α1ブロッカー単独療法無効前立腺肥大症患者に対する酢酸クロルマジノン徐放錠併用による臨床効果と前立腺縮小効果

Abstract

塩酸タムスロシンを4週間以上投与されたにも拘わらず改善効果不十分な症例に対し, 酢酸クロルマジノン徐放錠を16週間併用し, その臨床効果と前立腺縮小効果について検討した. 1)I-PSSによる自覚症状の検討では, 頻尿, 尿線途絶, 尿勢, いきみに有意の改善が認められた.また合計点においても有意な改善が認められた.特に閉塞症状に有意の改善が認められた. 2)経直腸的超音波検査による前立腺推定容積の検討では, 前立腺全体及びtransition zone共に有意な縮小が認められた. 3)他覚所見では, 最大尿流量率に有意の改善が認められた.また, 残尿量及び残尿率は投与12週までは有意な改善が認められた. 4)副作用では1例に肝機能障害が認められ, 投薬が中止された. 5)臨床検査値では, 赤血球数, ヘモグロビン値の有意の低下が認められたが, 正常範囲内であった

Alpha adrenergic blocker has become the first choice in the medical treatment of benign prostatic hyperplasia (BPH). The efficacy of alpha adrenergic blocker has been suggested to be related to the prostatic tissue components, and to be ineffective in treating the clinical symptoms caused by BPH in some cases. The efficacy and prostate reduction of an anti-androgenic agent, chlormadinone acetate, combined with alpha adrenergic blocker, tamsulosin hydrochloride, were evaluated using 40-BPH patients insufficiently treated with tamsulosin hydrochloride alone. Fifty mg of chlormadinone acetate and 0.2 mg of tamsulosin hydrochloride were administered orally once a day for 16 weeks to patients with a prostate subjective symptoms score, I-PSS, of greater than 13 or a peak flow rate of less than 12 ml/s, even after the treatment with 0.2 mg of tamsulosin hydrochloride alone for more than four weeks. Total I-PSS decreased significantly after four weeks. The total irritative symptom score did not change for 16 weeks, but the total obstructive symptom score decreased significantly, as did the total I-PSS. In objective data, the estimated volume of both total prostate and the transition zone on transrectal ultrasonogram decreased significantly at the end of the treatment, and the peak flow rate decreased significantly after 12 weeks. These findings suggest that the addition of chlormadinone acetate may be a reasonable alternative in the treatment of BPH patients responding insufficiently to tamsulosin hydrochloride alone, and that combination therapy using chlormadinone acetate and tamsulosin hydrochloride may be useful for BPH patients with serious obstructive symptoms.