熊瑋 12 , 王坤杰 1 , 王莉 3 , 王佳 1 , 魏強 1 , 李虹 1
  • 1. 四川大學(xué)華西醫(yī)院泌尿外科（成都 610041）2. 四川省醫(yī)學(xué)科學(xué)院?四川省人民醫(yī)院器官移植科（成都610072）3. 四川大學(xué)華西醫(yī)院中國循證醫(yī)學(xué)中心;

目的 　系統(tǒng)評價α1腎上腺素受體阻滯劑坦索羅辛治療輸尿管結(jié)石的療效。
方法 　計算機檢索PubMed、EMbase、BIOSIS和International Pharmaceutical Abstracts（IPA）數(shù)據(jù)庫，Cochrane圖書館（2006年第3期），中國期刊全文數(shù)據(jù)庫（1995.1～2006.9）及重要學(xué)術(shù)會議論文集，系統(tǒng)收集坦索羅辛治療輸尿管結(jié)石的隨機對照試驗。由2名評價者共同評價納入研究質(zhì)量并提取資料，合并同質(zhì)研究進行Meta分析，采用STATA9.0完成定量資料分析。
結(jié)果 　共納入16個隨機對照試驗，包括1521例輸尿管下段結(jié)石患者。Meta分析結(jié)果顯示：① 坦索羅辛組比僅使用飲水和鎮(zhèn)痛藥的保守療法結(jié)石排出率高［RR 1.50，95%CI（1.20，1.87）］，縮短排石時間［SMD –1.29，95%CI（–2.27，–0.31）］，并降低后期ESWL或輸尿管鏡治療率［RR 0.40，95%CI（0.27，0.59）］，差異有統(tǒng)計學(xué)意義（P lt;0.05）。② 坦索羅辛/地夫可特聯(lián)用組比保守療法排石率高[RR 1.59，95％CI（1.31，1.93）］，縮短排石時間［SMD –0.8，95％CI（–1.18，–0.42）］，明顯減少后期ESWL或輸尿管鏡治療率［RR 0.13，95％CI（0.06，0.31）］，差異有統(tǒng)計學(xué)意義（P lt;0.05）。③ 坦索羅辛與地夫可特聯(lián)用組與單用地夫可特組在結(jié)石排出率方面沒有差異［RR 1.31，95％CI（0.78，2.23），P=0.31］，但能明顯減少鎮(zhèn)痛藥劑量［SMD 15.20，95%CI（14.98，15.52）］和后期輸尿管鏡治療率［RR 0.09，95%CI（0.02，0.47）］，差異有統(tǒng)計學(xué)意義。④ 坦索羅辛與地夫可特聯(lián)用組比硝苯地平與地夫可特聯(lián)用組結(jié)石排出率高［RR 1.20，95%CI（1.07，1.35），P=0.002］，而排石時間［SMD –1.34，95%CI（–3.47，0.79）］和后期ESWL或輸尿管鏡治療率［RR 0.34，95%CI（0.05，2.22）］無差異（P gt;0.05）。⑤以坦索羅辛為主的干預(yù)組和保守療法在藥物副作用方面沒有差異（P均 gt;0.05）。
結(jié)論 　目前的證據(jù)支持：坦索羅辛對輸尿管下段和膀胱壁間段結(jié)石具有較高的促排石率，能縮短排石時間和降低后期侵入性治療率。0.4mg/d坦索羅辛對下段輸尿管結(jié)石治療安全有效。有限證據(jù)支持坦索羅辛與地夫可特聯(lián)用有助于提高排石率，但需要大樣本的研究結(jié)果予以支持。

引用本文： 熊瑋,王坤杰,王莉,王佳,魏強,李虹. 坦索羅辛用于輸尿管結(jié)石排石治療隨機對照試驗的Meta分析. 中國循證醫(yī)學(xué)雜志, 2007, 07(7): 506-515. doi: 復(fù)制

1. Zhang XZ, Zhu X. The effect of tamsulosin and doxazosin in treatment for distal ureteral calculi-a randomized controlled trial. [in Chinese], in Association CU: The 13th annual meeting of Chinese Urological Association. SHENYANG, Chinese Urological Association, 2006: 577.
