奥美拉唑预防卒中后应激性溃疡出血疗效的Meta分析

Preventive Effects of Omeprazole Against Stress Ulcer Bleeding for Post-stroke Patients: A Meta Analysis

目的系统评价奥美拉唑预防卒中后患者应激性溃疡出血(stress ulceration and bleeding,SUB)的疗效,及其与H_2受体阻滞剂(histamine-2 receptor antagonists,H_2RA)疗效的对比。方法计算机检索Cochrane、Pub Med、Embase、CNKI、Wan Fang和VIP。纳入奥美拉唑预防卒中后SUB的随机对照试验,对纳入的研究采用Rev Man 5.2软件进行Meta分析。结果共纳入17个随机对照试验(1739例患者)。Meta分析结果显示:预防性使用奥美拉唑能降低卒中后SUB的发生率[比值比(odds ratio,OR)0.1,95%可信区间(confidence interval,CI)0.06~0.14,P<0.00001];奥美拉唑降低卒中后患者SUB的发生率效果优于H_2RA(OR 0.24,95%CI 0.15~0.38,P<0.00001);奥美拉唑可降低卒中后患者的病死率(OR 0.17,95%CI 0.09~0.33,P<0.00001)。结论现有证据表明,预防性使用奥美拉唑,能降低卒中后患者SUB的发生率与病死率,且其效果优于H_2RA。

Objective To evaluate the preventive effects of omeprazole against stress ulcer bleeding（USB）for post-stroke patients,and compare their effectiveness between Histamine-2 receptor antagonists（H_2RA）.Methods Cochrane,Pud Med,Embase,CNKI,Wang Fang and VIP were searched systematically.Case-control studies of omeprazole protects against SUB for post stroke patients were included,and the articles were performed Meta analysis by Rev Man 5.2 software.Results A total of 17 case-control studies（1739 cases）were included.The results of meta-analysis were as followed：Prophylactic use of omeprazole could decrease the incidence of SUB for post-stoke patients[odds ratio（OR）0.01,95%confidence interval（CI）0.06-0.14,P〈0.00001];and the treatment effectives of USB with omeprazole was better than H_2RA（OR 0.24,95%CI 0.15-0.38,P〈0.00001）.The use of omeprazole could decrease the mortality of post-stroke patients（OR 0.17,95%CI 0.09-0.33,P〈0.0001）.Conclusion Evidence indicates that prophylactic use of omeprazole can decrease the incidence of SUB and mortality among post-stoke patients,and the effectiveness is better than H_2RA.