兰索拉唑治疗胃食管反流病临床疗效的Meta分析

Meta-Analysis for Efficacy of Gastroesophageal Reflux Disease Treated by Lansoprazole

目的系统评价兰索拉唑与其它质子泵抑制剂治疗胃食管反流病(GERD)的临床疗效,为临床用药提供参考。方法计算机检索中国期刊全文数据库(CNKI)、万方、维普、Pub Med、Medline、Cochrane Library数据库,收集国内外已公开发表的比较兰索拉唑和其它质子泵抑制剂治疗胃食管反流病疗效的随机对照试验(RCT),以临床症状缓解率和内镜下治愈率为评价指标,采用Cochrane协作网提供的Meta分析软件Rev Man5.0进行数据的处理与分析。结果最终共纳入中文RCT 13篇,英文RCT 6篇,合计9143例患者,Meta分析结果显示:兰索拉唑与奥美拉唑[OR=0.71,95%CI(0.33,1.54),P>0.05]、雷贝拉唑[OR=0.59,95%CI(0.26,1.37),P>0.05]临床症状缓解率相当,但不及埃索美拉唑[OR=0.38,95%CI(0.24,0.62),P<0.05],仅一篇文献比较了与泮托拉唑临床症状缓解率,结果无统计学差异;兰索拉唑与奥美拉唑[OR=1.08,95%CI(0.86,1.35),P>0.05]、泮托拉唑[OR=0.72,95%CI(0.44,1.16),P>0.05]内镜下治愈率相当,但不及雷贝拉唑[OR=0.44,95%CI(0.22,0.85),P<0.05]、埃索美拉唑[OR=0.48,95%CI(0.33,0.70),P<0.05]。结论在治疗胃食管反流病时,兰索拉唑与奥美拉唑、泮托拉唑疗效相当,不及埃索美拉唑、雷贝拉唑,但该结论仍需大规模多中心研究进一步证实。

OBJECTIVE To systematically evaluate the therapeutic efficacy of lansoprazole vs other proton pump inhibitors in the treatment of gastroesophageal refluxdisease（ GERD）,so as to provide reference for its clinical medication. METHODS The randomized controlled trials（ RCT） that compare the efficacy of lansoprazole and other proton pump inhibitors in the treatment of GERD were collected from CNKI,Wanfang,VIP,Pub Med,Medline,Cochrane Library. The clinical symptom remission rate and endoscopic cure rate were used as the evaluation index,and meta-analysis software Rev Man5. 0 in Cochrane Collaboration was used to do the data processing and analysis. RESULTS A total of 13 Chinese RCT and 6 English RCT were included,involving 9 143 patients. Results of Meta-analysis showed that： there were no difference in the clinical symptom remission rate between lansoprazole,omeprazole [OR = 0. 71,95% CI（ 0.33,1. 54）,P〈0.05],and rabeprazole [OR = 0. 59,95% CI（ 0. 26,1. 37）,P〉0.05],but lansoprazole not as good as esomeprazole[OR =0. 38,95% CI（ 0. 24,0. 62）,P〈0.05],only one RCT compared with pantoprazole,no difference between the results. There were no difference in the endoscopic cure rate between lansoprazole,omeprazole [OR = 1. 08,95% CI（ 0. 86,1. 35）,P〈0.05 ],pantoprazole [OR = 0. 72,95% CI（ 0. 44,1. 16）,P〉0.05],but lansoprazole not as good as rabeprazole [OR = 0. 44,95% CI（ 0. 22,0.85）,P〈0.05],esomeprazole [OR = 0. 48,95% CI（ 0. 33,0. 70）,P〈0.05]. CONCLUSION In the treatment of GERD,there were no difference in the therapeutic efficacy between lansoprazole,omeprazole and pantoprazole,but lansoprazole not as good as esomeprazole,rabeprazole. Large scale,multiple center studies are required to validate those conclusions.