H2受体拮抗剂应用与肺炎发生危险的Meta分析

A Meta-analysis of histamine-receptor antagonists use and risk of pneumonia

目的:评估H2受体拮抗剂(histamine-receptor antagonists,H2RA)应用是否增加肺炎的发生危险。方法:应用计算机检索EMBASE、CENTRAL(the Cochrane central register of con-trolledtrials)、Medline、万方数据库、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)等,搜集公开发表的关于H2RA应用与肺炎发生危险的随机对照研究(randomized con-troled trials,RCT)。以受试者肺炎发生的相对危险度(relative risk,RR)及相应的95%置信区间(95%confidence interval,95%CI)作为效应指标进行合并统计量。各研究间的统计学异质性采用Q统计量的I2检验来分析,双侧P>0.05认为各研究间不存在明显的统计学异质性,采用固定效应模型进行分析,反之采用随机效应模型进行分析。应用Egger法对发表偏倚进行量化检测。结果:共有18篇研究符合纳入标准,2974例受试者,H2RA组1508例,对照组1466例。Me-ta分析显示,H2RA可增加受试者肺炎的发生风险(RR=1.22,95%CI=1.05～1.41,Z=2.61,P=0.009);亚组分析,H2RA与安慰剂相比,使受试者的肺炎风险增加21%(RR=1.21,95%CI=1.02～1.45,Z=2.17,P=0.03),H2RA与硫糖铝相比并不增加受试者肺炎的发生风险(RR=1.22,95%CI=0.93～1.60,Z=1.45,P=0.148)。结论:H2RA的应用可能是肺炎发生的一个危险因素。

To evaluate whether the use of histamine-receptor antagonists will increase the risk of pneumonia. METHODS： By searching EMBSE , CENTRAL（the Cochrane central reg- ister of controlledtrials）, CBM, Medline, CNKI and WANFANG et al , we collected publishedrandomized controled trials（RCTs） about hista- mine use and risk of pneumonia. The effect size was incidence of pneumonia measured relative risk （RR） and its 95~/6o confidence interval （950//00 CI）. The cochran＇s chi-square test （Q test） was used to test the statistical heterogeneity. The Egger test was used to test the publication bias. RESULTS： 18 trials that included a total of 2974 subjects were included in the meta-analysi. 1508 subjects were in the histamine-receptor antago- nists group and 1466 were in the placebo of su- cralfate group. The pooled relative risk of pneu-monia was higher in histamine-receptor antago- nists group compared with placebo/sucralfate group（RR = 1.22,95% CI = 1.05 - 1.41, Z= 2.61,P=0.009）. Sub-group analysis ,thepneu- monia risk was increase 21% in histamine-recep- tor antagonists group compared with placebo group（RR=l. 21, 95%CI=1.02-1.45,Z= 2.17, P = 0.03）. But statistical difference was observed between histamine-receptor antagonists group and sucralfate group RR=1. 22, 95%CI= 0.93- 1.60,Z= 1. SlON. The use of hi may increase 45, P ： 0. 148）. CONCLU- stamme-receptor antagomsts risk of pneumonia.