内镜套扎术与β受体阻滞剂预防食管静脉曲张首次出血:一项随机对照试验的meta分析

Endoscopic variceal ligation versus β-receptor blockers for prophylaxis of primary esophageal variceal bleeding:a meta-analysis of randomized controlled trials

目的比较内镜下套扎术（EVL）和β受体阻滞剂（βB）预防食管静脉曲张首次出血的有效性和安全性。方法计算机检索至2015年5月EMBASE、PubMed、CENTRAL、万方数据库、中国知网期刊全文数据库和谷歌学术等数据库中的相关随机对照试验（RCT）。研究终点为首次曲张静脉出血、全因死亡、出血相关性死亡和主要不良事件。采用RevMan 5.3进行meta分析固定效应模型合并比值比（OR）与95%置信区间（CI）。结果共纳入14篇RCT文献,总计1 280例患者。Meta分析结果显示,与βB相比,EVL治疗可减少首次曲张静脉出血的发生（OR=0.67,95%CI 0.49～0.91,P=0.010,I2=21%）;两种方法治疗的患者全因死亡率和出血相关性死亡率差异均无统计学意义（全因死亡率：OR=1.14,95%CI 0.87～1.50,P=0.35,I2=0%;出血相关性死亡率：OR=0.72,95%CI 0.44～1.17,P=0.19,I2=0%）;与非选择性βB相比,EVL治疗具有较低不良事件发生率（OR=0.43,95%CI 0.29～0.64,P〈0.000 1,I2=40%）,但与卡维地洛相比EVL治疗不良事件发生率更高（OR=10.59,95%CI 2.37～47.27,P=0.002）。结论 EVL预防食管静脉曲张首次出血较βB更有效,但两种预防措施的全因死亡和出血相关性死亡无明显差别。

Objective To compare the efficacy and safety of endoscopic variceal ligation （EVL） and β-receptor blockers （βB） administration for prophylaxis of primary esophageal variceal bleeding. Methods EMBASE, PubMed, CENTRAL, Wan- fang Database, CNKI database and Google Scholar were comprehensively searched in May 2015 for eligible full-text randomized controlled trials （RCTs）. Endpoints of interest were first variceal bleeding, all-cause mortality, bleeding-related mortality and main adverse events. A fixed-effect model was firstly utilized to calculate the pooled odds risk （OR） with 95% confidence intervals （CIs）. Results Fourteen studies involving 1 280 patients were identified fulfilled the inclusion criteria in this analysis. Compared with βB, EVL significantly reduced the incidence rate of first variceal bleeding （OR=0. 67, 95 %CI： 0. 49-0. 91,P= 0.010, 12 = 21%）. All-cause and bleeding-related mortality had no significant difference in the two groups （all-cause mortality [OR=1. 14, 95%CI： 0. 87-1.50, P=0. 35, 12 =0%]2 and bleeding-related mortality [OR=0. 72, 95%CI： 0. 44-1. 17, P= 0. 19, 12 = 0 %]）. EVL had lower incidence rate of main adverse events than non-selective βB （OR= 0.43, 95 %CI： 0.29-0.64, P〈 0.000 1, 12 = 40%）. However, compared with EVL, the incidence rate of main adverse events in Carvedilol was significantly lower （OR=10. 59, 95%CI： 2. 37 47. 27, P= 0. 002）. Conclusion EVL is more effective in preventing the primary esophageal variceal bleeding compared with βB, but the two methods have no differences in all-cause mortality or bleeding-related mortality.