Haddad Firas, Farhat Walid A, Cannon Shannon
Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Divison of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
Front Pediatr. 2024 Dec 2;12:1396659. doi: 10.3389/fped.2024.1396659. eCollection 2024.
To evaluate existing clinical evidence for the efficacy of alpha blockers in the management of pediatric stone disease.
We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort and randomized control trials of patients less than 18 years old with kidney stones managed with alpha-adrenergic antagonists were included. Outcomes included stone expulsion time, stone passage rate, mean number of pain episodes, and mean need for analgesics. We performed data extraction of the selected articles, and results were assimilated and synthesized qualitatively. Data extraction and risk of bias assessment was conducted by two independent reviewers.
Of 257 relevant studies, 9 studies with 1,039 patients were included. Six studies measured stone expulsion time, with 5 studies noting statistically significant decreases in stone expulsion time for the treatment group compared to the control. Seven studies measured the stone expulsion rate, and 5 reported a statistically significant increased expulsion rate in the treatment group. Four studies reported a decrease in the mean number of pain episodes in the treatment group and two studies showed a decreased analgesic requirement compared to control. Two studies found alpha blockers not superior to watchful waiting after shock wave lithotripsy. Risk of bias was high in some studies, primarily due to incomplete reporting on methodology and study design.
Alpha blockers are supported by a growing body of evidence to be effective against nephrolithiasis in children, however large-scale, well-designed studies are needed to confirm these findings.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330068, PROSPERO (CRD42022330068).
评估α受体阻滞剂治疗小儿结石病疗效的现有临床证据。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了一项系统评价。纳入了使用α-肾上腺素能拮抗剂治疗的18岁以下肾结石患者的队列研究和随机对照试验。结局指标包括结石排出时间、结石排出率、平均疼痛发作次数以及平均镇痛需求。我们对所选文章进行了数据提取，并对结果进行了定性的汇总和综合。数据提取和偏倚风险评估由两名独立的评审员进行。
在257项相关研究中，纳入了9项研究，共1039例患者。6项研究测量了结石排出时间，其中5项研究指出，与对照组相比，治疗组的结石排出时间在统计学上有显著缩短。7项研究测量了结石排出率，5项报告治疗组的结石排出率在统计学上有显著提高。4项研究报告治疗组的平均疼痛发作次数减少，2项研究显示与对照组相比镇痛需求减少。2项研究发现，冲击波碎石术后α受体阻滞剂并不优于观察等待。一些研究的偏倚风险较高，主要原因是方法和研究设计的报告不完整。
越来越多的证据支持α受体阻滞剂对儿童肾结石有效，然而需要大规模、设计良好的研究来证实这些发现。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330068，PROSPERO（CRD42022330068）。
