雷贝拉唑治疗反流性食管炎疗效及安全性的Meta分析

Efficacy and safety of rabeprazole in the treatment of reflux esophagitis: a Meta-analysis

目的系统评价雷贝拉唑与奥美拉唑治疗反流性食管炎(reflux esophagitis,RE)的疗效及安全性,为临床合理用药提供参考。方法检索收集中国知网、万方数据、维普网、中国生物医学数据库、PubMed、Cochrane Library、Web of science、Embase从建库至2020年12月31日的数据,纳入以雷贝拉唑对比奥美拉唑治疗反流性食管炎的随机对照试验(randomized controlled trial,RCT),提取所需数据,使用RevMan5.3进行分析。结果共有15篇RCT,1607名患者被纳入研究。Meta分析结果显示,雷贝拉唑治疗RE的总有效率高于奥美拉唑[OR=4.46,95%CI(3.01~6.59),P<0.001];雷贝拉唑组治疗4周和8周后的总有效率优于奥美拉唑组[OR=3.10,95%CI(1.63~5.90),P<0.001];[OR=5.41,95%CI(3.29~8.91),P<0.001],差异具有统计学意义;内镜下评估雷贝拉唑治疗RE的效果较奥美拉唑更显著,差异有统计学意义[OR=0.36,95%CI(0.22~0.59),P<0.001]。此外,雷贝拉唑组不良反应的发生率低于奥美拉唑组[OR=0.32,95%CI(0.18,0.56),P<0.001],安全性较高。结论雷贝拉唑治疗RE的效果较奥美拉唑显著,且不良反应发生率较低,但奥美拉唑更为便宜。临床医生可在考虑安全性、有效性的基础上,结合药品的经济性和患者意愿,为患者选择合适的药品。

Objective To systematically evaluate the efficacy and safety of rabeprazole versus omeprazole in the treatment of reflux esophagitis(RE) and to provide reference for clinical rational drug use. Methods The databases of CNKI,Wanfang Data, CQVIP、PubMed, Cochrane Library, Web of Science and Embase were searched for related articles published from inception to December 3, 2020. Randomized controlled trials(RCT) with rabeprazole versus omeprazole in the treatment of RE were included, and the data needed was retrieved and analyzed using RevMan5.3. Results Fifteen RCTs were included in the study, involving a total of 1 607 patients. Meta-analysis results showed that the total effective rate of rabeprazole in the treatment of RE was higher than that of omeprazole[OR=4.46, 95%CI(3.01~6.59),P<0.001]. Subgroup analysis showed that the total effective rate after 4 weeks and 8 weeks of treatment was higher in the experimental group than in the control group [OR=3.10, 95%CI(1.63~5.90), P<0.001];[OR=5.41, 95%CI(3.29~8.91),P<0.001]. Endoscopy suggested that rabeprazole was more effective than omeprazole, and the difference was statistically significant [OR=0.36, 95%CI(0.22~0.59), P<0.001]. In addition, the incidence of adverse reactions in the rabeprazole group was lower than that of the omeprazole group [OR=0.32,95%CI(0.18,0.56), P<0.001]. Conclusion Rabeprazole is more effective in the treatment of RE than omeprazole, and the incidence of adverse reactions is lower, but omeprazole is cheaper. Clinicians can select appropriate drugs for patients on the basis of safety, effectiveness and cost of drugs.