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首页> 外文期刊>JAMA: the Journal of the American Medical Association >Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis.
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Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis.

机译：慢性前列腺炎/慢性盆腔疼痛综合征的管理：系统评价和网络荟萃分析。

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CONTEXT: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is common, but trial evidence is conflicting and therapeutic options are controversial. OBJECTIVE: To conduct a systematic review and network meta-analysis comparing mean symptom scores and treatment response among alpha-blockers, antibiotics, anti-inflammatory drugs, other active drugs (phytotherapy, glycosaminoglycans, finasteride, and neuromodulators), and placebo. DATA SOURCES: We searched MEDLINE from 1949 and EMBASE from 1974 to November 16, 2010, using the PubMed and Ovid search engines. STUDY SELECTION: Randomized controlled trials comparing drug treatments in CP/CPPS patients. DATA EXTRACTION: Two reviewers independently extracted mean symptom scores, quality-of-life measures, and response to treatment between treatment groups. Standardized mean difference and random-effects methods were applied for pooling continuous and dichotomous outcomes, respectively. A longitudinal mixed regression model was used for network meta-analysis to indirectly compare treatment effects. DATA SYNTHESIS: Twenty-three of 262 studies identified were eligible. Compared with placebo, alpha-blockers were associated with significant improvement in symptoms with standardized mean differences in total symptom, pain, voiding, and quality-of-life scores of -1.7 (95% confidence interval [CI], -2.8 to -0.6), -1.1 (95% CI, -1.8 to -0.3), -1.4 (95% CI, -2.3 to -0.5), and -1.0 (95% CI, -1.8 to -0.2), respectively. Patients receiving alpha-blockers or anti-inflammatory medications had a higher chance of favorable response compared with placebo, with pooled RRs of 1.6 (95% CI, 1.1-2.3) and 1.8 (95% CI, 1.2-2.6), respectively. Contour-enhanced funnel plots suggested the presence of publication bias for smaller studies of alpha-blocker therapies. The network meta-analysis suggested benefits of antibiotics in decreasing total symptom scores (-9.8; 95% CI, -15.1 to -4.6), pain scores (-4.4; 95% CI, -7.0 to -1.9), voiding scores (-2.8; 95% CI, -4.1 to -1.6), and quality-of-life scores (-1.9; 95% CI, -3.6 to -0.2) compared with placebo. Combining alpha-blockers and antibiotics yielded the greatest benefits compared with placebo, with corresponding decreases of -13.8 (95% CI, -17.5 to -10.2) for total symptom scores, -5.7 (95% CI, -7.8 to -3.6) for pain scores, -3.7 (95% CI, -5.2 to -2.1) for voiding, and -2.8 (95% CI, -4.7 to -0.9) for quality-of-life scores. CONCLUSIONS: alpha-Blockers, antibiotics, and combinations of these therapies appear to achieve the greatest improvement in clinical symptom scores compared with placebo. Anti-inflammatory therapies have a lesser but measurable benefit on selected outcomes. However, beneficial effects of alpha-blockers may be overestimated because of publication bias.
机译：背景：慢性前列腺炎/慢性盆腔疼痛综合征（CP / CPPS）很常见，但试验证据相互矛盾，治疗选择也存在争议。目的：进行系统评价和网络荟萃分析，比较α-受体阻滞剂，抗生素，抗炎药，其他活性药物（植物疗法，糖胺聚糖，非那雄胺和神经调节剂）和安慰剂的平均症状评分和治疗反应。数据来源：我们使用PubMed和Ovid搜索引擎搜索了1949年的MEDLINE和1974年至2010年11月16日的EMBASE。研究选择：比较CP / CPPS患者药物治疗的随机对照试验。数据提取：两名评价者独立提取平均症状评分，生活质量指标以及治疗组之间对治疗的反应。分别采用标准化的均值差和随机效应方法合并连续和二分结果。纵向混合回归模型用于网络荟萃分析，以间接比较治疗效果。数据综合：262项研究中有23项符合条件。与安慰剂相比，α-受体阻滞剂与症状的显着改善相关，总症状，疼痛，排尿和生活质量得分的标准化平均差异为-1.7（95％置信区间[CI]，-2.8至-0.6 ），-1.1（95％CI，-1.8至-0.3），-1.4（95％CI，-2.3至-0.5）和-1.0（95％CI，-1.8至-0.2）。与安慰剂相比，接受α-受体阻滞剂或抗炎药的患者有较高的良好反应机会，合并RR分别为1.6（95％CI，1.1-2.3）和1.8（95％CI，1.2-2.6）。轮廓增强的漏斗图表明，对于较小的α受体阻滞剂研究，存在出版偏倚。网络荟萃分析显示抗生素可降低总症状评分（-9.8; 95％CI，-15.1至-4.6），疼痛评分（-4.4; 95％CI，-7.0至-1.9），排尿评分（- 2.8; 95％CI，-4.1至-1.6）和生活质量得分（-1.9; 95％CI，-3.6至-0.2）与安慰剂相比。与安慰剂相比，组合使用α受体阻滞剂和抗生素可获得最大的益处，总症状评分相应降低-13.8（95％CI，-17.5至-10.2），-5.7降低（95％CI，-7.8至-3.6）。疼痛评分，排尿评分为-3.7（95％CI，-5.2至-2.1），生活质量评分为-2.8（95％CI，-4.7至-0.9）。结论：与安慰剂相比，α-受体阻滞剂，抗生素以及这些疗法的组合似乎在临床症状评分方面取得了最大的改善。抗炎疗法对某些结局的益处较小但可衡量。但是，由于出版偏见，可能会高估了α受体阻滞剂的有益作用。

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