质子泵抑制剂对非甾体抗炎药相关胃肠疾病的疗效:荟萃分析

Role of Proton Pump Inhibitors in Non-steroidal Anti-inflammatory Drugs-associated Gastrointestinal Diseases:a Meta-analysis

质子泵抑制剂(PPI)广泛应用于非甾体抗炎药(NSAIDs)相关胃肠疾病的治疗,但其疗效缺乏相关循证医学资料证实。目的:评价PPI治疗NSAIDs相关胃肠疾病的疗效。方法:通过Medline和中国生物医学文献数据库检索1979～2005年10月发表的有关PPI治疗NSAIDs相关胃肠疾病的单中心或多中心随机对照临床试验。根据入选标准,共有6项临床试验纳入本研究。由2名作者各自独立地对入选研究中的试验设计、研究对象特征、研究结果等内容进行摘录。应用RevMan4.2软件,以随机效应模型进行荟萃分析。结果:6项随机临床试验中共2280例患者满足纳入标准。荟萃分析结果显示:PPI与安慰剂相比,RR为1.33,95%CI为1.00～1.76,P=0.05;PPI与胶体铋相比,RR为0.99,95%CI为0.85～1.17,P=0.95;PPI与H2受体拮抗剂(H2RA)相比,RR为1.26,95%CI为1.08～1.46,P=0.002。但PPI与安慰剂相比和PPI与胶体铋相比均存在异质性。结论:PPI在不停用NSAIDs的情况下仍能有效缓解NSAIDs引起的胃肠道损害,其疗效优于H2RA,但与胶体铋相比并无明显优势。

Background： Proton pump inhibitors （PPI） are widely used in the treatment of non-steroidal anti-inflammatory drugs （NSAIDs）-associated gastrointestinal diseases, but corresponding evidenee-based information is scarce. Aims： to evaluate the clinical efficacy of PPI in NSAIDs-associated gastrointestinal diseases. Methods： Medline and China Biological Medicine Disk were searched for mono- or muhicenter randomized controlled clinical trials in patients witb the above diseases published from 1979 to October 2005. According to the inclusion criteria, six studies were selected. Two authors cited the details about the design of trials, identities of the participants and the outcomes from the studies independently. The data were analyzed by RevMan4.2 software using random effects model. Results： Six randomized clinical trials including 2280 patients were included. The results of meta-analysis were as iollows： PPI vs. placebo： RR 1.33, 95% CI 1.00-1.76, P=0.05; PPI vs. colloidal bismuth： RR 0.99, 95% CI 0.85-1.17, P=-0.95; PPI vs. H2 receptor antagonist （H2RA）： RR 1.26, 95% CI 1.08-1.46, P=0.002. But homogeneity was not significant for PPI vs. placebo and PPI vs. colloidal bismuth. Conclusions： PPI is effective in relieving NSAIDs-associated gastrointestinal diseases while NASIDs is used continuously. PPI is superior to H2RA, but not to colloidal bismuth.