泮托拉唑与H_2受体拮抗剂防治脑出血后应激性溃疡出血疗效对比的Meta分析

Efficacy comparison of pantoprazole and H_2 receptor antagonists in preventing and treating stress ulcer bleeding in intracerebral hemorrhage patients: a Meta-analysis

目的:系统评价泮托拉唑和H2受体拮抗剂(H2RA)在防治脑出血后应激性溃疡出血方面疗效及安全性的差异。方法:计算机检索PubMed,EMbase,Cochrane图书馆临床对照试验资料库,CBM,CNKI和万方数据库,检索时限截至2012年8月。收集泮托拉唑防治脑出血并发应激性溃疡的随机对照试验(RCT),对符合纳入标准的临床研究进行质量评价和资料提取后,采用RevMan 5.0软件进行Meta分析。结果:共纳入16个RCT,包括1 762例患者。Meta分析结果显示:①应激性溃疡发生率的比较:共纳入11个研究(1 290例患者)为预防用药,与H2RA组相比,泮托拉唑组应激性溃疡的发生率显著降低,差异有统计学意义[OR=0.26,95%CI(0.18,0.36)]。②有效率的比较:共纳入5个研究(472例患者)为治疗用药,与H2RA组相比,泮托拉唑组有效率升高,差异有统计学意义[OR=2.85,95%CI(1.49,5.45)]。③死亡率的比较:纳入6个研究(778例患者)为预防用药,与H2RA组相比,泮托拉唑组死亡率显著降低,差异有统计学意义[OR=0.34,95%CI(0.23,0.51)]。结论:现有的临床研究证据显示,与H2RA组相比,泮托拉唑组在预防用药时能显著降低应激性溃疡的发生率、患者的死亡率,在治疗用药时能提高有效率。

Objective： To analyze the difference in the efficacy and safety of pantoprazole and H2 receptor antagonists （H2RA） in the prevention and treatment of stress ulcer bleeding in intracerebral hemorrhage patients. Methods： We searched PubMed, EMbase, the Cochrane Library （Central Register of Controlled Trials） , CBM, CNKI and Wanfang database until the end of August 2012. Randomized controlled trials （RCTs） of pantoprazole for the prevention and treatment of stress ulcer bleeding in intracerebral hemorrhage patients were collected. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used to carry out statistical analysis. Results： Sixteen RCTs involving 1 762 patients were included. The results of Meta-analyses showed that, as prophylaxis, pantoprazole significantly reduced the incidence of stress ulcer in intracerebral hemorrhage patients compared to H2RA group [ OR =0.26, 95% CI（0.18 ,0. 36） ] ; as treat- ment, pantoprazole significantly increased efficiency of stress ulcer in intracerebral hemorrhage patients compared to H2RA group [OR = 2.85, 95% CI （1.49,5.45）]; as prophylaxis, mortality was significantly lower in panto-prazole group than in H2RA group [ OR =0.34, 95% CI （0.23,0.51） ]. Conclusion： The currently available evi- dence shows that pantoprazole as a preventive medication can reduce the incidence of stress ulcer and mortality in intracerebral hemorrhage patients; pantoprazole as a treatment medication can improve efficiency of stress ulcer bleeding compared to H2RA group.