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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 王炯珵 | 使用降血脂的藥物沒有辦法治療攝護腺肥大 | 2007/9/28 上午 06:17:34 | 0 |
| 原 文 | 題 目 | Atorvastatin treatment for men with lower urinary tract symptoms and benign prostatic enlargement. |
| 作 者 | Mills IW | |
| 出 處 | European urology | |
| 出版日期 | 2007 Aug;52(2):503-9. | |
| 評 論 |
攝護腺肥大藥物治療以α-blocker和5-α-reductase inhibitors 兩大類為主流，當病患有攝護腺肥大加上膀胱過動症時，Antimuscarinic agents也可以考慮為治療選擇可是有些病患就是針對這三大類藥物治療都沒效，請問還有其他選擇？ 流行病學研究顯示，肥胖、高血脂和Metabolic syndrome等和攝護腺肥大有關，動物實驗顯示降血脂的藥，像Atorvastatin (Lipitor®)是HMG-COA reductase inhibitor；可以有效降低G-proteins Rho和Ras 調降connective tissue growth factors，增加通過下泌尿道的血流，進而放鬆攝護腺平滑肌，從這角度來看似乎可以使用Atorvastatin來治療攝護腺肥大。 來自英國由Pfizer贊助的研究團隊進行了一個phase2雙盲隨機安慰劑控制為期26週的臨床試驗，結果顯示Atorvastatin對於LUTS和最大尿流速的改善和安慰劑相似， 攝護腺體積有沒有明顯縮小，唯一有差別的是治療組的血脂肪下降。 還好沒有辦法使用降血脂的藥物來治療攝護腺肥大，不然這個話題又可以炒作一番了，這個世界還是單純一點較好 |
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| abstract |
OBJECTIVE: To evaluate the effects of atorvastatin in men with lower urinary tract symptoms (LUTS) and prostatic enlargement due to presumed BPH. METHODS: This was a phase 2, double-blind, randomised, placebo-controlled clinical study. Eligible patients were aged > or =50 yr, with International Prostate Symptom Score (IPSS) > or = 13, total prostate volume (TPV) > or = 30 ml, and maximum urinary flow rate 5-15 ml/s. All patients had serum low-density lipoprotein (LDL) 100-190 mg/dl at baseline. Patients received either atorvastatin 80 mg daily (n=176) or placebo (n=174) for 26 wk. End points included IPSS, TPV, transition zone volume (TZV), maximum urinary flow rate (Q(max)), serum PSA, and lipids. RESULTS: There was no difference between the effects of atorvastatin and placebo on the primary end point of mean change from baseline in IPSS after 26 wk of double-blind treatment (-4.5 vs. -4.3; p=0.263). Similarly, no effect was seen on the lower urinary tract secondary end points including TPV (-1.6 vs. -1.9 ml; p=0.654), TZV (-0.0 vs. -0.8 ml; p=0.421), Q(max) (+1.1 vs. +0.7 ml/s; p=0.612), and PSA (-0.24 vs. -0.14 ng/ml; p=0.235). Atorvastatin had a significant effect on serum lipid levels compared with placebo (eg, LDL: -75.6 vs. -6.1 mg/dl; p<0.001). CONCLUSIONS: Atorvastatin is not effective over 6 mo in the treatment of men with LUTS and prostatic enlargement due to presumed BPH who have serum LDL in the range 100-190 mg/dl. |
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