重复硬化剂注射联合奥曲肽治疗肝硬化食管静脉曲张再出血的Meta分析

Combination of sclerotherapy and octreotide in the treatment of patients with esophageal variceal bleeding:A meta analysis

目的系统评价硬化剂注射联合奥曲肽治疗肝硬化食管静脉曲张再出血的疗效。方法计算机检索中国生物医学文献光盘数据库、Cochrane图书馆、Cochrane图书馆临床对照试验资料库、MEDLINE、EMbase和SCIE等数据库,收集硬化剂联合奥曲肽治疗肝硬化食管静脉曲张再出血的随机对照试验。采用Cochrane协作网推荐的RevMan4.2软件对数据进行统计分析。结果纳入5个RCT,包括511例患者,其中硬化剂联合奥曲肽（试验组）255例,对照组（单用硬化剂）256例。结果显示,硬化剂联合奥曲肽治疗组早期止血率优于硬化剂治疗组,OR为2.65（95%CI为1.66~4.23）,再出血率低于硬化剂组,OR为0.52（95%CI为0.32~0.84）;随访期内两组病死率无显著性差异,OR为0.75（95%CI为0.44~1.29）;副反应发生频率较高的主要有高血糖反应、食管溃疡、肝性脑病、头痛,但两组比较无显著性差异;同时,漏斗图比较对称,存在发表偏倚的可能性小。结论在两组病死率相当的情况下,重复硬化剂联合奥曲肽治疗肝硬化食管静脉曲张再出血优于单独硬化剂治疗。

Objective To evaluate the efficacy of sclerotherapy plus octreotide for esophageal variceal hemorrhage. Methods We searched CBM,the Cochrane Library,the Cochrane Controlled Trials Register, MEDLINE,EMBASE and SCIE for randomized controlled trials about sclerotherapy plus octreotide versus sclerotherapy only. The Meta-analyses were conducted by using The Cochrane Collaboration＇s RevMan 4.2 software. Results Five randomized controlled trials involving 511 patients were included including 255 patients in sclerotherapy plus octreotide and 256 patients in sclerotherapy alone group. The rates ofearly hemostasis,the rates of rebleeding,the rates of mortality and adverse events were analyzed. Meta-analyses showed that the early hemostasis in sclerotherapy plus octreotide group was better than in sclerotherapy group （OR=2.65,95%CI=1.66 to 4.23） ; rebleeding was more frequent in sclerotherapy group（OR= 0.52,95%CI=0.32 to 0.84） ; However, the incidence of death was similar in both groups （OR=0.75,95%CI=0.44 to 1.29）;The most frequent adverse events was hyperglycemia,esophageal ulcer,hepatic encephalopathy and headache,and it showed no significant difference in the two groups. Funnel plot showed symmetrical, suggesting the lover possibility of publication bias. Conclusions Sclerotherapy plus octreotide therapy is better for hemostasis of esophageal variceal bleeding than sclerotherapy alone.