氨甲环酸治疗上消化道出血有效性的Meta分析  

Effect of tranexamic acid for upper gastrointestinal bleeding:a Meta-analysis of random controlled trials

作　　者：丁浩 胡琰婷 丁楠 李红玲[1] 蒋思思 王璇[1] 陈迹[1] DING Hao;HU Yanting;DING Nan;LI Hongling;JIANG Sisi;WANG Xuan;CHEN Ji(Department of Pharmacy,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院药学部,乌鲁木齐830011

出　　处：《中国临床药学杂志》2021年第2期119-125,共7页Chinese Journal of Clinical Pharmacy

基　　金：新疆维吾尔自治区药学会科研基金(编号YXH201922)。

摘　　要：目的通过Meta分析,探讨氨甲环酸用于上消化道出血的有效性。方法全面检索英文数据库(Cochrane Library、PubMed、EMBASE和Web of Science)和中文数据库(中文科技期刊全文数据库、中国生物医学文献数据库和万方数据库),检索自各数据库建库至2019年8月发表的关于氨甲环酸治疗上消化道出血的相关研究。利用RevMan 5.3软件进行统计分析,氨甲环酸与对照组的结局指标均采用相对危险度(RR)和95%的置信区间表示。结果共纳入9项随机对照试验(RCTs)。与对照组相比,氨甲环酸治疗上消化道出血可使患者死亡率降低(RR:0.58,95%CI:0.41~0.83,P=0.003),再出血发生率减少(RR:0.68,95%CI:0.50~0.93, P=0.02);但手术干预方面(RR:0.58,95%CI:0.33~1.03,P=0.07)和再输血发生率(RR:0.95,95%CI:0.84~1.07,P=0.37)方面,氨甲环酸与对照组之间差异无统计学意义。结论基于目前的证据,虽然与安慰剂相比,氨甲环酸可以降低上消化道出血患者的死亡率和再出血率,但不建议将氨甲环酸作为上消化道出血患者的常规药物使用。建议未来研究中开展大样本、多中心的研究,进一步探索氨甲环酸用于上消化道出血的安全性和有效性。AIM To evaluate the effectiveness of tranexamic acid for upper gastrointestinal bleeding by Metaanalysis. METHODS Manual and electronic searches of The Cochrane Library, PubMed, Web of Science, CNKI, CBM, and Wanfang were combined. Qualitative studies related to discussion theme were retrieved from these databases, and the retrieval time was from inception to August, 2019. The data were analyzed using Cochrane Collaboration Review Manager 5.3 software. Results presented as RR with 95% confidence intervals. RESULTS Nine randomized trials on tranexamic acid vs placebo were included. In total, 45 of 950 participants randomly assigned to tranexamic acid and 77 of 946 in the control group died(RR: 0.58, 95% CI: 0.41-0.83, P=0.003). Rebleeding was diagnosed for 133 of 929 participants in the tranexamic acid group and for 174 of 921 participants in the control group(RR: 0.68, 95% CI: 0.50-0.93, P=0.02). No significant differences were found on bleeding, surgery or transfusion requirements. CONCLUSION The present review suggests that tranexamic acid may reduce all-cause mortality and rebleeding. However, because of limitations in the internal and external validity of included trials, additional evidence is needed before treatment recommendations can be made.

关 键 词：氨甲环酸 上消化道出血 META分析 

分 类 号：R573.2[医药卫生—消化系统]