學術論壇
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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 鍾旭東 | 下尿路症狀輕微至無症狀之病患，最快尿流速是否能預測其發生偶突發之下尿路症狀?REDUCE研究的結果 | 2017/8/31 下午 05:54:19 | 0 |
| 原 文 | 題 目 | Does Peak Urine Flow Rate Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from REDUCE. |
| 作 者 | Simon RM, Howard LE, Moreira DM, Roehrborn C, Vidal A, Castro-Santamaria R5, Freedland SJ. | |
| 出 處 | J Urol. 2017 Apr 17 [Epub ahead of print] | |
| 出版日期 | 2017 April | |
| 評 論 |
尿流速(uroflowmery)為評估攝護腺肥大造成之下泌尿道症狀(lower urinary tract symptoms, LUTS)，及攝護腺肥大治療後追蹤療效的重要檢查。最大尿流速 (peak urine flow, Qmax)在男病患的正常值為大於15ml/s，女性為大於20ml/s。本篇欲探討當前下泌尿道症狀輕微或無症狀的男性若最大尿流速下降，是否代表日後產生”偶發性下泌尿道症狀”(incident LUTS)的機會增加? 作者從REDUCE 研究(REDUCE trial, REduction by DUtasteride of prostate Cancer Events)中招攬 3140位下尿路無症狀或症狀輕微(即國際攝護腺症狀量表IPSS<8分)的男性，每半年追蹤其IPSS分數，共追蹤四年。作者比較Qmax與進展成為”偶突發之下泌尿道症狀”(指第一次接受藥物或手術治療、症狀持續、或臨床上有意義之下泌尿道症狀)之關聯性。在多變項分析中，不論病患使用dutasteride或安慰劑，Qmax減慢均會增加偶突發之下泌尿道症狀發生的機會(p=0.002)。而在單變相分析中，若將病患依最快尿流速分為Qmax ≥15mL/s、10-14.9mL/s、及<10mL/s三組，則10-14.9mL/s及<10mL/s這兩組發生偶突發下泌尿道症狀的機會增加(p值分別為 0.011及<0.001);在多變項分析中，僅<10mL/s這組發生偶突發下泌尿道症狀的機會增加。 根據本篇研究結論,在IPSS<8，即下泌尿道症狀輕微的這一群男性，若做尿流速檢查發現Qmax下降,則日後可能會增加有突發性的下泌尿道症狀。故建議此族群男性應密切追蹤其排尿症狀避免突發之下泌尿道症狀發生。另外提醒大家 尿流速的檢查除了最大尿流速Qmax以外,尿流的時間長短以及平均尿流速與波型都是很重要的臨床數據,也要列入評估病情的判斷 |
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| abstract |
Purpose: To determine whether decreased peak urine flow is associated with future incident lower urinary tract symptoms (LUTS) in men with mild to no LUTS. Materials and Methods: Our population consisted of (3,140) men from the REDUCE trial with mild to no LUTS defined as an International Prostate Symptom Score (IPSS)<8. REDUCE was a randomized trial of dutasteride vs.placebo for prostate cancer prevention in men with an elevated PSA and a negative biopsy. IPSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident LUTS, defined as the first of medical treatment, surgery, or sustained,clinically significant LUTS symptoms was tested using multivariable Cox models adjusting for various baseline characteristics and treatment arm. Results: On multivariable analysis, as a continuous variable decreased peak urine flow rate was significantly associated with increased risk of incident LUTS (p=0.002); results were similar in the dutasteride and placebo arms. When peak flow was categorized as ≥15mL/s, 10-14.9mL/s, and <10mL/s, flow rates of 10-14.9mL/s and <10mL/s were associated with a significantly increased risk of developing incident LUTS in univariable analysis (HR=1.39, p=0.011 and HR=1.67, p<0.001, respectively). Results were similar in multivariable analysis,though the 10-14.9 mL/s group was no longer statistically significant (HR 1.26, p=0.071). Conclusions: In men with mild to no LUTS, decreased peak urine flow rate is independently associated with incident LUTS. If confirmed, these men should be followed closer for incident LUTS |
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