卡维地洛或普萘洛尔联合内镜套扎术预防肝硬化食管静脉曲张再出血的疗效和安全性的meta分析  

Efficacy and Safety of Carvedilol or Propranolol Combined With Endoscopic Ligation for Prevention of Esophageal Variceal Rebleeding in Cirrhotic Patients: A Meta-analysis

作　　者：魏重操 邢欣 澹台新兴 肖彩兰 陈丽容 刘娜[1] 王进海[1] WEI Zhongcao;XING Xin;TANTAI Xinxing;XIAO Cailan;CHEN Lirong;LIU Na;WANG Jinhai(Department of Gastroenterology,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an (710004))

机构地区：[1]西安交通大学第二附属医院消化内科,710004

出　　处：《胃肠病学》2018年第12期727-732,共6页Chinese Journal of Gastroenterology

摘　　要：背景:非选择性β受体阻滞剂联合内镜套扎术是食管静脉曲张破裂出血二级预防的首选方案。卡维地洛联合内镜套扎术可能有更好的治疗潜能。目的:系统评价卡维地洛或普萘洛尔联合内镜套扎术预防肝硬化食管静脉曲张再出血的疗效和安全性。方法:计算机检索中国知网、维普、万方、Pub Med、Embase、Cochrane Library数据库,纳入卡维地洛+内镜套扎术(试验组)与普萘洛尔+内镜套扎术(对照组)治疗肝硬化食管静脉曲张再出血的随机对照试验。采用Rev Man 5. 3软件对纳入文献行meta分析。结果:共纳入7篇文献。Meta分析结果显示,试验组总有效率显著高于对照组(RR=5. 40,95%CI:3. 01～9. 69,P <0. 000 1),总出血率、不良反应发生率显著低于对照组(RR=0. 57,95%CI:0. 36～0. 89,P=0. 01; RR=0. 46,95%CI:0. 29～0. 73,P=0. 000 9),而两组死亡率、心率降低程度、平均动脉压降低程度无明显差异(RR=0. 66,95%CI:0. 33～1. 30,P=0. 23; MD=-4. 99,95%CI:-10. 04～0. 07,P=0. 05; MD=3. 59,95%CI:-0. 71～7. 89,P=0. 10)。结论:卡维地洛联合内镜套扎术对肝硬化食管静脉曲张破裂再出血的疗效优于普萘洛尔联合内镜套扎术,出血率较低,不良反应较少,且不增加死亡率,安全可靠。Background: Non-selective beta blocker combined with endoscopic ligation is the preferred method for secondary prevention of esophageal variceal bleeding. Carvedilol combined with endoscopic ligation may have better therapeutic potential. Aims: To systematically evaluate the efficacy and safety of carvedilol or propranolol combined with endoscopic ligation for prevention of esophageal variceal rebleeding in cirrhotic patients. Methods: Randomized controlled trials( RCTs) of carvedilol plus endoscopic ligation( experimental group) or propranolol plus endoscopic ligation( control group) for the treatment of esophageal variceal rebleeding in cirrhotic patients were retrieved from CNKI,VIP,Wanfang Data,Pub Med,Embase and Cochrane Library. Meta-analysis was conducted by Rev Man 5. 3 software. Results: Seven RCTs were finally included. Meta-analysis results showed that the total effective rate was significantly increased in experimental group than in control group( RR = 5. 40,95% CI: 3. 01-9. 69,P < 0. 000 1),total bleeding rate and adverse effects rate were significantly decreased in experimental group than in control group( RR = 0. 57,95% CI: 0. 36-0. 89,P = 0. 01; RR = 0. 46,95% CI: 0. 29-0. 73,P = 0. 000 9),however,no significant differences in mortality rate( RR = 0. 66,95% CI: 0. 33-1. 30,P = 0. 23),heart rate reduction( MD =-4. 99,95% CI:-10. 04-0. 07,P = 0. 05)and average arterial pressure reduction( MD = 3. 59,95% CI:-0. 71-7. 89,P = 0. 10) were found between the two groups. Conclusions: The efficacy of carvedilol combined with endoscopic ligation for esophageal variceal rebleeding in cirrhotic patients is better than that of propranolol combined with endoscopic ligation,and has less adverse reactions,less rebleeding rate and with no increased mortality rate.

关 键 词：卡维地洛 普萘洛尔 内镜套扎术 食管静脉曲张再出血 治疗 META分析 

分 类 号：R575.2[医药卫生—消化系统] R571.3[医药卫生—内科学]