硝酸酯类药物治疗贲门失弛缓症的系统评价

A systematic review: nitrates for achalasia

背景 硝酸酯类药物用于贲门失弛缓症已有较长时间,但其疗效仍有争议。目的 评价硝酸酯类药物对贲门失弛缓病人的短期和长期疗效。检索策略 检索Cochrane对照试验注册资料库(2001年4期),MEDLINE(1966-2001),EMBASE(1980-2001),LILACS——拉丁美洲和加勒比海健康科学文库(1982-2001),和CBM——中国生物医学数据库(1981-2000)、中国循证医学中心手检资料中的随机对照试验。选择标准 各种硝酸酯药物治疗贲门失弛缓症的随机对照试验。资料收集与分析 按意向治疗的原则收集数据,包括症状改善,食管下括约肌压力、压力波振幅、食管排空率、食管滞留率的变化,副作用等。计算以上改变的比值比(OR),预防1例不良事件发生需要治疗的人数(NNT)。主要结果 发现两个随机试验。但两篇报道均为交叉试验,都没有第一次分配后的治疗结果,因此其结果尚不能纳入本评价。目前正与两文作者联系。评价员的结论 现阶段还不能得出对临床实践的建议。评价硝酸酯类药物治疗失弛缓症还需更多的随机对照试验。

Background Though nitrates have been used in achalasia for a long time, the effectiveness of nitrates for achalasia is still controversial. Objectives To quantify short-term and long-term effects of nitrate therapy in patients with achalasia. Search strategy Trials were identified by searching the Cochrane Controlled Trials Register (Issue 4 - 2001), MEDLINE (1966 - 2001), EMBASE (1980 - 2001) , LILACS - Latin American and Caribbean health science literature (1982 - 2001 )and CBM-Chinese Biomedical Database( 1980 - 2000). Additionally, all references in the identified trials were checked for further relevant trials. Selection criteria All randomised controlled trials involving achalasic patients given any type of nitrates were included. Data collection & analysis Data were extracted by two independent observers based on the intention to treat principle. Odds ratios for the patients need to treat by invasive procedures, improvement of symptoms, LES pressure decrease, oesophageal emptying, and side effects were calculated. Numbers needed to treat (NNT) for avoiding invasive procedure, improvement of symptoms, oesophageal emptying, and numbers needed to harm (NNH) of side effects were also determined. Main results Two randomised cross-over studies were found, But no results are included. Due to the design of the studies and the method of reporting the results in the original paper it was not possible to extract the necessary information to examine any of the outcomes. Authors have been contacted to obtain this information. Reviewers' conclusions We can conclude no implications for practice at this stage. Much more RCT data are needed to determine the effects of nitrates.