三种质子泵抑制剂治疗应激性溃疡出血的网状Meta分析

Meta-Analysis of Three Kinds of Proton Pump Inhibitors in the Treatment of Stress Ulcer Bleeding

目的:系统评价三种质子泵抑制剂治疗应激性溃疡出血的疗效及安全性。方法:检索电子数据库,纳入关于艾司奥美拉唑、泮托拉唑及奥美拉唑治疗应激性溃疡出血的随机对照试验(艾司奥美拉唑、泮托拉唑和奥美拉唑中的任意两种进行比较),采用R3.6.1软件和Stata 12.0 SE软件进行网状Meta分析。结果:共纳入15篇文献,包含应激性溃疡出血患者1 255例。网状Meta分析结果显示,在临床显效率方面,艾司奥美拉唑与泮托拉唑(OR=1.26,90%CI=0.46~3.48)、泮托拉唑与奥美拉唑(OR=1.80,90%CI=0.66~4.87)、艾司奥美拉唑与奥美拉唑(OR=2.27,90%CI=0.80~6.50)之间的差异无统计学意义;在临床总有效率方面,艾司奥美拉唑不优于泮托拉唑(OR=2.42,90%CI=0.91~6.43),泮托拉唑优于奥美拉唑(OR=2.64,90%CI=1.01~6.89),艾司奥美拉唑优于奥美拉唑(OR=6.39,90%CI=2.31~17.67)。安全性方面,艾司奥美拉唑、泮托拉唑和奥美拉唑的不良反应总发生率以及头痛头晕发生率比较,差异均无统计学意义。结论:对于应激性溃疡出血患者,在临床总有效率方面,艾司奥美拉唑不优于泮托拉唑,但艾司奥美拉唑、泮托拉唑均优于奥美拉唑;在临床显效率及安全性方面,三种质子泵抑制剂相似。

OBJECTIVE:To systematically evaluate the efficacy and safety of three kinds of proton pump inhibitors in the treatment of stress ulcer bleeding.METHODS:Databases were electronically searched for randomized controlled trials of esomeprazole,pantoprazole and omeprazole in the treatment of stress ulcer bleeding(any two of esomeprazole,pantoprazole and omeprazole were compared).Network Meta-analysis was performed by using R 3.6.1 and Stata 12.0 SE software.RESULTS:Totally 15 literature were collected,including 1255 cases of stress ulcer bleeding.Network Meta-analysis showed that in terms of clinical efficiency,there were no statistically significant differences between esomeprazole and pantoprazole(OR=1.26,90%CI=0.46-3.48),pantoprazole and omeprazole(OR=1.80,90%CI=0.66-4.87),esomeprazole and omeprazole(OR=2.27,90%CI=0.80-6.50).In terms of total clinical efficiency,esomeprazole was not better than pantoprazole(OR=2.42,90%CI=0.91-6.43),pantoprazole was superior to omeprazole(OR=2.64,90%CI=1.01-6.89),and esomeprazole was better than omeprazole(OR=6.39,90%CI=2.31-17.67).In terms of safety,there were no statistically significant differences in the total incidence of adverse drug reactions and the incidence of headache and dizziness among esomeprazole,pantoprazole and omeprazole.CONCLUSIONS:For patients with stress ulcer bleeding,esomeprazole is not better than pantoprazole in terms of total clinical efficiency,but esomeprazole and pantoprazole are both superior to promeprazole.Yet in terms of clinical efficiency and safety,the three proton pump inhibitors are similar.