埃索美拉唑与奥美拉唑治疗急性非静脉曲张性消化道出血疗效的Meta分析  

Efficacy of esomeprazole versus omeprazole in the treatment of non-variceal gastrointestinal bleeding: a meta-analysis

作　　者：朱洁云 罗毅沣[1] 李柏成 王霄玲 张剑锋[1] ZHU Jieyun;LUO Yifeng;LI Bocheng;WANG Xiaoling;ZHANG Jianfeng(Department of Emergency,the Second Affiliated Hospital of Guangxi Medical University,Nanning,530007,P.R.China)

机构地区：[1]广西医科大学第二附属医院急诊科

出　　处：《中国循证医学杂志》2019年第8期939-945,共7页Chinese Journal of Evidence-based Medicine

基　　金：2017广西重点研发项目(编号：桂科AB17195002);2017年度广西高等教育本科教学改革工程立项项目(编号：2017JGA159)

摘　　要：目的系统评价埃索美拉唑与奥美拉唑治疗急性非静脉曲张性上消化道出血(ANVUGIB)的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集埃索美拉唑与奥美拉唑治疗ANVUGIB的疗效和安全性的随机对照试验(RCT),检索时限均从建库至2019年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入17个RCT,包括2 086例患者。Meta分析结果显示:埃索美拉唑总有效率高于奥美拉唑[RR=1.09,95%CI(1.04,1.14),P=0.000 6],不良反应发生率低于奥美拉唑[OR=0.27,95%CI(0.18,0.40),P<0.000 01],平均止血时间短于奥美拉唑组[MD=-0.64,95%CI(-0.94,-0.34),P<0.000 1],差异均有统计学意义。结论当前证据显示,与奥美拉唑相比,埃索美拉唑在治疗ANVUGIB上止血迅速、效果更好、不良反应更少,但受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objectives To systematically review the efficacy and safety of esomeprazole versus omeprazole in the treatment of acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and VIP databases were electronically searched to collect the randomized controlled trials(RCTs)about the efficacy and safety of esomeprazole versus omeprazole in the treatment of ANVUGIB from inception to January,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by using RevMan 5.3 software.Results A total of 17 RCTs involving 2 086 patients were included.The results of meta-analysis showed that,the total effective rate of esomeprazole group was higher than omeprazole group(RR=1.09,95%CI 1.04 to 1.14,P=0.000 6),the incidence of adverse reactions was lower than omeprazole group(OR=0.27,95%CI 0.18 to 0.40,P<0.000 01),the average hemostasis time was shorter than omeprazole group(MD=-0.64,95%CI-0.94 to-0.34,P<0.0001),and the difference were statistically significant.Conclusions Current evidence shows that in the treatment of ANVUGIB,esomeprazole has rapid hemostasis,significant effect and fewer adverse reactions,which is worthy of wide application and promotion.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusions.

关 键 词：埃索美拉唑 奥美拉唑 消化道出血 META分析 系统评价 随机对照试验 

分 类 号：R57[医药卫生—消化系统]