Nishino Yoshinori, Masue Takako, Miwa Kousei, Takahashi Yoshito, Ishihara Satoshi, Deguchi Takashi
Department of Urology, Division of Disease Control, Research Field of Medical Sciences, Graduate School of Medicine, Gifu University, Japan.
BJU Int. 2006 Apr;97(4):747-51, discussion 751. doi: 10.1111/j.1464-410X.2006.06030.x.
To compare the efficacy of two alpha(1)-adrenoceptor antagonists, alpha(1A)-adrenoceptor-selective tamsulosin hydrochloride and alpha(1D)-adrenoceptor-selective naftopidil, in the treatment of lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH).
Thirty-four patients (mean age 72.4 years, sd 4.3, range 66-79) with LUTS (International Prostate Symptom Score, IPSS >8) secondary to BPH were enrolled in a randomized crossover study. Seventeen patients were initially prescribed naftopidil 50 mg for 4 weeks, followed by tamsulosin 0.2 mg for 4 weeks (group A); another 17 were initially prescribed tamsulosin 0.2 mg, followed by naftopidil 50 mg (group B). Patients changed to the alternative treatment after a 1-week washout period. Efficacy criteria were improvement in LUTS (IPSS), quality of life (QoL), uroflowmetry, and pressure-flow study (PFS) values based on the treatment with each agent.
At baseline there were no significant differences between the groups in IPSS, QoL, uroflowmetry values or PFS values, except for the volume at maximum desire to void. After treatment with each agent, the IPSS and QoL were significantly improved and the reduction in bladder outlet obstruction confirmed by PFS. Naftopidil was significantly more effective than tamsulosin in relieving nocturia. The increases from baseline (before treatment) to the endpoint (after treatment with each agent) in the volume at first desire and maximum desire to void were significantly higher with naftopidil than with tamsulosin. Involuntary contractions disappeared in two patients with relief of nocturia with naftopidil, but not with tamsulosin. The decrease in other symptoms of the IPSS, QoL, increase in uroflowmetry values and changes in other PFS values were similar for both agents.
The two agents provided similar efficacy in the treatment of LUTS with BPH. However, naftopidil was better than tamsulosin for nocturia. The disappearance of involuntary contraction and the greater increase in first-desire volume with naftopidil may be associated with the relief of nocturia. The alpha(1D)-adrenoceptor antagonist is effective in alleviating both voiding and storage symptoms. The alpha(1D)-adrenoceptor antagonist may be more effective than the alpha(1A)-adrenoceptor antagonist in LUTS with BPH.
比较两种α1肾上腺素能受体拮抗剂，即α1A肾上腺素能受体选择性盐酸坦索罗辛和α1D肾上腺素能受体选择性萘哌地尔，治疗良性前列腺增生（BPH）所致下尿路症状（LUTS）的疗效。
34例因BPH继发LUTS（国际前列腺症状评分，IPSS>8）的患者纳入一项随机交叉研究。17例患者最初服用萘哌地尔50mg，持续4周，随后服用坦索罗辛0.2mg，持续4周（A组）；另外17例患者最初服用坦索罗辛0.2mg，随后服用萘哌地尔50mg（B组）。经过1周的洗脱期后，患者更换为另一种治疗药物。疗效标准为基于每种药物治疗的LUTS（IPSS）、生活质量（QoL）、尿流率测定和压力-流率研究（PFS）值的改善情况。
基线时，除最大尿意尿量外，两组在IPSS、QoL、尿流率测定值或PFS值方面无显著差异。使用每种药物治疗后，IPSS和QoL均显著改善，PFS证实膀胱出口梗阻减轻。萘哌地尔在缓解夜尿症方面明显比坦索罗辛更有效。与坦索罗辛相比，萘哌地尔使首次尿意尿量和最大尿意尿量从基线（治疗前）到终点（每种药物治疗后）的增加幅度显著更高。两名夜尿症缓解的患者在服用萘哌地尔后不自主收缩消失，但服用坦索罗辛后未消失。两种药物在IPSS的其他症状减轻、QoL改善、尿流率测定值增加以及其他PFS值变化方面相似。
两种药物在治疗BPH所致LUTS方面疗效相似。然而，萘哌地尔在治疗夜尿症方面优于坦索罗辛。萘哌地尔使不自主收缩消失以及首次尿意尿量增加幅度更大可能与夜尿症缓解有关。α1D肾上腺素能受体拮抗剂在缓解排尿和储尿症状方面均有效。在BPH所致LUTS中，α1D肾上腺素能受体拮抗剂可能比α1A肾上腺素能受体拮抗剂更有效。
