沃诺拉生和质子泵抑制剂预防早期胃癌内镜黏膜下剥离术后迟发性出血的比较:最新系统综述和荟萃分析  

Comparison of Vonoprazan and proton pump inhibitors in preventing delayed bleeding after endoscopic submucosal dissection of early gastric cancer:an update systematic review and Meta-analysis

作　　者：朱思莹 韩牧洲 邵琳琳[1] 李鹏[1] 施海韵[1] ZHU Siying;HAN Muzhou;SHAO Linlin;LI Peng;SHI Haiyun(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Beijing key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,国家消化系统疾病临床医学研究中心,北京市消化疾病中心,消化疾病癌前病变北京市重点实验室,北京100050

出　　处：《胃肠病学和肝病学杂志》2025年第3期331-338,共8页Chinese Journal of Gastroenterology and Hepatology

基　　金：北京市医院管理中心“青苗”计划专项经费资助(QML20190104,QML20180102);北京市科技新星计划(Z201100006820147);北京市科学技术委员会资助(Z181100001718221)。

摘　　要：目的探讨在上消化道内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后,应用沃诺拉生(Vonoprazan,VPZ)是否能比质子泵抑制剂(proton pump inhibitors,PPIs)更有效地减少术后并发症。方法检索PubMed、EmBase、The Cochrane Library、Web of Science等数据库中关于VPZ和PPIs预防胃ESD术后迟发性出血有效性的研究。采用Cochrane偏倚风险评估工具和Newcastle Ottawa质量评价量表进行文献质量评价。采用Stata 15.1软件进行统计学分析,包括绘制森林图、亚组分析、敏感性分析和发表偏倚检测。结果该研究纳入17项涉及51294例患者的研究。VPZ组与PPIs组的总体迟发性出血率差异有统计学意义。VPZ治疗术后迟发性出血的总体平均RR为0.72(95%CI:0.67~0.77,P<0.05)。VPZ组与PPIs组的溃疡收缩率差异有统计学意义,WMD为2.68(95%CI:0.44~4.91,P<0.05)。但两组的输血事件发生率差异无统计学意义(RR=0.76,95%CI:0.41~1.40)。敏感性分析表明,所有结果都是稳健的。结论与PPIs相比,VPZ在降低迟发性出血发生率和促进人工溃疡收缩方面具有更好的疗效。早期胃癌患者ESD术后应用VPZ可能是一种更合适的选择。Objective To explore whether the application of Vonoprazan(VPZ)can reduce postoperative complications more effectively than proton pump inhibitors(PPIs)after endoscopic submucosal dissection(ESD)of the upper digestive tract.Methods We searched studies that reported the effectiveness of VPZ and PPIs in preventing delayed bleeding after gastric ESD by using PubMed,EmBase,The Cochrane Library and Web of Science.The Cochrane Risk of Bias Tool and Newcastle Ottawa Quality Assessment Scale were applied to evaluate the quality of the researches.All statistical analyses were carried out using Stata 15.1,including drawing the forest map,subgroup analysis,sensitivity analysis and detection of publication bias.Results Seventeen studies with 51294 patients were included.There was a statistically difference in the overall delayed bleeding rate between the VPZ group and PPIs group.The overall mean RR for delayed bleeding following the administration of VPZ was 0.72(95%CI:0.67-0.77,P<0.05).There was a statistical difference in the shrinkage ratio between the VPZ group and the PPIs group,the WMD was 2.68(95%CI:0.44-4.91,P<0.05).However,there was no statistically difference in the incidence of blood transfusion events between the two groups(RR=0.76,95%CI:0.41-1.40).The sensitivity analysis showed all results were robust.Conclusion Compared to PPIs,VPZ demonstrates superior efficacy in reducing the incidence of delayed bleeding and enhancing the contraction of artificial ulcers.Therefore,using VPZ for postoperative management of gastric ESD in patients with early gastric cancer may be a suitable choice.

关 键 词：沃诺拉生 质子泵抑制剂 早期胃癌 内镜黏膜下剥离术 迟发性出血 

分 类 号：R735.2[医药卫生—肿瘤]