奥曲肽联合常规治疗用于缓解恶性肠梗阻有效性与安全性的Meta分析

Efficacy and Safety of Octreotide Combined with Conventional Therapy in Alleviating MBO:a Meta-analysis

目的:系统评价奥曲肽联合常规治疗用于缓解恶性肠梗阻(MBO)的有效性和安全性,旨在为临床用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国期刊全文数据库、万方数据库、谷歌学术,收集奥曲肽联合常规治疗(试验组)对比常规治疗(对照组)用于缓解MBO的随机对照试验(RCT)。筛选文献、提取数据后采用Cochrane系统评价员手册5.1.0偏倚风险评估工具对纳入文献质量进行评价,采用Rev Man 5.3软件进行Meta分析。结果:共纳入13项RCT,共计850例患者。Meta分析结果显示,试验组患者的总有效率显著高于对照组[OR=5.30,95%CI(3.47,8.10),P<0.00001];亚组分析结果显示,试验组单次给药患者[OR=6.88,95%CI(3.22,4.68),P<0.00001]和持续给药患者[OR=4.60,95%CI(2.76,7.68),P<0.00001]的总有效率均显著高于对照组。试验组患者的腹胀缓解时间[MD=-3.92,95%CI(-4.15,-3.70),P<0.00001]、腹痛缓解时间[MD=-3.37,95%CI(-3.61,-3.14),P<0.00001]、恶心呕吐缓解时间[MD=-2.46,95%CI(-2.81,-2.21),P<0.00001]、排气缓解时间[MD=-2.88,95%CI(-3.31,-2.46),P<0.00001]均显著短于对照组。排气缓解时间的亚组分析结果显示,试验组单次给药患者[MD=-2.90,95%CI(-3.48,-2.32),P<0.00001]和持续给药患者[MD=-2.71,95%CI(-3.14,-2.29),P<0.00001]的排气缓解时间均显著短于对照组。试验组患者治疗后胃肠减压量(P<0.005)、不良反应发生率[OR=0.28,95%CI(0.13,0.62),P=0.001]均显著低于对照组。结论:奥曲肽联合常规治疗用于缓解MBO的疗效和安全性均较好。

OBJECTIVE:To systematically evaluate the efficacy and safety of octreotide combined with conventional therapy in alleviating malignant bowel obstruction(MBO),and provide evidence-based reference for clinical medication.METHODS:Retrieved from Cochrane Library,PubMed,Embase,CNKI,Wanfang database and Google academic,RCTs about octreotide combined with conventional therapy(trial group)vs.conventional therapy(control group)for relieving MBO were collected.After literature screening,data extraction and quality evaluation with Cochrane system evaluator manual 5.0 risk evaluation tool,Meta-analysis was conducted by using Rev Man 5.3 statistical software.RESULTS:A total of 13 items of RCT were included,with a total of 850 patients.Meta-analysis results showed that total response rate of trial group was significantly higher than control group[OR=5.30,95%CI(3.47,8.10),P<0.00001].Results of subgroup analysis showed that total response rate of single administration patients[OR=6.88,95%CI(3.22,4.68),P<0.00001]and continuous administration patients[OR=4.60,95%CI(2.76,7.68),P<0.00001]in trial group were significantly higher than control group.The abdominal distension relief time[MD=-3.92,95% CI(-4.15,-3.70),P<0.00001],abdominal pain relief time[MD=-3.37,95%CI(-3.61,-3.14),P<0.00001],nausea and vomiting relief time[MD=-2.46,95%CI(-2.81,-2.21),P<0.00001]and exhaust relief time[MD=-2.88,95%CI(-3.31,-2.46),P<0.00001]in trial group were significantly shorter than control group.Subgroup analysis of exhaust relief time showed that exhaust relief time of single administration patients[MD=-2.90,95%CI(-3.48,-2.32),P<0.00001]and continuous administration patients[MD=-2.71,95%CI(-3.14,-2.29),P<0.00001]in trial group were significantly shorter than control group.After treatment,the gastrointestinal decompression volume(P<0.05)and the incidence of ADR[OR=0.28,95%CI(0.13,0.62),P=0.001]in trial group were significantly lower than in control group.CONCLUSIONS:Octreotide combined with conventional treatment is safe and effective in alleviating MBO.