普萘洛尔预防肝硬化上消化道再出血的荟萃分析

A meta-analysis of propranolol for prevention of recurrent upper gastrointestinal bleeding in patients with cirrhosis

目的 :对普萘洛尔能否预防肝硬化并发上消化道出血进行系统评价。方法 :检索 1 980年 1月至 2 0 0 0年 1 2月期间发表的有关普萘洛尔预防肝硬化并发上消化道出血的随机对照临床试验。按照入选标准 ,有 9项临床试验纳入本研究。结果 :上消化道再出血和因出血死亡的合并优势比 (OR)分别为0 .3 0 [95 %CI 0 .2 2 ,0 .42 ],0 .43 [95 %CI 0 .2 3 ,0 .84],P <0 .0 5 ;而死亡的OR为 0 .67[95 %CI0 .44,1 .0 4],P >0 .0 5。肝功能越差 ,预防效果越好。结论 :普萘洛尔可以预防肝硬化并发上消化道再出血 ,并可降低再出血所致的死亡率。

AIM:To evaluate systematically whether the recurrent upper gastrointestinal bleeding in patients with cirrhosis may be prevented by propranolol. METHODS: MEDLINE and China Biological Medicine Disk on randomized controlled trials about studying the prevention of the recurrent upper gastrointestinal bleeding by propranolol in patients with cirrhos is were searched. According to included criteria, nine studies were chosen at last. RESULTS: The pooled odds ratios (OR) of the recurrent upper gastrointestinal bleeding, and death caused by bleeding were 0.30 [95 %CI 0.22, 0.42], 0.43 [95 %CI 0.23, 0.84], P <0.05; but the pooled OR of death was 0.67 [95 %CI 0.44, 1.04], P >0.05. The more severe the liver function was, the better the efficacy of propranolol was. CONCLUSION: Propranolol can prevent the recurrent upper gastrointestinal bleeding in patients with cirrhosis, and can also reduce the rate of death caused by bleeding, but can not reduce the rate of death in cirrhotic patients. The liver function is a important factor which can affect propranolol in the prevention of the recurrent upper gastrointestinal bleeding.