2. Lv JJ, Wei LJ, Zhang H, et al. Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones. [Chinese]. Chinese J of Urol, 2006, 27(9): 612-614.
3. Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol, 2006, 16(2): 71-76.
4. Dal Moro F, Abate A, Lanckriet GR, et al. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines. Kidney Int, 2006, 69(1): 157-160.
5. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med, 2004, 350(7): 684-693.
6. Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol, 2002, 34(1): 25-29.
7. Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology, 2005, 66(4): 712-715.
8. Resim S, Ekerbicer HC, Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology, 2005, 66(5): 945-948.
9. Kupeli B, Irkilata L, Gurocak S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology, 2004, 64(6): 1111-1115.
10. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg, 2000, 87(11): 1448-1454.
11. Coll DM, Varanelli MJ, Smith RC. Relationship of Spontaneous Passage of Ureteral Calculi to Stone Size and Location as Revealed by Unenhanced Helical CT. Am J Roentgenol, 2002, 178(1): 101-103.
12. Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315: 629-634.
13. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol, 2003, 170(6 Pt 1): 2202-2205.
14. Porpiglia F, Ghignone G, Fiori C, et al. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol, 2004, 172(2): 568-571.
15. Autorino R, De Sio M, Damiano R, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res, 2005, 33(6): 460-464.
16. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol, 2005, 174(1): 167-172.
17. Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol, 2005, 12(7): 615-620.
18. Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
19. De Sio M, Autorino R, Di Lorenzo G, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol, 2006, 20(1): 12-16.
20. Porpiglia F, Vaccino D, Billia M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol, 2006, 50(2): 339-344.
21. Taghavi R, Mahdavi R, Darabi MR, et al. The effect of tamsulosin in the passage of juxtavesical stones. Int J Urol, 2006, 13 (Suppl 1): A39.
22. Hong Y, Lee Y, Lee J, et al. Medical Therapy for Lower Ureteral Lithiasis: Prospective Study Using Tamsulosin in Combination with Furosemide. Int J Urol, 2006, 13(Suppl 1): A6.
23. Puthenveetil R, Deka P, Barua S, et al. Role of tamsulosin in the management of patients with pre-vesical ureteral calculi. Urology, 2006, 68(Suppl 1): 81-81.
24. 張選志, 朱煊. 兩種不同α1受體阻滯劑——坦索羅辛和多沙唑嗪在治療輸尿管下段結(jié)石上的應(yīng)用. 見: 第十三屆全國泌尿外科學(xué)術(shù)會議暨第八屆全球華人泌尿外科學(xué)術(shù)會議. 沈陽: 中華醫(yī)學(xué)會泌尿外科學(xué)分會; 2006: 577.
25. 呂家駒, 尉立京, 張輝, 等. 坦索羅辛和硝苯地平在輸尿管下段結(jié)石輔助排石中作用的比較. 中華泌尿外科雜志, 2006, 27(9): 612-614.
26. Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn, 2005, 24(2): 142-148.
27. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol, 2001, 40(4): 362-371.
28. Yucel S, Baskin LS. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol, 2003, 170(3): 945-948.
29. Hollingsworth JM, Rogers MAM, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet, 2006, 368(9542): 1171-1179.
30. Tekin A, Alkan E, Beysel M, et al. Alpha-1 receptor blocking therapy for lower ureteral stones: a randomized prospective trial (abstract). J Urol, 2004, 171(suppl): 304.
31. Porpiglia F, Destefanis P, Fiori C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology, 2000, 56(4): 579-582.
32. Porpiglia F, Destefanis P, Fiori C, et al. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology, 2002, 59(6): 835-838.
33. Roehrborn CG. Are all alpha-blockers created equal? An update. Urology, 2002, 59(2 Suppl 1): 3-6.
34. Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol, 2004, 171(3): 1029-1035.
  1. 1. Zhang XZ, Zhu X. The effect of tamsulosin and doxazosin in treatment for distal ureteral calculi-a randomized controlled trial. [in Chinese], in Association CU: The 13th annual meeting of Chinese Urological Association. SHENYANG, Chinese Urological Association, 2006: 577.
