鋸櫚草與alfuzosin併用治療良性前列腺肥大之探討

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Title:	鋸櫚草與alfuzosin併用治療良性前列腺肥大之探討
Other Titles:	Evaluation of the combined use of saw palmetto and alfuzosin in the treatment of benign prostatic hyperplasia
Authors:	張素真 Chang, Shu-chen
Contributors:	自然醫學研究所辜美安 Malcolm Koo
Keywords:	最大尿流速率(Qmax);國際前列腺症狀評分(IPSS);良性前列腺肥大(或稱增生)(BPH);鋸櫚草 alfuzosin;International Prostate Symptom Score (IPSS);saw palmetto;Benign prostatic hyperplasia (BPH);maximal flow rate (Qmax)
Date:	2006
Issue Date:	2015-08-06 11:11:00 (UTC+8)
Abstract:	本研究探討植物性鋸櫚草萃取物與alfuzosin及兩者併用，對於緩解患有良性前列腺肥大(benign prostatic hyperplasia)病患症狀之效果。經臨床症狀診斷為患有良性前列腺肥大症患者並符合參與此項研究的28名受試者，由醫師依病況分成3組，病況較輕者編入第1組(n=10)，每天服用鋸櫚草萃取物膠囊(320 mg/day), 中度者編入第2組(n=10), 每天服用alfuzosin錠劑一顆(10 mg/day), 而較重者編入第3組(n=8)，每天服用鋸櫚草萃取物膠囊(320 mg/day)與alfuzosin錠劑一顆(10 mg/day)。在介入措施前的基準階段及3個月療程後，分別檢測受試者之前列腺特異抗原、最大尿流速、前列腺總體積及以國際前列腺症狀評分表（IPSS）作評估症狀。結果顯示服用鋸櫚草萃取物或併用鋸櫚草萃取物與alfuzosin的受試者，其前列腺體積分別下降4.8±8.2立方厘米和3.8±1.8立方厘米，比只有服用alfuzosin的受試者有顯著差異(p=0.032)。　　　在國際前列腺症狀分數方面，併用鋸櫚草萃取物與alfuzosin的受試者的改善最為顯著(p=0.003)，平均下降達7.6±3.0分及4.3±1.3分。此改變主要來自阻塞性之症狀，併用鋸櫚草萃取物與alfuzosin的受試者，比只有服用鋸櫚草萃取物的受試者呈顯著改善(p=0.005)。屬於阻塞性症狀之4個項目中，排尿不乾淨症狀(p=0.029)、小便斷斷續續症狀(p=0.032)及小便無力症狀(p=0.018)均發現併用鋸櫚草萃取物與alfuzosin的受試者比只有服用鋸櫚草萃取物的受試者的改善為顯著，但只有服用鋸櫚草萃取物的受試者與只有服用alfuzosin的受試者並無顯著差異，而且併用鋸櫚草萃取物與alfuzosin的受試者亦與只有服用alfuzosin的受試者並無顯著差異。　　　綜合以上結果，鋸櫚草萃取物可改善某些因前列腺肥大所引至的症狀，尤其是屬於阻塞性之症狀。鋸櫚草萃取物與alfuzosin合併使用時的效果比它們獨立使用時更為顯著，值得作進一步的臨床研究，讓前列腺肥大症之病患可有更多的治療選擇。　　This study aims to investigate the clinical effects of a phytotherapeutic agent saw palmetto, the drug Alfuzosin, both singly and jointly in patients experiencing lower urinary tract symptoms (LUTS) who were also diagnosed with benign prostatic hyperplasia (BPH). A total of 28 patients diagnosed with BPH and met the study criteria were divided into three groups based on the severity of their symptoms. Those of mild severity (n=10) were asked to take saw palmetto extract at 320mg per day (Group P) and those of moderate severity (n=10) were asked to take alfuzosin at 10 mg per day (Group A). Those of greatest severity (n=8) were asked to take both saw palmetto extract and alfuzosin (Group PA). Serum prostate specific antigen (PSA), maximal flow rate (Qmax), prostate volume (PV), and the International Prostate Symptom Score (IPSS) were obtained at the baseline and at the end of the three-month intervention. Results indicated that PV decreased by 4.8±8.2cc and 3.8±1.8cc in the Group P and Group PA and the reduction was significantly lowered than that in the Group A (p=0.032). 　　　In the IPSS score, the reduction in Group PA (-7.6±3.0) and Group A (-4.3±1.3) were significantly greater than that of Group P (-3.1±3.0) (p=0.003). The reduction in score was attributed by the changes in the obstructive symptoms (p=0.005) and three of its four items, namely, incomplete emptying (p=0.029), intermittency (p=0.032), and weak stream (p=0.018). The reduction in Group P was not significantly differed from that of Group A and that Group PA was not significantly differed from that of Group A. In conclusion, this study found that saw palmetto extract can improve certain lower urinary tract symptoms, particularly those of obstruction in nature, associated with BPH. 　　　The combined effect of saw palmetto and alfuzosin appeared to be more significant than when these agents were used singly. Future clinical studies in this area may provide patients with BPH additional therapeutical choices.
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