三种方案治疗腺性膀胱炎的网络Meta分析

摘要

Objective This network meta-analysis was conducted to assess the efficiency and safety of transurethral resection alone and postoperative chemotherapeutics bladder irrigation for glandular cystitis. Method We searched databases including PubMed, MEDLINE, Cochrane Library, CNKI and CBM to enroll all available randomized controlled trials (RCTs)about the effects of transurethral resection alone (TUR), postoperative irrigation of bladder with Pirarubicin (TUR+THP) or Mitomycin (THP+MMC) for glandular cystitis. The cure rate, overall response rate (ORR), recurrence rate and adverse effects rate were set to be the outcomes. ADDIS software was adopted to achieve the network meta-analysis. Result 22 RCTs with 1 544 patients were enrolled. There was no significant inconsistence between direct and indirect evidence. TUR+THP and TUR+MCC were proved superior to TUR in cure rate and ORR. TUR+THP was found to be the better choice[ORcure rate=1.63, 95%CI(1.10,2.46); ORORR=1.79, 95%CI(1.10,3.07)]. Postoperative chemotherapeutics bladder irrigation significantly reduced the recurrence rate [ORTUR+MMC=0.26, 95%CI(0.14,0.49); ORTUR+THP=0.14, 95%CI(0.07, 0.25)]. The difference of adverse effects rate was not statistically significant among three treatments. Conclusion Based on available evidence, the rank of cure rate and overall response rate was TUR+THP, TUR+MMC, TUR. Postoperative chemotherapeutics bladder irrigation significantly reduced the recurrence rate. However, there were no significant differences for three therapies in terms of adverse effects rate. The confidence of this network meta-analysis needs to be further confirmed by future large, high quality RCTs.%目的：采用网络Meta分析评价单纯经尿道切除及术后联合丝裂霉素或吡柔比星膀胱灌注治疗腺性膀胱炎的疗效及安全性。方法检索PubMed、MEDLINE、Cochrane 图书馆、EMBASE、中国期刊全文数据库、中国生物医学文献数据库，纳入单纯经尿道切除术、术后联合吡柔比星或丝裂霉素膀胱灌注治疗腺性膀胱炎的随机对照研究，以治愈率、总有效率、复发率及不良反应发生率为研究指标，采用ADDIS软件进行网络 Meta分析。结果共纳入22项研究（1544例患者）。收敛性良好，非一致性检验无统计学意义（P＞0.05）。联合膀胱灌注较单纯经尿道切除术的治愈率及有效率更高，术后联合吡柔比星的疗效显著优于术后联合丝裂霉素[治愈率的比值比1.63，95％可信区间（1.10，2.46）；有效率的比值比1.79，95％可信区间（1.10，3.07）]；此外，对比单纯经尿道切除术，联合膀胱灌注能显著降低腺性膀胱炎的复发率[联合丝裂霉素的比值比0.26，95％可信区间（0.14，0.49）；联合吡柔比星的比值比0.14，95％可信区间（0.07，0.25）]；丝裂霉素联合组不良反应发生率最低，但差异无统计学意义。结论联合膀胱灌注较单纯经尿道切除术能显著提高腺性膀胱炎的治愈率、总有效率并降低复发率；术后联合吡柔比星较联合丝裂霉素的治愈率及有效率更高；三种方案的不良反应发生率差异无统计学意义。本网络Meta分析的结论尚需开展更多高质量、大样本的随机对照研究加以验证。