Liu Luhao, Zhao Shankun, Li Futian, Li Ermao, Kang Ran, Luo Lianmin, Luo Jintai, Wan Shawpong, Zhao Zhigang
Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
J Sex Med. 2016 Sep;13(9):1297-1310. doi: 10.1016/j.jsxm.2016.07.006. Epub 2016 Jul 27.
5α-Reductase inhibitors (5ARIs) are widely used for the treatment of benign prostatic hyperplasia (BPH) and androgenetic alopecia (AGA).
To review all the available data on the effect of 5ARIs on sexual function and assess whether 5ARIs increase the risk of sexual dysfunction.
A systematic search of the literature was conducted using the Medline, Embase, and Cochrane databases. The search was limited to articles published in English and up to October 2015. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Data were analyzed using Stata 12.0. A fixed- or a random-effects model was used to calculate the overall combined risk estimates. Publication bias was assessed using Begg and Egger tests.
Sexual dysfunction, erectile dysfunction, and decreased libido.
After screening 493 articles, 17 randomized controlled trials with 17,494 patients were included. Nine studies evaluated the efficacy of 5ARIs in men with BPH. The other eight reported using 5ARIs in the treatment of men with AGA. The mean age of participants was 60.10 years across all studies. We included 10 trials (6,779 patients) on the efficacy and safety of finasteride, 4 trials (6,222 patients) on the safety and tolerability of dutasteride, and 3 trials (4,493 patients) using finasteride and dutasteride for AGA. The pooled relative risks for sexual dysfunction were 2.56 (95% CI = 1.48-4.42) in men with BPH and 1.21 (95% CI = 0.85-1.72) in men with AGA; those for erectile dysfunction were 1.55 (95% CI = 1.14-2.12) in men with BPH and 0.66 (95% CI = 0.20-2.25) in men with AGA; and those for decreased libido were 1.69 (95% CI = 1.03-2.79) in men with BPH and 1.16 (95% CI = 0.50-2.72) in men with AGA. Estimates of the total effects were generally consistent with the sensitivity analysis. No evidence of publication bias was observed.
Evidence from the randomized controlled trials suggested that 5ARIs were associated with increased adverse effects on sexual function in men with BPH compared with placebo. However, the association was not statistically significant in men with AGA. Well-designed randomized controlled trials are indicated to study further the mechanism and effects of 5ARIs on sexual function.
5α-还原酶抑制剂（5ARIs）广泛用于治疗良性前列腺增生（BPH）和雄激素性脱发（AGA）。
回顾所有关于5ARIs对性功能影响的可用数据，并评估5ARIs是否会增加性功能障碍的风险。
使用Medline、Embase和Cochrane数据库对文献进行系统检索。检索限于2015年10月前发表的英文文章。根据基于系统评价和Meta分析的首选报告项目标准的检索策略进行文章筛选。使用Stata 12.0分析数据。采用固定效应或随机效应模型计算总体合并风险估计值。使用Begg和Egger检验评估发表偏倚。
性功能障碍、勃起功能障碍和性欲减退。
在筛选493篇文章后，纳入了17项随机对照试验，共17494例患者。9项研究评估了5ARIs对BPH男性患者的疗效。其他8项报告了5ARIs用于治疗AGA男性患者。所有研究中参与者的平均年龄为60.10岁。我们纳入了10项关于非那雄胺疗效和安全性的试验（6779例患者）、4项关于度他雄胺安全性和耐受性的试验（6222例患者）以及3项使用非那雄胺和度他雄胺治疗AGA的试验（4493例患者）。BPH男性患者性功能障碍的合并相对风险为2.56（95%CI = 1.48 - 4.42），AGA男性患者为1.21（95%CI = 0.85 - 1.72）；BPH男性患者勃起功能障碍的合并相对风险为1.55（95%CI = 1.14 - 2.12），AGA男性患者为0.66（95%CI = 0.20 - 2.25）；BPH男性患者性欲减退的合并相对风险为1.69（95%CI = 1.03 - 2.79），AGA男性患者为1.16（95%CI = 0.50 - 2.72）。总效应估计值通常与敏感性分析一致。未观察到发表偏倚的证据。
随机对照试验的证据表明，与安慰剂相比，5ARIs与BPH男性患者性功能的不良反应增加相关。然而，在AGA男性患者中，这种关联在统计学上并不显著。需要设计良好的随机对照试验来进一步研究5ARIs对性功能的作用机制和影响。
