Gomes Cristiano M, Sammour Zein M, Bessa Junior Jose de, Barbosa Egberto R, Lopes Roberto I, Sallem Flávio S, Trigo-Rocha Flavio E, Bruschini Homero, Nitti Victor W, Srougi Miguel
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2014;69(12):817-22. doi: 10.6061/clinics/2014(12)05.
To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease.
In a prospective study, 33 consecutive men (mean age 59.2 ± 7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated.
Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4 ± 7.5 to 11.1 ± 6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8 ± 1.1 to 1.0 ± 1.0 (p<0.001) and the maximum urinary flow varied from 9.3 ± 4.4 to 11.2 ± 4.6 ml/s (p=0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson's Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson's Disease Rating Scale scores did (RR=3.10, 95% CI=[1.15 to 5.37], p=0.011).
Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson's disease. The response to treatment is dependent on the severity of neurological disability.
评估选择性α-肾上腺素能受体拮抗剂多沙唑嗪用于治疗帕金森病男性患者下尿路症状时的反应预测因素。
在一项前瞻性研究中，对33例连续的帕金森病伴下尿路症状男性患者（平均年龄59.2±7.0岁）进行评估。采用统一帕金森病评定量表评估神经功能障碍。在基线期以及使用4mg/日缓释多沙唑嗪治疗12周后进行泌尿外科评估，包括使用国际尿失禁协会男性简表问卷进行症状评估、评估下尿路症状对生活质量的影响以及尿动力学检查。特别评估了反应的临床和尿动力学预测因素。
与基线期评分相比，多沙唑嗪给药后国际尿失禁协会男性简表总分降低，从17.4±7.5降至11.1±6.9（p<0.001）。下尿路症状对生活质量的影响也显著降低，从1.8±1.1降至1.0±1.0（p<0.001），最大尿流率从9.3±4.4变化至11.2±4.6ml/s（p=0.025）。神经功能损害的严重程度是临床反应的唯一预测因素。此外，统一帕金森病评定量表评分低于70分的患者接受多沙唑嗪治疗后临床改善的机会显著高于评分较高的患者（RR=3.10，95%CI=[1.15至5.37]，p=0.011）。
多沙唑嗪可改善下尿路症状和最大尿流率，且在帕金森病男性患者中耐受性良好。治疗反应取决于神经功能障碍的严重程度。
