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目的评价 M-受体阻滞剂与α-受体阻滞剂联合用药治疗良性前列腺增生(BPH)下尿路症状(LUT)的有效性及安全性。方法选择经1周特拉唑嗪治疗后,梗阻症状缓解,但刺激症状仍明显的 BPH/LUT 患者69例,主要的排除标准为最大尿流率(Q_(max))<10 ml/s、残余尿>50 ml、前列腺体积>50 ml。随机分成两组,特拉唑嗪组给予特拉唑嗪治疗,联合用药组给予托特罗定与特拉唑嗪联合治疗。用药时间6周,评估内容包括总症状评分(IPSS)及梗阻症状评分及刺激症状评分、尿流率和残余尿量等,并登记不良事件。结果两组间基础临床指标比较差异无统计学意义。用药6周后联合用药组 IPSS 评分由19.1±2.9降低到14.0±4.2,P<0.001。刺激症状评分由13.2±3.2降至9.2±2.9,P<0.001。特拉唑嗪组 IPSS 评分由18.5±3.2降低到17.3±4.1,P=0.033。刺激症状评分由12.7±3.1降至11.7±3.0,P=0.001。治疗后两组间比较显示:(1)联合用药组 IPSS 评分的改善优于特拉唑嗪组(-5.09 vs -1.19,P<0.001),联合用药组刺激评分的改善优于特拉唑嗪组(-4vs -1,P<0.001),而梗阻症状评分的改善两组间差异无统计学意义(-1.09 vs -0.2,P<0.168)。(2)治疗6周后两组间 Qmax、残余尿差异无统计学意义。联合用药组无急性尿潴留和其他严重并发症发生。结论托特罗定与α-受体阻滞剂联合应用于前列腺轻中度肥大、轻中度肥大的患者,可不同程度降低患者 IPSS 评分,其中以刺激症状评分的改善更明显。未见严重不良反应和急性尿潴留出现。
Objective To evaluate the efficacy and safety of combination of M-blockers and α-blockers in the treatment of lower urinary tract symptoms (LUT) in patients with benign prostatic hyperplasia (BPH). Methods Sixty - nine BPH / LUT patients with symptomatic relief of obstructive symptoms were treated with terazosin for one week. The main exclusion criteria were maximal flow rate (Q max) <10 ml / s, Residual urine> 50 ml, prostate volume> 50 ml. Randomly divided into two groups, terazosin group terazosin treatment, combination therapy group was given tocloster and terazosin combination therapy. The medication time was 6 weeks. The evaluation included the total symptom score (IPSS), obstructive symptom score and irritation symptom score, urinary flow rate and residual urine volume, and registered the adverse events. Results There was no significant difference in basic clinical indexes between the two groups. After 6 weeks of treatment, the IPSS score of combination group decreased from 19.1 ± 2.9 to 14.0 ± 4.2, P <0.001. The irritation symptom score decreased from 13.2 ± 3.2 to 9.2 ± 2.9, P <0.001. The terazosin group IPSS score decreased from 18.5 ± 3.2 to 17.3 ± 4.1, P = 0.033. Stimulation symptoms decreased from 12.7 ± 3.1 to 11.7 ± 3.0, P = 0.001. After treatment, the comparison between the two groups showed that: (1) the improvement of IPSS score in combination group was better than that of terazosin group (-5.09 vs -1.19, P <0.001); the improvement of stimulation score in combination group was better than that of terazosin Group (-4 vs -1, P <0.001), while there was no significant difference between the two groups in improvement of obstruction symptom score (-1.09 vs -0.2, P <0.168). (2) There was no significant difference in Qmax and residual urine between the two groups after 6 weeks of treatment. The combination group had no acute urinary retention and other serious complications. Conclusion The combination of tolterodine and α-blockers in mild to moderate hypertrophy of patients with mild to moderate hypertrophy can reduce the degree of IPSS in patients with varying degrees, of which the improvement of the symptom score is more obvious. No serious adverse reactions and acute urinary retention occurred.