评估α受体阻滞剂与米拉贝隆用于输尿管结石药物排石治疗的安全性和有效性：一项系统评价和荟萃分析。
Evaluating the safety and effectiveness of α-blockers versus mirabegron for medical expulsive therapy in ureteral calculi: A Systematic review and meta-analysis.
作者信息
Yan Huilei, Li Xiaoni, Zheng Xiaobo, Cui Yuanshan, Huang Jing, Cheng Yan
机构信息
Department of Urology, Liaocheng People's Hospital, Liaocheng, China.
Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, China.
出版信息
PLoS One. 2024 Dec 27;19(12):e0315328. doi: 10.1371/journal.pone.0315328. eCollection 2024.
INTRODUCTION AND AIM
The main categories of drugs employed for medical expulsive therapy in patients with ureteral calculi (UC) are alpha-blockers (α-B) and beta-adrenoceptor agonists. This meta-analysis evaluated the safety and effectiveness of α-B versus mirabegron (MIR) in treating UC.
METHODS
From January 1980 to October 2024, we extensively searched the Pubmed, Web of science, Cochrane and EMBASE databases to identify randomized controlled trials (RCTs) that compared the effectiveness of α-B and MIR in managing UC. Furthermore, a systematic review and meta-analysis were carried out.
RESULTS
The meta-analysis included six publications with 592 patients, comparing α-B with MIR. The stone expulsion rate (SER) was found to be significantly greater in the α-B group than in the MIR group, as indicated by an odds ratio (OR) of 1.51 (95% confidence interval [CI]: 1.05 to 2.16, P = 0.03) in the meta-analysis. However, no significant differences were found between the α-B group and the MIR group for stone expulsion time (SET) (mean difference [MD]: 1.20; 95% CI, -2.71 to 5.10; P = 0.55), pain episodes (PE) (MD: 0.36; 95% CI, -0.04 to 0.76; P = 0.07), or analgesic requirements (MD: 0.79; 95% CI, -0.37 to 1.94; P = 0.18). The α-B group exhibited a significantly higher incidence of adverse events compared to the MIR group for orthostatic hypotension (OR 12.16, 95% CI 3.36 to 43.95, P = 0.0001), headache (OR 3.46, 95% CI 1.41 to 8.49, P = 0.007), and retrograde ejaculation (OR 16.30, 95% CI 5.87 to 45.31, P < 0.00001). While in the dizziness (OR 1.65, 95% CI 0.67 to 4.09, p = 0.28), it made no difference.
CONCLUSIONS
Our meta-analysis identified a substantial enhancement in the SER among patients with UC who received α-B therapy instead of those who were administered MIR therapy. Nonetheless, α-B therapy was connected to an increased risk of adverse events.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, ID CRD42024595934.
引言与目的
用于输尿管结石（UC）患者药物排石治疗的主要药物类别是α受体阻滞剂（α-B）和β肾上腺素能受体激动剂。本荟萃分析评估了α-B与米拉贝隆（MIR）治疗UC的安全性和有效性。
方法
从1980年1月至2024年10月，我们广泛检索了PubMed、科学网、Cochrane和EMBASE数据库，以确定比较α-B和MIR治疗UC有效性的随机对照试验（RCT）。此外，还进行了系统评价和荟萃分析。
结果
荟萃分析纳入了6篇文献共592例患者，比较了α-B与MIR。荟萃分析结果显示，α-B组的结石排出率（SER）显著高于MIR组，比值比（OR）为1.51（95%置信区间[CI]：1.05至2.16，P = 0.03）。然而，α-B组与MIR组在结石排出时间（SET）（平均差[MD]：1.20；95% CI，-2.71至5.10；P = 0.55）、疼痛发作次数（PE）（MD：0.36；95% CI，-0.04至0.76；P = 0.07）或镇痛需求（MD：0.79；95% CI，-0.37至1.94；P = 0.18）方面未发现显著差异。与MIR组相比，α-B组在体位性低血压（OR 12.16，95% CI 3.36至43.95，P = 0.0001）、头痛（OR 3.46，95% CI 1.41至8.49，P = 0.007）和逆行射精（OR 16.30，95% CI 5.87至45.31，P < 0.00001）方面不良事件发生率显著更高。而在头晕方面（OR 1.65，95% CI 0.67至4.09，P = 0.28），两组无差异。
结论
我们的荟萃分析发现，接受α-B治疗的UC患者的SER较接受MIR治疗的患者有显著提高。尽管如此，α-B治疗与不良事件风险增加有关。
系统评价注册
PROSPERO，编号CRD42024595934。
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