β受体阻滞剂对肝硬化伴临床显著性门静脉高压无或小食管静脉曲张一级预防的Meta分析  

Meta-analysis ofβ-blockers for the primary prevention of liver cirrhosis with clinically significant portal hypertension with no or small esophageal varices

作　　者：苏鑫 李文洁 陈哲[1] 吴其标[2] 殷旻皓 韩旭 张丹萍 周希乔 朱宏[1] Su Xin;Li Wenjie;Chen Zhe;Wu Qibiao;Yin Minhao;Han Xu;Zhang Danping;Zhou Xiqiao;Zhu Hong(Department of Gastroenterology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;State Key Laboratory of Quality Research in Chinese Medicine,Faculty of Chinese Medicine,Macao University of Science and Technology,Macao 999078,China;Department of Endocrinology,the Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210004,China)

机构地区：[1]南京医科大学第一附属医院消化内科,南京210029 [2]澳门科技大学中医药学院,中药质量研究国家重点实验室,中国澳门999078 [3]南京中医药大学附属医院内分泌科,南京210004

出　　处：《中华肝脏病杂志》2022年第11期1237-1245,共9页Chinese Journal of Hepatology

基　　金：江苏省“333”工程项目(LGY2016010);南京市科技局项目(201715003);江苏省六大人才高峰(WSN-030)。

摘　　要：目的肝硬化可导致门静脉高压,其并发症以胃食管静脉曲张破裂出血最为常见。肝硬化合并大食管静脉曲张患者使用非选择性β受体阻滞剂(non-selective beta-blocker,NSBB)进行一级预防的效果是显著的。然而,肝硬化伴临床显著性门静脉高压(clinically significant portal hypertension,CSPH)无或小食管静脉曲张患者是否可以使用NSBB进行一级预防尚存在争议。本研究探究NSBB是否适用于肝硬化伴CSPH无或小食管静脉曲张的一级预防。方法从Cochrane library、PubMed、EMBASE、SinoMed、CNKI、万方数据库中检索各数据库建库至2020年12月12日的相关文献,搜集所有关于NSBB用于肝硬化伴CSPH无或小食管静脉曲张一级预防的随机对照试验(randomized controlled trial,RCT),按照所制定的纳入与排除标准严格筛选文献,采用比值比(odds ratio,OR)及95%可信区间(cofidence interval,CI)合并效应量。主要结局指标为:食管静脉曲张发展、首次上消化道出血;次要结局指标为:死亡(最长平均随访时间约5年)、不良事件(药物不良反应等)。结果共纳入9篇RCT文献,1396例患者。Meta分析结果显示,与安慰剂比较,NSBB显著降低肝硬化伴CSPH无或小食管静脉曲张进展为大食管静脉曲张的发生率(OR=0.51,95%CI:0.29~0.89,P=0.02)、死亡率(最长平均随访时间约5年)(OR=0.64,95%CI:0.44~0.92,P=0.02),两组首次上消化道出血率无明显差异(OR=0.82,95%CI:0.44~1.52,P=0.53),NSBB组不良事件发生率则高于安慰剂组(OR=1.74,95%CI:1.27~2.37,P=0.005)。结论肝硬化伴CSPH无或小食管静脉曲张患者,使用NSBB虽然不能降低首次上消化道出血率,且增加了不良事件的发生率,但其可延缓胃食管静脉曲张的进展,并降低患者的死亡率。Objective To explore whether NSBB is suitable for the primary prevention of liver cirrhosis accompanied by CSPH with no or small esophageal varices.Methods Relevant literatures were retrieved from Cochrane library,PubMed,EMBASE,SinoMed,CNKI and Wanfang databases until December 12,2020.All randomized controlled trials(RCTs)on NSBB use for primary prevention of cirrhosis accompanied by CSPH with no or small esophageal varices were collected.The literature was strictly screened according to the established inclusion and exclusion criteria,odds ratio(OR),and 95%confidence interval(CI)combined effect size.The development of esophageal varices and the initial upper gastrointestinal bleeding were the primary outcome measures.Death(with a maximum average follow-up of about five years)and adverse events(adverse drug reactions,etc.)were the secondary outcome measures.Results A total of 9 RCTs with 1396 cases were included.Meta-analysis results showed that,compared with placebo,NSBB significantly reduced the incidence of liver cirrhosis accompanied by CSPH with no or small esophageal varices to large esophageal varices progression(OR=0.51,95%CI:0.29-0.89,P=0.02),and mortality(with maximum average follow-up of about five years)(OR=0.64,95%CI:0.44-0.92,P=0.02);however,there was no statistically significant difference in the initial upper gastrointestinal bleeding rate between the two groups(OR=0.82,95%CI:0.44-1.52,P=0.53).Adverse event incidence was greater in the NSBB than the placebo group(OR=1.74,95%CI:1.27-2.37,P=0.0005).Conclusions NSBB use cannot reduce the initial upper gastrointestinal bleeding rate or adverse event incidence in patients with liver cirrhosis accompanied by CSPH with no or small esophageal varices,but it can delay the progression of gastroesophageal varices and reduce patient mortality.

关 键 词：非选择性Β受体阻滞剂 肝硬化 门静脉高压 食管静脉曲张 一级预防 

分 类 号：R575.2[医药卫生—消化系统]