非选择性β受体阻滞剂对肝硬化伴腹水患者死亡率影响的Meta分析  

Effects of Non-selective β-blockers on Mortality of Patients with Cirrhosis and Ascites:A Meta-analysis

作　　者：陈肖 郑姣妮 何瑶 阮一 陈杨 郑晓媛 CHEN Xiao;ZHENG Jiaoni;HE Yao;RUAN Yi;CHEN Yang;ZHENG Xiaoyuan(Dept.of Pharmacy,Chongqing Fourth People’s Hospital,Chongqing 400014,China)

机构地区：[1]重庆市第四人民医院药剂科,重庆400014

出　　处：《中国药房》2020年第8期1003-1008,共6页China Pharmacy

基　　金：重庆市科卫联合医学科研项目(No.2018MSXM147)。

摘　　要：目的:系统评价非选择性β受体阻滞剂(NSBB)对肝硬化伴腹水患者死亡率的影响,为临床用药提供循证参考。方法:计算机检索PubMed、Cochrane图书馆、Embase、Web of Science、中国知网、万方数据库,收集关于NSBB对肝硬化伴腹水患者死亡率影响的随机对照试验(RCT)和队列研究。试验组患者给予NSBB治疗,对照组患者给予空白对照或单硝酸异山梨酯、静脉曲张套扎术等其他预防静脉曲张出血的措施。检索时限均为自建库起至2019年9月30日。筛选文献并提取资料,分别采用Cochrane系统评价手册5.1.0中推荐的偏倚风险评估工具和纽卡斯尔-渥太华量表评价RCT和队列研究的质量;采用Rev Man 5.3统计软件对两组患者的全因死亡率进行Meta分析。结果:共纳入18项研究,合计8 649例患者,其中4项为RCT、14项为队列研究。Meta分析结果显示,使用NSBB的所有肝硬化伴腹水患者[RR=0.85,95%CI(0.65,1.11),P=0.22]、重度腹水患者[RR=0.58,95%CI(0.15,2.22),P=0.42]或难治性腹水患者[RR=0.85,95%CI(0.61,1.20),P=0.36]的全因死亡率与对照组比较,差异均无统计学意义。分别按研究方法(RCT vs.队列研究)和用药种类进行亚组分析,结果显示,使用NSBB的试验组患者的全因死亡率与对照组比较差异均无统计学意义(P>0.05)。结论:使用NSBB不会增加肝硬化伴腹水,甚至伴重度腹水或难治性腹水患者的全因死亡率。OBJECTIVE:To systematically evaluate the effects of non-selective β-blockers(NSBB) on mortality of patients with cirrhosis and ascites,and to provide evidence-based reference for clinical drug use. METHODS:Retrieved from PubMed,the Cochrane Library,Embase,Web of Science,CNKI and Wanfang database,randomized controlled trials(RCTs)and cohort studies about the effects of NSBB on mortality of patients with cirrhosis and ascites were collected from the date of database establishment to Sept. 30 th,2019. The patients in the trial group were treated with NSBB,the patients in the control group were treated with blank control or isosorbidemononitrate,variceal ligation or other measures to prevent variceal bleeding. After literature screening and data extraction,the quality of RCTs and cohort studies were evaluated by using bias risk evaluation tool recommended by Cochrane system evaluator manual 5.1.0 and Newcastle-Ottawa scale. Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS:Totally 18 studies were included,involving 8 649 patients,4 RCTs and 14 cohort studies. Results of Meta-analysis showed that,there was no significant difference in all-cause mortality between the patients using NSBB of trial group [RR=0.85,95% CI(0.65,1.11),P=0.22],severe ascites [RR=0.58,95% CI(0.15,2.22),P=0.42] or refractory ascites [RR=0.85,95%CI(0.61,1.20),P=0.36] and the control group. Subgroup analysis showed that,there was no significant difference in all-cause mortality between the patients using NSBB of trial group and control group according to the research method(RCT vs. cohort study)and the type of drug use(P>0.05). CONCLUSIONS:The use of NSBB does not increase the incidence of all-cause mortality in cirrhosis patients with ascites,or even in those with severe ascites or refractory ascites.

关 键 词：非选择性Β受体阻滞剂 肝硬化 腹水 死亡率 META分析 

分 类 号：R575.2[医药卫生—消化系统]