Boyle P, Roehrborn C, Harkaway R, Logie J, de la Rosette J, Emberton M
Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
Eur Urol. 2004 May;45(5):620-6; discussion 626-7. doi: 10.1016/j.eururo.2003.09.012.
This analysis examines the relative effectiveness of current medical therapies for BPH in preventing AUR, AUR-related catheterisation and surgery in real-life clinical practice.
This is a retrospective analysis of observational data from the General Practice Research Database (UK) (GPRD). The cohort contains 4500 patients experiencing BPH or lower urinary tract symptoms strongly suggestive of BPH, aged over 50 years, who were prescribed a 5ARI (finasteride) or an alpha-blocker (alfuzosin, doxazosin, indoramin, prazosin, tamsulosin, terazosin) as their first BPH treatment between 1996 and 1999 inclusive. Cox regression and competing risks analyses, adjusted for age and year of first treatment, followed patients from the start of their first BPH treatment to AUR, catheterisation or surgery, or censoring.
Patients prescribed an alpha-blocker were significantly more likely to experience AUR (hazard ratio 2.32, 95%CI 1.37, 3.94) or surgery (hazard ratio 1.78, 95%CI 1.30, 2.44) than patients prescribed a 5ARI. These differences were sustained with sensitivity analyses.
Real-life clinical practice shows that significantly fewer BPH patients prescribed a 5ARI experienced serious complications associated with the progression of BPH compared with those prescribed an alpha-blocker.
本分析旨在研究当前治疗良性前列腺增生（BPH）的药物疗法在现实临床实践中预防急性尿潴留（AUR）、AUR相关导尿及手术方面的相对有效性。
这是一项对来自英国全科医学研究数据库（GPRD）的观察性数据进行的回顾性分析。该队列包含4500例年龄超过50岁、患有BPH或有强烈提示BPH的下尿路症状的患者，他们在1996年至1999年（含）期间首次接受BPH治疗时被处方了5α还原酶抑制剂（非那雄胺）或α受体阻滞剂（阿夫唑嗪、多沙唑嗪、吲哚拉明、哌唑嗪、坦索罗辛、特拉唑嗪）。采用Cox回归和竞争风险分析，对年龄和首次治疗年份进行调整，从患者首次接受BPH治疗开始随访至发生AUR、导尿或手术，或进行截尾。
与处方5α还原酶抑制剂的患者相比，处方α受体阻滞剂的患者发生AUR（风险比2.32，95%置信区间1.37，3.94）或手术（风险比1.78，95%置信区间1.30，2.44）的可能性显著更高。敏感性分析维持了这些差异。
现实临床实践表明，与处方α受体阻滞剂的BPH患者相比，处方5α还原酶抑制剂的BPH患者发生与BPH进展相关的严重并发症的情况明显更少。
