静脉曲张套扎术与口服β-受体阻滞剂对预防首次静脉曲张破裂出血效果的荟萃分析  

The clinical effect of endoscopic variceal ligation and β-blocker for preventing primary prophylaxia of oesophageal variceal bleed:a meta-analysis

作　　者：周瑶军[1] 王矩伟[1] 王要军 Zhou Yaojun;Wang Juwei;Wang Yaojun(Department of Critical Care Medicine,Puyang Oilfield General Hospital,Puyang 457001,China)

机构地区：[1]濮阳市油田总医院重症医学科,457001 [2]山东潍坊阳光融和医院消化科

出　　处：《中华保健医学杂志》2019年第1期45-49,共5页Chinese Journal of Health Care and Medicine

摘　　要：目的评价内镜下食管静脉曲张套扎术(EVL)与口服β-受体阻滞剂对预防肝硬化患者首次食管胃底静脉曲张破裂出血的效果。方法检索Pubmed/Medicine、中国生物医学文献服务系统等数据库,已经发表的关于EVL与口服β-受体阻滞剂对预防首次食管胃底静脉曲张破裂出血的临床随机对照研究,检索时间至2017年4月。由两名评价员对检索文献进行数据提取、质量评价,并运用Stata12.0软件对数据进行统计分析。结果共检索文献545篇,其中纳入文献14篇,总样本量为1 441例,纳入文献的研究质量评分均较高。结果表明:套扎vs.普萘洛尔首次出血率RR=0.78(95%CI 0.59～1.03),I2=11%,P=0.34;套扎vs.卡维地洛首次出血率RR=1.54(95%CI 0.69～3.42),I2=38.8%,P=0.20,套扎vs.普萘洛尔出血死亡率RR=0.83(95%CI 0.52～1.34),I2=0%,P=0.954;套扎vs.卡维地洛出血死亡率RR=0.84(95%CI 0.29～2.46),I2=0%,P=0.770,套扎vs.普萘洛尔总死亡率RR=1.08(CI 0.88～1.32),I2=0%,P=0.837;套扎vs.卡维地洛总死亡率RR=0.91(CI 0.58～1.42),I2=25.2%,P=0.248;EVL与β-受体阻滞剂不良反应发生率相对危险度RR=1.19(CI 0.81～1.77),I2=87.3%,P=0。结论 EVL与口服β-受体阻滞剂在首次出血率、出血病死率、总死亡率以及不良反应方面均无明显差异,但考虑到患者依从性、医疗负担等方面,临床建议口服β-受体阻滞剂预防静脉曲张首次出血。Objective We design the meta-analysis in order to evaluate the safety and efficacy of Endoscopic variceal ligation andβ-blocker for prophylaxia of oesophageal variceal bleed.Methods PubMed/Medicine,Chinese biomedical literature service system,of Controlled Trials databases were searched for relevant randomized double-blind placebo controlled trials published before April 2017.Two authors independently assessed study quality and extracted data.Stata software was used to investigateheterogeneity between studies,and analysis was performedusing a randomized-effects model to calculate and merge data.Results Fourteen studies,with 1441 subjects,were included.This meta-analysis indicated that EVL vsβ-blocker(propranolol,carvedilol)in the First bleeding rate,Bleeding related mortality,Total mortality,Adverse events.First bleeding rate:EVL VS PPL RR=0.78(CI 0.59-1.03),I2=11%,P=0.34;First bleeding rate:EVL VS CAR RR=1.54(CI 0.69-3.42),I2=38.8%,P=0.20,Bleeding related mortality:EVL VS PPL RR=0.83(CI 0.52-1.34),I2=0%,P=0.954;EVL VS CAR:RR=0.84(CI 0.29-2.46),I2=0%,P=0.770,Total mortality EVL VS PPL:RR=1.08(CI 0.88-1.32),I2=0%,P=0.837;EVL VS CAR:RR=0.91(CI 0.58-1.42),I2=25.2%,P=0.248;Adverse events RR=1.19(CI 0.81-1.77),I2=87.3%,P=0.Conclusion There was no significant difference between EVL andβ-blocker(propranolol,carvedilol)on preventing for the primary variceal bleeding in First bleeding rate,Bleeding related mortality,Total mortality,Adverse events.But considering the cost and compliance,β-blocke is the better choice for preventing on the primary bleeding wasr.

关 键 词：静脉曲张 套扎术 Β-受体阻滞剂 普萘洛尔 卡维地洛 

分 类 号：R543.6[医药卫生—心血管疾病]