Sivkov A V, Kirpatovskyi V I
N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia.
Urologiia. 2021 Mar(1):131-139.
Based on literature data, feasibility of combined therapy with Serenoa repens extracts (including Permixon) and 1-adrenoblocators in patients with LUTS/BPH based on the pathogenesis of these drugs and clinical results was analyzed. The composition and biological activity of various SRE is influenced by the extraction method, as well as the production technology used by the manufacturer, which can lead to different results of experimental and clinical studies. The mechanism of action of SRE, including hexane extract Permixon, is multicomponent, which combines an antiandrogenic effect, influence on neurogenic regulation of urinary tract function (-adrenoreceptors, M-holinoreceptors, vanilloid receptors), anti-inflammatory and anti-edematous actions. At the same time, the effect of these preparations is not limited to the influence on the prostate gland, but can directly affect the bladder, helping to reduce functional disorders. A wider range of mechanisms of action and a possible direct effect of SRE on the bladder provides the same clinical effect as other traditionally used drugs (-blockers, 5-reductase inhibitors) with a significantly lower frequency of side effects of therapy. A number of publications demonstrate the feasibility of combined therapy with 1-adrenoblockers and SRE in patients with LUTS/BPH, especially with a high degree of urination dysfunction. Futher investigations are needed. The role of Serenoa repens extracts in the combination therapy of LUTS/BPH is still under discussion. Serenoa repens extracts monotherapy demonstrates similar effectiveness in patients with LUTS as 1-adrenoblockers and 5-reductase inhibitors. Recent studies indicate the advantages of combining Serenoa repens extracts with 1-adrenoblockers, especially in patients with moderate or severe symptoms. These advantages are associated with the multicomponent action of Serenoa repens extracts, which complements the blockade of 1-adrenergic receptors with other mechanisms of action (in particular, anti-inflammatory). The combination of drugs with different mechanisms of action, in particular, Serenoa repens extracts (Permixon) and 1-adrenoblockers has certain pathophysiologically based advantages, which allows to increase the efficiency of therapy. In addition, combination therapy is not associated with an increased rate of side effects.
根据文献资料，基于锯叶棕提取物（包括保列治）和α-肾上腺素能阻滞剂的发病机制及临床结果，分析了二者联合治疗下尿路症状/良性前列腺增生（LUTS/BPH）患者的可行性。不同锯叶棕提取物（SRE）的成分和生物活性受提取方法以及制造商所采用的生产工艺影响，这可能导致实验研究和临床研究结果各异。SRE（包括己烷提取物保列治）的作用机制是多组分的，兼具抗雄激素作用、对尿路功能神经源性调节的影响（α-肾上腺素能受体、M-胆碱能受体、香草酸受体）、抗炎和消肿作用。同时，这些制剂的作用不仅限于对前列腺的影响，还可直接作用于膀胱，有助于减少功能障碍。SRE更广泛的作用机制以及对膀胱可能的直接作用，产生了与其他传统使用药物（α-阻滞剂、5-还原酶抑制剂）相同的临床效果，且治疗副作用的发生率显著更低。一些出版物证明了α-肾上腺素能阻滞剂与SRE联合治疗LUTS/BPH患者的可行性，尤其是对于排尿功能障碍程度较高的患者。仍需进一步研究。锯叶棕提取物在LUTS/BPH联合治疗中的作用仍在讨论中。锯叶棕提取物单药治疗在LUTS患者中的有效性与α-肾上腺素能阻滞剂和5-还原酶抑制剂相似。近期研究表明锯叶棕提取物与α-肾上腺素能阻滞剂联合使用的优势，特别是对于中度或重度症状患者。这些优势与锯叶棕提取物的多组分作用相关，它以其他作用机制（特别是抗炎）补充了α-肾上腺素能受体的阻断作用。具有不同作用机制的药物联合使用，特别是锯叶棕提取物（保列治）和α-肾上腺素能阻滞剂，具有一定基于病理生理学的优势，从而提高了治疗效果。此外，联合治疗不会增加副作用发生率。
