BPH的藥物聯(lián)合治療

1、1會(huì)計(jì)學(xué)BPH的藥物聯(lián)合治療的藥物聯(lián)合治療Chatelain C et al. Benign Prostatic hyperplasia. 2000Kirby R, et al. Urology 2003;61(1):119-126Kirby R, et al. Urology 2003;61(1):119-1261 1多沙唑嗪多沙唑嗪(n=249)非那雄胺非那雄胺(n=237)多沙唑嗪多沙唑嗪 + 非那雄胺非那雄胺(n=261)安慰劑安慰劑(n=252)*1098765432108.3 0.46.6 0.48.5 0.45.7 0.4Kirby R, et al. Urology 2003;

2、61(1):119-126多沙唑嗪多沙唑嗪(n=236)非那雄胺非那雄胺(n=228)多沙唑嗪多沙唑嗪 +非那雄胺非那雄胺(n=252)安慰劑安慰劑(n=245)*0.00.51.01.52.02.53.03.54.03.6 0.31.8 0.33.8 0.31.4 0.34.5Kirby R, et al. Urology 2003;61(1):119-126 多沙唑嗪多沙唑嗪(n=275)非那雄胺非那雄胺(n=264)多沙唑嗪多沙唑嗪非那雄胺非那雄胺(n=286)安慰劑安慰劑(n=269)急性尿潴留急性尿潴留0.0 %1.1 %0.0 %1.5 %TURP0.4 %1.1 %0.0 %2.

3、6 %急性尿潴留急性尿潴留或或TURP0.4 %1.9 %0.0 %2.6 %Kirby R, et al. Urology 2003;61(1):119-126Kirby R, et al. Urology 2003;61(1):119-126McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398(*) Define as the time from randomization to the first occurrence of any of the five BPH progressio

4、n events defined aboveMcConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-23980 01 12 23 34 45 56 6每100患者年中的終點(diǎn)數(shù)PSA4.0McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-239834396

5、6危險(xiǎn)性下降危險(xiǎn)性下降多沙唑嗪非那雄胺聯(lián)合治療7.07.05.05.06.06.04.04.00 02 24 46 68 8安慰劑多沙唑嗪非那雄胺多沙唑嗪非那雄胺AUA評(píng)分較基線值的改變 多沙唑嗪顯著優(yōu)于非那雄胺多沙唑嗪顯著優(yōu)于非那雄胺 (P=0.002)(P=0.002) 聯(lián)合治療顯著優(yōu)于單藥治療聯(lián)合治療顯著優(yōu)于單藥治療 (P0.05)(P0.05)McConnell, etc; NEJM;2003,349:2387-23983.73.72.22.22.52.51.41.40 01 12 23 34 4安慰劑多沙唑嗪非那雄胺多沙唑嗪非那雄胺Q(chēng)max較基線值的改變 (mL/s) 多沙唑嗪優(yōu)于非

6、那雄胺多沙唑嗪優(yōu)于非那雄胺 聯(lián)合治療顯著優(yōu)于單藥治療聯(lián)合治療顯著優(yōu)于單藥治療 (P0.01)(P0.01)McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398BPH的藥物聯(lián)合治療的藥物

7、聯(lián)合治療Ji Youl Lee et al, BJU, June, 2004Ji Youl Lee et al, BJU, June, 2004Ji Youl Lee et al, BJU, June, 2004Cardura X 3月CarduraimprovedCardura+tolterodineimprovedBOOCardura X 3月CarduraimprovedCardura+tolterodineimprovedBOO+OABUDSLUTS1441447676（5353）6868（4747）YesYesYesYesNoNoNoNoWatchful waitingProstat

8、e smallPSA lowPreventive therapy5a-inhibitor ?Prostate largePSA highIPSS7BPHAdd OAB MedicationContinueBPH的藥物聯(lián)合治療的藥物聯(lián)合治療De Rose AF, et al. International J. of Importence Research.2002;14:50-530 01 12 23 34 45 56 67 78 89 950-59 50-59 歲歲60-6960-69歲歲70-7970-79歲歲IPSS = 0IPSS = 0IPSS 1-7IPSS 1-7IPSS 8-19

9、IPSS 8-19IPSS 19IPSS 19Age effectLUTS effectLUTS effectLUTS effectJOHN M. FITZPATRICK and FRANOIS DESGRANDCHAMPS*，2 0 0 5 B J U60天天De Rose AF, et al. International J. of Importence Research.2002;14:50-53非器質(zhì)性非器質(zhì)性DEDE萬(wàn)艾可治療效果不佳萬(wàn)艾可治療效果不佳入選試驗(yàn)入選試驗(yàn) n=28萬(wàn)艾可萬(wàn)艾可+安慰劑安慰劑萬(wàn)艾可萬(wàn)艾可+可多華可多華IIEF5 5101015152020基礎(chǔ)值基礎(chǔ)值30天

10、30天60天60天萬(wàn)艾可+可多華萬(wàn)艾可+可多華萬(wàn)艾可+安慰劑萬(wàn)艾可+安慰劑1010151520202525基礎(chǔ)值基礎(chǔ)值30天30天60天60天萬(wàn)艾可+可多華萬(wàn)艾可+可多華萬(wàn)艾可+安慰劑萬(wàn)艾可+安慰劑IIEF基礎(chǔ)值：基礎(chǔ)值：6-10IIEF基礎(chǔ)值：基礎(chǔ)值：11-16De Rose AF, et al. International J. of Importence Research.2002;14:50-53注：有其他研究顯示，與1受體阻滯劑合用時(shí)，萬(wàn)艾可的劑量如果超過(guò)25mg，部分患者有出現(xiàn)低血壓的可能。故服用受體阻滯劑后4小時(shí)內(nèi)應(yīng)避免服用50mg或100mg的萬(wàn)艾可，25mg不受限制。0 01 12 23 34 45 56 6每100患者年中的終點(diǎn)數(shù)PSA4.0McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-2398McConnell, etc; NEJM;2003,349:2387-23985 5101015152020基礎(chǔ)值基礎(chǔ)值30天30天60天60天萬(wàn)艾可+可多華萬(wàn)艾可+可多華萬(wàn)艾可+安慰劑萬(wàn)艾可+安慰劑1010151520202525基礎(chǔ)值基礎(chǔ)值30天30天60天60天萬(wàn)艾可+可多華萬(wàn)艾可+可多華萬(wàn)艾可+安慰劑萬(wàn)艾可+安慰劑IIEF基礎(chǔ)值：基礎(chǔ)值：6-10IIEF基礎(chǔ)值：