Yoshida Masaki, Sugiyama Yutaka, Masunaga Koichi, Maeda Yoshihiro, Satoji Yo, Nagata Takashi, Inadome Akito
Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Drugs Today (Barc). 2007 Jun;43 Suppl B:1-7.
Benign prostatic hyperplasia (BPH) affects quality of life (QOL), and the goal of treatment is to improve lower urinary tract symptoms (LUTS), thus improving patient QOL. However, the international prostate symptom score (IPSS) used for evaluating LUTS does not always reflect the level of patient bother, and improvement in the IPSS score does not always reflect patient QOL. Therefore, in the present study, we observed the therapeutic effects of alpha(1)-blockers on IPSS, QOL index, and the bother score for individual symptoms. Ninety-three men diagnosed with BPH who had not yet been treated were enrolled (mean age 70 years). The IPSS, QOL index, and bother score for each symptom of IPSS (maximum 42 points, 7 grades, from 0 to 6: not at all bothersome, not bothersome, not much bother, neutral, a little bothersome, somewhat bothersome, very bothersome) were assessed in order to examine the correlation between LUTS and QOL. After treatment with tamsulosin hydrochloride 0.2 mg/day for 4 weeks, the change in each IPSS and bother score and the correlation was reassessed. Furthermore, the contribution of improvements in each symptom score and bother score to improvement in QOL index was examined using a path analysis model. On the IPSS at initial evaluation, the score was highest for slow stream. The bother scores were high for slow stream, nocturia, and daytime frequency. For slow stream, patients with a high IPSS score also had a high bother score, but for nocturia, there was a large discrepancy between the IPSS and bother score. After treatment, total IPSS, QOL and total bother scores were significantly improved (p <0.01). Improvements in all individual symptom scores and bother scores were also observed (p <0.01). The most predictable symptom for improvement in QOL after treatment was the improvement in the bother score for nocturia (F test; p <0.01). Treatment with tamsulosin hydrochloride showed significant improvement of each IPSS and the bother score. For nocturia, there was a large discrepancy between the IPSS and bother score. After treatment, the improvement in bother score for nocturia showed the strongest contribution to improvement in QOL. The present study suggests that in addition to the IPSS, the evaluation of bother score for each symptom may be necessary in the management for patients with LUTS suggestive of BPH.
良性前列腺增生（BPH）会影响生活质量（QOL），治疗的目标是改善下尿路症状（LUTS），从而提高患者的生活质量。然而，用于评估LUTS的国际前列腺症状评分（IPSS）并不总是能反映患者的困扰程度，IPSS评分的改善也并不总是能反映患者的生活质量。因此，在本研究中，我们观察了α1受体阻滞剂对IPSS、QOL指数以及各个症状困扰评分的治疗效果。招募了93名尚未接受治疗的BPH诊断患者（平均年龄70岁）。评估IPSS的各项症状的IPSS评分、QOL指数以及困扰评分（最高42分，7个等级，从0到6：完全不困扰、不困扰、不太困扰、中性、有点困扰、有些困扰、非常困扰），以研究LUTS与QOL之间的相关性。在用0.2mg/天的盐酸坦索罗辛治疗4周后，重新评估每个IPSS和困扰评分的变化以及相关性。此外，使用路径分析模型研究每个症状评分和困扰评分的改善对QOL指数改善的贡献。在初始评估时，IPSS评分中排尿缓慢的得分最高。排尿缓慢、夜尿症和日间尿频的困扰评分较高。对于排尿缓慢，IPSS评分高的患者困扰评分也高，但对于夜尿症，IPSS和困扰评分之间存在较大差异。治疗后，总IPSS、QOL和总困扰评分均显著改善（p<0.01）。所有单个症状评分和困扰评分也有改善（p<0.01）。治疗后QOL改善最可预测的症状是夜尿症困扰评分的改善（F检验；p<0.01）。盐酸坦索罗辛治疗使每个IPSS和困扰评分都有显著改善。对于夜尿症，IPSS和困扰评分之间存在较大差异。治疗后，夜尿症困扰评分的改善对QOL改善的贡献最大。本研究表明，对于疑似BPH的LUTS患者的管理，除了IPSS外，可能还需要评估每个症状的困扰评分。
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