Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Department of İnternal Medicine, Istanbul, Turkey.
Department of İnternal Medicine, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.
Int Urol Nephrol. 2024 Aug;56(8):2489-2494. doi: 10.1007/s11255-024-03968-z. Epub 2024 Mar 8.
Although it is known that alpha-adrenergic receptor antagonists have positive effects on metabolic parameters such as glucose metabolism, lipid profile, and insulin sensitivity, it is unclear whether this is a class effect. Tamsulosin is reported to have adverse effects on glucose metabolism and insulin resistance, and this may be because of its lack of glycolysis-enhancing effect compared with other alpha-adrenergic receptor antagonists with glycolysis-enhancing effects such as doxazosin, terazosin, and alfuzosin. The aim of this study was to compare the effect of tamsulosin on metabolic parameters with another alpha-1 adrenergic receptor antagonist, doxazosin.
In this prospective, observational, controlled, 12-week clinical study, a total of 60 male patients aged ≥ 40 years who were first started on tamsulosin (n = 30; 0.4 mg/day, oral; mean age, 59.20 ± 8.97 years) or doxazosin (n = 30; 4 or 8 mg/day, oral; mean age, 58.50 ± 8.93 years) for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) were enrolled. The groups were compared according to the changes in anthropometric and biochemical parameters (glycemia, lipid profile, and insulin sensitivity) at the end of treatment.
In intragroup analyses, systolic blood pressure, diastolic blood pressure, total cholesterol, and HbA1c levels decreased significantly in the doxazosin group compared with baseline (p < 0.05 for all), while no significant change was observed in the tamsulosin group. In comparisons between groups, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels showed a significant decrease in the doxazosin group compared with the tamsulosin group (percent change: - 6.68 ± 13.08 vs. 0.53 ± 11.02, p = 0.025; - 3.63 ± 9.56 vs. 4.02 ± 10.86, p = 0.005; and - 5.62 ± 18.18 vs. 5.24 ± 15.42, p = 0.015, respectively).
Although these results do not support previous findings that tamsulosin has adverse effects on metabolic parameters, they suggest that doxazosin treatment may be a reason for preference in patients with BPH or LUTS accompanied by metabolic disorder.
尽管已知α-肾上腺素能受体拮抗剂对葡萄糖代谢、血脂谱和胰岛素敏感性等代谢参数具有积极影响，但尚不清楚这是否是一类效应。坦索罗辛被报道对葡萄糖代谢和胰岛素抵抗有不良影响，这可能是由于与具有增强糖酵解作用的其他α-肾上腺素能受体拮抗剂（如多沙唑嗪、特拉唑嗪和阿夫唑嗪）相比，它缺乏增强糖酵解的作用。本研究旨在比较坦索罗辛和另一种α-1 肾上腺素能受体拮抗剂多沙唑嗪对代谢参数的影响。
在这项前瞻性、观察性、对照、为期 12 周的临床研究中，共纳入了 60 名首次开始接受坦索罗辛（n=30；0.4mg/天，口服；平均年龄 59.20±8.97 岁）或多沙唑嗪（n=30；4 或 8mg/天，口服；平均年龄 58.50±8.93 岁）治疗良性前列腺增生（BPH）或下尿路症状（LUTS）的男性患者。根据治疗结束时人体测量学和生化参数（血糖、血脂谱和胰岛素敏感性）的变化对两组进行比较。
在组内分析中，与基线相比，多沙唑嗪组的收缩压、舒张压、总胆固醇和 HbA1c 水平显著降低（p<0.05），而坦索罗辛组无明显变化。组间比较时，与坦索罗辛组相比，多沙唑嗪组的收缩压、总胆固醇和低密度脂蛋白胆固醇水平显著降低（百分比变化：-6.68±13.08 对 0.53±11.02，p=0.025；-3.63±9.56 对 4.02±10.86，p=0.005；-5.62±18.18 对 5.24±15.42，p=0.015）。
尽管这些结果不支持坦索罗辛对代谢参数有不良影响的先前发现，但它们表明，多沙唑嗪治疗可能是患有 BPH 或 LUTS 伴代谢紊乱的患者的首选原因。
