特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性的Meta分析  

Efficacy and safety of terlipressin combined with somatostatin in the treatment of upper gastrointestinal bleeding in patients with cirrhosis:a meta-analysis

作　　者：于金莲 魏晓华[1] 薛挺[1] YU Jin-lian;WEI Xiao-hua;XUE Ting(Department of Gastroenterology,Baoji Central Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市中心医院消化内科,陕西宝鸡721000

出　　处：《海南医学》2024年第15期2222-2229,共8页Hainan Medical Journal

摘　　要：目的系统评价特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性。方法检索自建库至2023年7月在PubMed、Cochrane Library、Embase、Web of Science、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(SinoMed)等发表的关于特利加压素联合生长抑素治疗肝硬化上消化道出血的随机对照试验(RCTs),试验组采用特利加压素联合生长抑素,对照组单用生长抑素。采用Revman5.3和Stata17软件对全因死亡率、总体有效率、不良事件发生率、止血时间、输血量和住院时间进行Meta分析。结果纳入20项RCTs,共计1502例患者。Meta分析结果显示:与对照组相比,试验组治疗肝硬化上消化道出血可降低全因死亡率(OR=0.34,95%CI:0.19~0.59,P<0.01)和输血量(SMD=-2.29,95%CI:-3.13~-1.46,P<0.01),缩短止血时间(SMD=-1.64,95%CI:-2.03~-1.25,P<0.01)和住院时间(MD=-7.12,95%CI:-7.47~-6.77,P<0.01),提高总体有效率(OR=3.50,95%CI:2.46~4.97,P<0.01);而不良事件的发生率比较差异无统计学意义(OR=1.20,95%CI:0.82~1.75,P=0.34)。结论现有证据表明,与单用生长抑素相比,特利加压素联合生长抑素治疗肝硬化上消化道出血可显著提高总体有效率,降低死亡风险和输血量,缩短止血时间及住院时间,且不增加不良反应。Objective To systematically evaluate the efficacy and safety of terlipressin combined with soma-tostatin in the treatment of upper gastrointestinal bleeding in patients with cirrhosis.Methods PubMed,Cochrane Li-brary,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database(VIP),SinoMed,and other databases were retrieved from inception to July 2023 to screen literature on randomized con-trolled trials(RCTs)of terlipressin combined with somatostatin in the treatment of upper gastrointestinal haemorrhage in patients with cirrhosis.Patients in the study group received terlipressin combined with somatostatin,while those in the control group received somatostatin alone.Meta-analysis was performed using Revman5.3 and Stata17 software to an-alyze the mortality,total effective rate,incidence of adverse events,hemostasis time,blood transfusion volume,and length of hospital stay.Results A total of 20 RCTs involving 1502 patients were included.Meta-analysis showed that compared with the control group,the study group could reduce mortality(OR=0.34,95%CI:0.19 to 0.59,P<0.01)and blood transfusion volume(SMD=-2.29,95%CI:-3.13 to-1.46,P<0.01),shorten hemostasis time(SMD=-1.64,95%CI:-2.03 to-1.25,P<0.01)and length of hospital stay(MD=-7.12,95%CI:-7.47 to-6.77,P<0.01),and increase total effective rate(OR=3.50,95%CI:2.46 to 4.97,P<0.01).However,there was no significant difference in the inci-dence of adverse events between the two groups(OR=1.20,95%CI:0.82 to 1.75,P=0.34).Conclusion Compared with somatostatin alone,terlipressin combined with somatostatin in the treatment of upper gastrointestinal bleeding in patients with cirrhosis can significantly improve the total effective rate,reduce the risk of death and blood transfusion volume,shorten hemostasis time and length of hospital stay,without increasing adverse reactions.

关 键 词：特利加压素 生长抑素 肝硬化 上消化道出血 META分析 

分 类 号：R657.31[医药卫生—外科学]