沃诺拉赞与质子泵抑制剂治疗反流性食管炎有效性比较  

Comparison of the efficacy and safety between vonoprazan with proton pump inhibitors for healing reflux esophagitis

作　　者：谷静[1] 陈丰运 刘纯伦[3] GU Jing;CHEN Feng-yun;LIU Chun-lun(Department of Gastroenterology,the First Branch of the First Affiliated Hospital of Chongqing Medical University,Chongqing 400015,China;不详)

机构地区：[1]重庆医科大学附属第一医院第一分院消化科,重庆400015 [2]重庆市九龙坡区人民医院全科医学科,重庆400050 [3]重庆医科大学附属第一医院消化内科,重庆400016

出　　处：《中国处方药》2023年第3期17-21,共5页Journal of China Prescription Drug

摘　　要：目的本文旨在对沃诺拉赞与质子泵抑制剂(proton-pump inhibitor,PPI)治疗反流性食管炎(reflux esophagitis,RE)有效性和安全性作Meta分析,以期指导RE药物治疗选择。方法计算机检索数据库:Pubmed、Cochrane、embase and medline、web of science及SinoMed、中国知网、万方和维普,收集沃诺拉赞与PPIs对比治疗RE的随机对照试验。从纳入文献提取资料、行质量评价,使用RevMan5.4.1软件对数据行Meta分析。结果最终入选5篇文献,均为英文发表,合计1666例患者。第2周沃诺拉赞组治疗有效率高于PPIs组[相对危险度(Relative risk,RR)=1.09,95%置信区间(confidence interval,CI)=(1.04,1.15),P=0.0010]。第4周有效率、第8周治愈率无显著差别[RR=1.02,95%CI(0.99,1.06),P=0.19;RR=1.02,95%CI(1.00,1.05),P=0.10]。洛杉矶分级(Los Angeles,LA)C/D级患者中,两组第2、4、8周有效率或治愈率差异均有统计学意义[RR=1.23,95%CI(1.09,1.38),P=0.0005;RR=1.14,95%CI(1.04,1.24),P=0.003;RR=1.09,95%CI(1.02,1.16),P=0.02]。但A/B级中,两组第2、4、8周有效率或治愈率无显著差异。两组严重不良事件(serious adverse events,SAEs)和治疗过程中不良事件(Treatment emergent adverse events,TEAEs)发生率差异均无统计学意义。结论沃诺拉赞治疗RE在2周疗程内效果显著优于PPIs,提示沃诺拉赞起效更迅速、作用更强。LA分级系统C/D级患者中,沃诺拉赞组疗效优于PPIs组,其治疗重度RE优势更显著。沃诺拉赞和PPIs治疗RE的安全性相当,未见劣势性。Objective The aim of this study is to evaluate the efficacy and safety of VPZ versus PPIs for healing RE.Methods We searched PubMed,Cochrane,embase and medline,web of science,SinoMed,Wanfang CNKI,and VIP from inception until April 2022,for randomized controlled trials comparing VPZ and PPIs in the management of RE.Revman5.4.1 was used for meta-analysis of the included literature data.Results A total of 5 literatures which were in English were included,with 1,666 patients.The effective rate of VPZ group at the 2nd week was higher than that of PPIs group[RR=1.09,95%CI(1.04,1.15),P=0.0010].While,there was no statistical difference between the cure rate at the 8th week or the effective rate at the 4th week.Among the patients with grade C/D,there were significant difference in the cure rate at 2nd,4th and 8th week between two groups[RR=1.23,95%CI(1.09,1.38),P=0.0005;RR=1.14,95%CI(1.04,1.24),P=0.003;RR=1.09,95%CI(1.02,1.16),P=0.02,respectively].The incidence of TEAEs and SAEs between two groups were no significant difference.Conclusion The effect of VPZ for treating RE was significantly better than PPIs in 2 weeks.Among the patients with grade C/D,the curative effect of VPZ group was better than that of PPIs group,while not in Grade A/B,suggesting that the treatment of severe RE using VPZ was more efficient.The safety of two groups in the treatment of RE is similar.

关 键 词：沃诺拉赞 反流性食管炎 质子泵抑制剂 META分析 洛杉矶分级 

分 类 号：R571[医药卫生—消化系统]