质子泵抑制剂和H_2受体阻滞剂预防应激性溃疡的系统评价再评价

Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis: an overview of systematic reviews

目的对质子泵抑制剂和H_2受体阻滞剂预防应激性溃疡的有效性和安全性系统评价进行再评价。方法计算机检索Cochrane图书馆、Pub Med、Embase、Web of Sciene、中国知网(CNKI)、中国科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)和万方医学数据库,检索时限均从建库至2016年5月。根据纳入排除标准,筛选符合纳入排除标准的系统评价和Meta分析,使用AMSTAR量表评价所纳入系统评价的方法学质量,Grade系统评价结局指标的证据质量,提取原始研究用Rev Man 5.3软件进行Meta分析。结果共纳入7个系统评价/Meta分析,方法学质量评分>7分者仅占41.86%;对21个单个结局指标分别进行质量评价,14个(67.77%)的证据质量均为低或极低。对36个研究(3 820例)数据进行再分析,PPI在预防应激性溃疡出血、临床大出血和显性出血方面优于H_2RA(P<0.001),但是在肺炎发生率、死亡率和ICU住院天数方面,PPI和H_2RA比较差异无统计学意义(P>0.05)。结论 PPI预防ICU的危重患者的应激性溃疡出血优于H_2RA,但原始研究质量不高,仍需后续更多的高质量、结局指标设计全面的前瞻性研究。

Objective To evaluate the efficacy and safety of proton pump inhibitors（ PPI） versus histamine 2 receptor antagonists（ H_2RA） for stress ulcer prophylaxis by overviewof systematic reviews. Methods The Cochrane library,Pub Med,EMbase,Web of Science,CNKI,VIP,CBMand Wanfang data were searched from the inception to May 2016. According to the inclusion and exclusion criteria,articles for systematic reviews and Meta-analysis were selected. The methodology quality of the systematic reviews and Meta-analysis was evaluated by the AMSTAR scale,and the quality of outcome was evaluated by Grade system. The original trial were extracted to undertake Meta-analysis by Rev Man 5. 3. Results A total of 7 articles were included,and the scores of AMSTAR scale in 41. 86% of articles were above 7. A total of 21 outcomes were included,and the results grading showed that 14 outcomes（ 67. 77%） were graded as lowor very lowquality. The results of 36 trials involving 3 820 cases showed that PPI was more effective than H_2 RA in reducing the risk of stress ulcer bleeding,overt bleeding and clinical important bleeding（ P〈0. 001）;however,there was no significant difference in the incidence of pneumonia,mortality and length of ICU stay（ P〉0. 05）. Conclusion PPI is more effective in preventing stress ulcer bleeding than H_2 RA. Because of the poor quality of the original studies,high quality randomized controlled trials are required to provide reliable evidences.