内镜下套扎与口服β受体阻滞剂对预防初次食管胃底静脉曲张破裂出血的Meat分析

Endoscopic varices ligation vs. β-blocker for primary prophylaxis of varices bleeding: a Meta-analysis

目的比较内镜下食管胃底静脉曲张套扎术(endoscopic varices ligation,VEL)与口服β受体阻滞剂对预防初次静脉曲张破裂出血的效果。方法检索Pubmed/Medicine、中国生物医学文献服务系统等数据库,已发表关于静脉曲张行套扎术与口服β受体阻滞剂对预防静脉曲张初次出血的临床随机对照研究,检索时间限制到2016年4月。由2位作者对检索文献进行数据提取、质量评价,运用Stata 12.0软件对数据进行统计分析。结果共检索文献545篇,纳入14篇,样本量1 441例,结果显示荟萃分析静脉曲张套扎术与普萘洛尔和卡维地洛在预防曲张静脉首次出血率、出血病死率、总死亡率及不良反应方面分别为:套扎术vs.普萘洛尔首次出血率RR=0.78(95%CI 0.59~1.03),I^2=11%,P=0.34;套扎术vs.卡维地洛首次出血率RR=1.54(95%CI 0.69~3.42),I^2=38.8%,P=0.20,套扎术vs.普萘洛尔出血死亡率RR=0.83(95%CI 0.52~1.34),I^2=0,P=0.954;套扎术vs.卡维地洛出血死亡率RR=0.84(95%CI 0.29~2.46),I^2=0,P=0.770,套扎术vs.普萘洛尔总死亡率RR=1.08(95%CI 0.88~1.32),I^2=0,P=0.837;套扎术vs.卡维地洛总死亡率RR=0.91(95%CI 0.58~1.42),I^2=25.2%,P=0.248;套扎术vs.β受体阻滞剂不良反应发生率RR=1.19(95%CI 0.81~1.77),I^2=87.3%,P=0。结论食管胃底静脉曲张患者行套扎术治疗与口服β受体阻滞剂方面在首次出血率、出血病死率、总死亡率及不良反应方面均无明显差异,但考虑到患者依从性、医疗负担等方面,临床建议口服β受体阻滞剂预防静脉曲张首次出血。

Objective To evaluate the efficacy of endoscopic varices ligation （EVL）andS-blocker for prophylaxis of oesophageal-gastric varices bleeding. Methods PubMed/Medicine, Chinese biomedical literature service system and other databases were searched for relevant clinical randomized controlled trials about EVL andS-blocker for prophylaxis of oesophageal-gastric varices bleeding published before April 2016. Two authors independently assessed study quality and extracted data. Statal2. 0 software was used to statistically analyze the data. Results Fourteen studies including 1 441 cases were included. This Meta- analysis results were as follows：bleeding rate for the first time： EVL vs. propranolol （RR = 0. 78,95% CI： 0.59-1.03,I2 =11%,P=0.34）,EVLvs. carvedilol（RR=1.54,95% CI：0.69-3.42,I2 =38.8%,P= 0. 20） ;bleeding related mortality： EVL vs. propranolol （ RR = 0. 83,95% CI： 0. 52-1.34, 12 = 0% , P = 0. 954） ,EVL vs. carvedilol（RR =0. 84,95% CI：O. 29-2.46,I2 =0% ,P =0. 770） ;total mortality： EVL vs. propranolol（RR = 1.08,95% CI：O. 88-1.32,I2 =0% ,P =0. 837） ,EVL vs. carvedilol（RR =0. 91,95% CI： 0. 58-1.42 ,I2 = 25. 2% , P = 0. 248 ） ; adverse effects rate： EVL vs.β β-bloeker （ RR = 1.19,95% CI： 0. 81- 1.77,12 = 87.3% ,P = 0）. Conclusions There are no significant differences on preventing for the primary varices bleeding in first bleeding rate, bleeding related mortality, total mortality and adverse effects rate between EVL andβ-blocker. But considering the cost and compliance, we recommend the best choice for preventing on the primary bleeding isβ-bloeker.