质子泵抑制剂治疗胃食管反流性咽喉炎的Meta分析

The Meta-analysis for the effects of proton pump inhibitors on the treatment of gastroesophageal reflux laryngitis

目的探讨质子泵抑制剂对胃食管反流性咽喉炎的治疗作用及其安全性,为胃食管反流性咽喉炎的临床治疗提供指导依据。方法计算机检索PubMed、CENTRAL、EMbase、the ISI Web of Knowledge databases、VIP、CNKI、CBM和WANFANG数据库,查找所有探讨质子泵抑制剂对胃食管反流性咽喉炎治疗作用的随机对照试验,检索时限均为建库至2012年3月2日。同时手检纳入文献的参考文献。按纳入排除标准由3名研究者独立进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析,并采用GRADE系统进行证据质量评价。结果共纳入8个研究,591例患者。Meta分析结果显示:质子泵抑制剂治疗胃食管反流性咽喉炎的总体有效率[OR=7.79,95%CI(2.20,27.51),P<0.05]高于对照组,咳嗽症状缓解效率[OR=2.29,95%CI(0.83,6.35),P>0.05],与对照组比较差异不显著,内镜检查好转率[OR=18.83,95%CI(1.86,190.60),P<0.05],高于对照组。结论质子泵抑制剂对胃食管反流性咽喉炎的治疗作用较对照组明显;但因纳入研究较少、质量参差不齐、样本含量小、各研究方法变异性大,建议临床上审慎选择使用;需要更多高质量、大样本、多中心的随机对照试验进一步论证。

Objective To investigate the effect of proton pump inhibitors on the treatment of gastroesophageal reflux laryngitis,and to form a foundation for clinical treatment of it.Methods PubMed,Cochrane Central Register of Controlled Trials（CENTRAL）,EMBASE,the ISI Web of Knowledge databases,VIP,CNKI,CBM and WANFANG were searched（the duration of search was from the building of database to Mar.2012）,and randomized controlled trials（RCTs） about effect of proton pump inhibitors on the treatment of gastroesophageal reflux laryngitis were searched.After selection,assessment,data collection,and assessing were under-taken by 3 reviewers independently,Meta-analysis was performed by the RevMan 5.1 software.The level of evidence was assessed by the GRADE system.Results 8 studies involing 591 patients met the including criteia.The results of Meta-analysis showed that： the overall effective rate of clinical symptoms in proton pump inhibitors groupwas better than that in control group.There was no obvious difference in the remission rate of cough and the effective rate of endoscope determination in proton pump inhibitors group was better than that in control group.Conclusion The effect of proton pump inhibitors on the treatment of gastroesophageal reflux laryngitis is very obvious.For the poor quality of the original studies,a prudent choice to use PPI using treatment of gastroesophageal reflux laryngitis is suggested;more high-quality,large sample studies are needed.