混合型5-HT_4受体激动剂/5-HT_3受体拮抗剂治疗肠易激综合征的系统评价  

Mixed 5-HT_3 antagonists/5-HT_4 agonists for irritable bowel syndrome:a systematic review

作　　者：何宛蓉[1] 张法灿[1] 梁列新[1] 

机构地区：[1]广西壮族自治区人民医院消化内科,广西壮族自治区南宁市530021

出　　处：《世界华人消化杂志》2011年第31期3277-3283,共7页World Chinese Journal of Digestology

基　　金：国家科技支撑计划基金资助项目;No.2007BAI07A17-01~~

摘　　要：目的:系统评价混合型5-HT4受体激动剂/5-HT3受体拮抗剂(西沙必利、莫沙必利、伦扎必利)治疗肠易激综合征(IBS)的有效性和安全性.方法:采用Cochrane协作网推荐的方法,对纳入的全世界范围内有关西沙必利、莫沙必利、伦扎必利治疗肠易激综合征的8个随机对照试验(n=2841)进行系统评价.结果:Meta分析结果显示,西沙必利对IBS总体症状[RR=0.91,95%CI(0.58,1.43)]、腹痛症状[RR=0.90,95%CI(0.72,1.11)]及便秘症状(RR=0.91,95%CI(0.74,1.12)的疗效均不优于安慰剂.伦扎必利1mg/d组和2mg/d组对IBS总体症状的疗效不优于安慰剂[RR=0.95,95%CI(0.67,1.35);RR=0.79,95%CI(0.67,1.17)],伦扎必利4mg/d组对IBS总体症状的疗效优于安慰剂[67.8%vs73.9%,RR=0.91,95%CI(0.86,0.96)].西沙必利[RR=1.52,95%CI(0.58,3.99)]和伦扎必利[RR=1.11,95%CI(0.98,1.24)]的药物不良事件发生率与安慰剂无显著性差异.结论:伦扎必利4mg/d可缓解IBS-C的总体症状,对缓解IBS腹痛/腹部不适症状的证据不足;伦扎必利1mg/d及2mg/d对缓解IBS总体症状及腹痛/腹部不适症状的证据均不足.西沙必利对缓解IBS总体症状及腹痛、便秘的证据不足,莫沙必利治疗IBS缺乏有效证据.大部分纳入试验的方法学质量均较低,期待更多大样本、高质量的随机对照试验.AIM：To systematically review the evidence for the efficacy and safety of mixed 5-HT3 antagonists/5-HT4 agonists in the treatment of irritable bowel syndrome（IBS） .METHODS：According to the recommendations of the Cochrane Collaboration,a meta-analysis was conducted on 2 841 patients from eight eligible trials with respect to the usage of these drugs.RESULTS：The unimprovement in IBS global symptoms[42.7%vs 46.9%,RR=0.91,95%CI（0.58,1.43） ],abdominal pain[53.2%vs 59.3%,RR =0.90,95%CI（0.72,1.11） ]or constipation[54.0% vs 58.5%,RR=0.91,95%CI（0.74,1.12） ]did not differ significantly in the presence of cisapridevs placebo.In the presence of renzapride,lower doses（1 mg/d and 2 mg/d） were found not to be superior to placebo in attenuating global symptoms[RR=0.95,95%CI（0.67,1.35）;RR= 0.79,95%CI（0.67,1.17） ];however,high dose of renzapride（4 mg/d） resulted in a significant difference[67.8%vs 73.9%,RR=0.91,95%CI（0.86,0.96） ].There was no significant difference in the incidence of adverse events among cisapride[RR =1.52,95%CI（0.58,3.99） ],renzapride[RR=1.11,95%CI（0.98,1.24） ]and placebo.CONCLUSION：Except for high dose of renza-pride（4 mg/d） which could relieve the global symptoms in IBS-C patients,there was no sufficient evidence to indicate that low dose renzapride or cisapride might be used to improve the global symptoms,abdominal pain as well as constipation discomfort.

关 键 词：西沙必利 莫沙必利 伦扎必利 肠易激综合征 系统评价 Meta分析 

分 类 号：R574[医药卫生—消化系统]