Zeng Hengda, Wang Ziqiao, Zhu Weian, Li Xiaoyang, Liu Bohao, Chen Chuhao, Huang Peiying, Luo Yun
Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Pharmacol. 2024 Jun 5;15:1358340. doi: 10.3389/fphar.2024.1358340. eCollection 2024.
Benign prostatic hyperplasia (BPH) is prevalent among the aging male population and often presents with distressing lower urinary tract symptoms. There is emerging evidence that commercial oral poly-herbal traditional Chinese medicine (TCM) formulation combined with Western medicine (WM) may offer enhanced therapeutic effects compared to WM alone in BPH treatment. Nevertheless, determining the optimal formulations for BPH remains controversial. We aimed to employ a network meta-analysis to compare and assess differences among commonly used and recommended poly-herbal TCM formulations outlined in the Chinese guidelines for BPH treatment, providing clinical medication recommendations and guidance. We extensively searched for RCTs of BPH patients that had oral poly-herbal TCM formulations and WM treatment, covering both English and Chinese databases up to 31 October 2023. The quality of the included studies was evaluated using the Cochrane risk-of-bias tool Version 2 (ROB2). A Bayesian network meta-analysis was performed to assess the effectiveness of various formulations, followed by sensitivity and subgroup analyses. Our meta-analysis included 107 RCTs involving 11,037 patients across 16 oral poly-herbal TCM formulations. The quality of the selected studies was assessed as "Some concerns". Most formulations combined with WM demonstrated superior therapeutic efficacy compared to WM alone. For clinical effective rate, Jingui Shenqi pill (JGSQ) + WM had the highest-ranking probability (87.38%). Concerning International Prostate Symptom Score (IPSS) and maximum flow rate of urine, Guizhi Fuling capsule (GZFL) + WM was most effective (91.10% and 98.55%). Regarding the quality of life score and postvoid residual urine, Pulean tablet (PLA) + WM ranked first (86.71% and 91.81%). In controlling prostate volume, Huange capsule (HE) + WM demonstrated the highest efficacy (95.65%). Additionally, among the interventions, Lingze (LZ) + WM capsule exhibited the lowest incidence of adverse drug reactions (2.32%). Combining oral poly-herbal TCM formulations with WM may provide greater therapeutic benefits in BPH treatment compared to WM alone. JGSQ, GZFL, PLA, and HE emerged as promising treatment options. However, further rigorous empirical studies are essential to substantiate these findings. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459651, CRD 42023459651.
良性前列腺增生（BPH）在老年男性人群中普遍存在，常伴有令人苦恼的下尿路症状。越来越多的证据表明，与单纯使用西药（WM）相比，商用口服多草药中药（TCM）配方联合西药在BPH治疗中可能具有更好的治疗效果。然而，确定BPH的最佳配方仍存在争议。我们旨在采用网络荟萃分析来比较和评估中国BPH治疗指南中常用和推荐的多草药中药配方之间的差异，提供临床用药建议和指导。我们广泛检索了截至2023年10月31日的中英文数据库中有关口服多草药中药配方和西药治疗BPH患者的随机对照试验（RCT）。使用Cochrane偏倚风险工具第2版（ROB2）评估纳入研究的质量。进行贝叶斯网络荟萃分析以评估各种配方的有效性，随后进行敏感性和亚组分析。我们的荟萃分析纳入了107项RCT，涉及16种口服多草药中药配方的11037例患者。所选研究的质量被评估为“有些担忧”。与单纯使用西药相比，大多数与西药联合使用的配方显示出更好的治疗效果。对于临床有效率，金匮肾气丸（JGSQ）+西药的概率排名最高（87.38%）。关于国际前列腺症状评分（IPSS）和最大尿流率，桂枝茯苓胶囊（GZFL）+西药最有效（91.10%和98.55%）。对于生活质量评分和残余尿量，普乐安片（PLA）+西药排名第一（86.71%和91.81%）。在控制前列腺体积方面，癃闭舒胶囊（HE）+西药疗效最高（95.65%）。此外，在干预措施中，灵泽（LZ）+西药胶囊的药物不良反应发生率最低（2.32%）。与单纯使用西药相比，口服多草药中药配方联合西药在BPH治疗中可能提供更大的治疗益处。金匮肾气丸、桂枝茯苓胶囊、普乐安片和癃闭舒胶囊成为有前景的治疗选择。然而，需要进一步严格的实证研究来证实这些发现。https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459651，CRD 42023459651 。
