α-reductase inhibitors)、或兩者藥物合併(combination)是大多數認可的第一線用藥。但是愈來愈多的證據顯示，第五型磷酸二酯酶抑制劑phosphodiesterase type 5 inhibitors (PDE5-Is)，對於有或無性功能障礙的攝護腺肥大相關下泌尿道症狀(LUTS/BPH)的患者，證明可以有效改善病人的排尿症狀。本篇由韓國金州市國立全北大學所發表的meta-analysis 研究分析結果顯示，不論在total IPSS score、IIEF and BII (benign prostate hyperplasia impact index)都有統計學上明顯的改善；至於對於最大尿流速Qmax的改善方面，只有5mg劑量的Tadalafil有達到統計學上的意義。有趣的是，PDE5-Is對於LUTS的改善現象，甚至有學者預測此每日型藥物，將可能是未來延緩泌尿系統老化，深具潛能的治療方式。 不過PDE5-Is雖然效果良好，但對於很多病患來說，錢不是問題，問題是沒有錢； 由於國內醫療保險普遍不將此類藥物納入保險給付，因此想要在台灣推廣這項自費治療模式顯然還不太容易。另外，對於此藥長期使用的療效以及安全性，也必須依賴更多大型及更久的臨床研究評估。不過以本文的研究分析結果顯示，PDE5-Is單獨或合併甲型交感神經接受體阻斷劑的組合，不但比單獨使用甲型交感神經接受體阻斷劑有更好的排尿症狀改善效果，更可以改善病患的性功能；對於有性功能障礙的攝護腺肥大相關下泌尿道症狀(LUTS/BPH)的患者，應該建議PDE5-Is做為治療的第一線用藥。 |
|
| abstract |
AIM: To review the efficacy of phosphodiesterase type 5 inhibitors (PDE5-Is) in lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (LUTS/BPH). METHODS: A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score (IPSS), IPSS subscore including voiding, storage and quality of life (QoL), Benign prostatic hyperplasia Impact Index (BII), maximum urinary flow rate (Qmax) and the International Index of Erectile Function (IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results. RESULTS: Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction (ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are -2.17, 4.88 and -0.43, P < 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are -1.97, 4.54 and -0.52, P < 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and QoL subscore (mean difference = -0.71, -1.23 and -0.33, P < 0.00001, respectively). Although four doses of tadalafil (2.5, 5, 10 and 20 mg) failed to reach significance in Qmax (mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax (mean difference = 0.33, P = 0.03). CONCLUSION: PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH. |
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