- 期刊
Discontinuation of an Alpha-1 Blocker or 5-Alpha-Reductase Inhibitor after Combination Medical Treatment in Patients with Benign Prostatic Hyperplasia
合併藥物治療良性前列腺肥大病人後停止甲型腎上腺素交感神經抑制劑或5α-還原酶抑制劑之研究
摘要
目的：對於使用甲型交感腎上腺素神經抑制劑及5α-還原酶抑制劑以治療前列腺肥大症病人，在合併治療後，停止其中一種藥物，對於病人前列腺容積、尿流速測定，以及臨床前列腺惡化情形之研究。材料與方法：本研究總共收集78位具有臨床良性前列腺肥大症之病人，並且進行為期兩年之臨床研究。病人首先接受合併Tamsulosin及Finasteride治療一年，然後隨機分派以停止其中一種藥物。對於病人在治療前、合併治療後，以及停止一種藥物十二個月之後，測量其前列腺容積、尿流速、前列腺特殊抗原及前列腺症狀積分。我們同時評估兩組病人藥物治療之效果，以及在停藥之後所造成臨床前列腺症狀惡化之情形。結果：在經過合併藥物治療之後，在兩組病人所有的臨床檢查值均顯示有意義的改善。然而在停止其中一種藥物使用後，停止Tamsulosin治療的病人組中有15位病人(35.7%)，停止Finasteride的病人組有12位病人(37.5%)會有臨床前列腺惡化的情形。而其餘的病人，不論何組，都持續在使用單一藥物下，有良好的治療效果，直到研究結束。在停止Finasteride治療的病人組中，最大前列腺容積及前列腺特殊抗原，在兩年的研究結束時，有明顯的上升。停止Finasteride治療的病人組，同時在停藥之後具有臨床前列腺症狀惡化者，他們在研究開始時的前列腺最大容積，比起停藥後沒有臨床前列腺惡化的病人，有顯著的較大之現象(42.5±17.2 v 32.0±12.2, p=0.05)。而大部分的病人在停藥後產生臨床前列腺惡化，再度恢復合併用藥，也都可以恢復良好的治療效果，一直到研究結束。結論：對於良性前列腺肥大的病人在合併甲型交感腎上腺素神經抑制劑及5α-還原酶抑制劑藥物治療，停止Tamsulosin後，仍然有Finasteride仍然64.3%及62.5%的病人，在單一藥物使用後一年，不會有臨床惡化的情形。至於有臨床惡化的病人，在恢復使用合併治療也都可以得到良好的治療結果。
並列摘要
Objective: To investigate changes in prostatic volume, uroflow measurements, and clinical benign prostatic hyperplasia (BPH) progression after withdrawal of an α-1 blocker or 5-α-reductase inhibitor (5ARI) in patients receiving combination therapy with these agents. Materials and Methods: A total of 74 patients with clinical BPH were enrolled in this 2-year trial of medical treatment for BPH. The patients were treated with both tamsulosin and finasteride for 1 year, then randomly assigned to discontinue one of the medications. The prostatic volume, uroflow, prostatic specific antigen, and symptom score were measured at baseline, end of combination therapy, and 12 months after discontinuation of one medication. Therapeutic efficacies and clinical BPH progression after discontinuing one medication were compared between groups. Results: All measured parameters showed significant improvement after combination therapy in both groups. Clinical BPH progression was found during the one-year follow-up in 15 patients (35.7%) in the tamsulosin discontinuation group and in 12 (37.5%) patients in the finasteride discontinuation group. The remaining patients in both groups continued to have good therapeutic results with a single medication at the end of the study. In the patients with finasteride discontinuation, total prostatic volume and prostatic specific antigen increased at the end of the two year treatment. Patients with finasteride discontinuation and clinical progression had a significantly higher total prostatic volume than those without clinical progression (42.5±17.2 v 32.0±12.2, p=0.05). The patients with clinical progression resumed combination therapy had good therapeutic results at the end of the study. Conclusion: One year after discontinuation of tamsulosin or finasteride following combination therapy, therapeutic effects were maintained without progression of BPH in 64.3% and 62.5% of patients, respectively.