  2. 2. Lv JJ, Wei LJ, Zhang H, et al. Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones. [Chinese]. Chinese J of Urol, 2006, 27(9): 612-614.
  3. 3. Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol, 2006, 16(2): 71-76.
  4. 4. Dal Moro F, Abate A, Lanckriet GR, et al. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines. Kidney Int, 2006, 69(1): 157-160.
  5. 5. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med, 2004, 350(7): 684-693.
  6. 6. Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol, 2002, 34(1): 25-29.
  7. 7. Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology, 2005, 66(4): 712-715.
  8. 8. Resim S, Ekerbicer HC, Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology, 2005, 66(5): 945-948.
  9. 9. Kupeli B, Irkilata L, Gurocak S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology, 2004, 64(6): 1111-1115.
  10. 10. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg, 2000, 87(11): 1448-1454.
  11. 11. Coll DM, Varanelli MJ, Smith RC. Relationship of Spontaneous Passage of Ureteral Calculi to Stone Size and Location as Revealed by Unenhanced Helical CT. Am J Roentgenol, 2002, 178(1): 101-103.
  12. 12. Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315: 629-634.
  13. 13. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol, 2003, 170(6 Pt 1): 2202-2205.
  14. 14. Porpiglia F, Ghignone G, Fiori C, et al. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol, 2004, 172(2): 568-571.
  15. 15. Autorino R, De Sio M, Damiano R, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res, 2005, 33(6): 460-464.
  16. 16. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol, 2005, 174(1): 167-172.
  17. 17. Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol, 2005, 12(7): 615-620.
  18. 18. Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
  19. 19. De Sio M, Autorino R, Di Lorenzo G, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol, 2006, 20(1): 12-16.
  20. 20. Porpiglia F, Vaccino D, Billia M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol, 2006, 50(2): 339-344.
  21. 21. Taghavi R, Mahdavi R, Darabi MR, et al. The effect of tamsulosin in the passage of juxtavesical stones. Int J Urol, 2006, 13 (Suppl 1): A39.
  22. 22. Hong Y, Lee Y, Lee J, et al. Medical Therapy for Lower Ureteral Lithiasis: Prospective Study Using Tamsulosin in Combination with Furosemide. Int J Urol, 2006, 13(Suppl 1): A6.
  23. 23. Puthenveetil R, Deka P, Barua S, et al. Role of tamsulosin in the management of patients with pre-vesical ureteral calculi. Urology, 2006, 68(Suppl 1): 81-81.
  24. 24. 張選志, 朱煊. 兩種不同α1受體阻滯劑——坦索羅辛和多沙唑嗪在治療輸尿管下段結(jié)石上的應(yīng)用. 見: 第十三屆全國泌尿外科學(xué)術(shù)會議暨第八屆全球華人泌尿外科學(xué)術(shù)會議. 沈陽: 中華醫(yī)學(xué)會泌尿外科學(xué)分會; 2006: 577.
  25. 25. 呂家駒, 尉立京, 張輝, 等. 坦索羅辛和硝苯地平在輸尿管下段結(jié)石輔助排石中作用的比較. 中華泌尿外科雜志, 2006, 27(9): 612-614.
  26. 26. Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn, 2005, 24(2): 142-148.
  27. 27. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol, 2001, 40(4): 362-371.
  28. 28. Yucel S, Baskin LS. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol, 2003, 170(3): 945-948.
  29. 29. Hollingsworth JM, Rogers MAM, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet, 2006, 368(9542): 1171-1179.
  30. 30. Tekin A, Alkan E, Beysel M, et al. Alpha-1 receptor blocking therapy for lower ureteral stones: a randomized prospective trial (abstract). J Urol, 2004, 171(suppl): 304.
  31. 31. Porpiglia F, Destefanis P, Fiori C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology, 2000, 56(4): 579-582.
  32. 32. Porpiglia F, Destefanis P, Fiori C, et al. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology, 2002, 59(6): 835-838.
  33. 33. Roehrborn CG. Are all alpha-blockers created equal? An update. Urology, 2002, 59(2 Suppl 1): 3-6.
  34. 34. Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol, 2004, 171(3): 1029-1035.