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中华消化病与影像杂志(电子版) ›› 2017, Vol. 07 ›› Issue (03) : 118 -124. doi: 10.3877/cma.j.issn.2095-2015.2017.03.006

所属专题： 文献；

循证医学

内镜下套扎与口服β受体阻滞剂对预防初次食管胃底静脉曲张破裂出血的Meat分析
张伟1, 田昭涛1, 崔云亮1,†()   
  1. 1. 250012　济南军区总医院重症医学科
  • 收稿日期:2017-04-21 出版日期:2017-06-01
  • 通信作者: 崔云亮

Endoscopic varices ligation vs. β-blocker for primary prophylaxis of varices bleeding: a Meta-analysis

Wei Zhang1, Zhaotao Tian1, Yunliang Cui1,†()   

  1. 1. Department of Critical Care Medicine, Jinan Military General Hospital, Jinan 250031, China
  • Received:2017-04-21 Published:2017-06-01
  • Corresponding author: Yunliang Cui
  • About author:
    Corresponding author: Cui Yunliang, Email:
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张伟, 田昭涛, 崔云亮. 内镜下套扎与口服β受体阻滞剂对预防初次食管胃底静脉曲张破裂出血的Meat分析[J]. 中华消化病与影像杂志(电子版), 2017, 07(03): 118-124.

Wei Zhang, Zhaotao Tian, Yunliang Cui. Endoscopic varices ligation vs. β-blocker for primary prophylaxis of varices bleeding: a Meta-analysis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2017, 07(03): 118-124.

目的

比较内镜下食管胃底静脉曲张套扎术(endoscopic varices ligation，VEL)与口服β受体阻滞剂对预防初次静脉曲张破裂出血的效果。

方法

检索Pubmed/Medicine、中国生物医学文献服务系统等数据库，已发表关于静脉曲张行套扎术与口服β受体阻滞剂对预防静脉曲张初次出血的临床随机对照研究，检索时间限制到2016年4月。由2位作者对检索文献进行数据提取、质量评价，运用Stata 12.0软件对数据进行统计分析。

结果

共检索文献545篇，纳入14篇，样本量1 441例，结果显示荟萃分析静脉曲张套扎术与普萘洛尔和卡维地洛在预防曲张静脉首次出血率、出血病死率、总死亡率及不良反应方面分别为：套扎术vs.普萘洛尔首次出血率RR＝0.78(95% CI 0.59～1.03)，I2＝11%，P＝0.34；套扎术vs.卡维地洛首次出血率RR＝1.54(95% CI 0.69～3.42)，I2＝38.8%，P＝0.20，套扎术vs.普萘洛尔出血死亡率RR＝0.83(95% CI 0.52～1.34)，I2＝0，P＝0.954；套扎术vs.卡维地洛出血死亡率RR＝0.84(95% CI 0.29～2.46)，I2＝0，P＝0.770，套扎术vs.普萘洛尔总死亡率RR＝1.08(95% CI 0.88～1.32)，I2＝0，P＝0.837；套扎术vs.卡维地洛总死亡率RR＝0.91(95% CI 0.58～1.42)，I2＝25.2%，P＝0.248；套扎术vs.β受体阻滞剂不良反应发生率RR＝1.19(95% CI 0.81～1.77)，I2＝87.3%，P＝0。

结论

食管胃底静脉曲张患者行套扎术治疗与口服β受体阻滞剂方面在首次出血率、出血病死率、总死亡率及不良反应方面均无明显差异，但考虑到患者依从性、医疗负担等方面，临床建议口服β受体阻滞剂预防静脉曲张首次出血。

关键词: 食管和胃静脉曲张, 套扎术, β受体阻滞剂, 普萘洛尔, 卡维地洛, 预防
Objective

To evaluate the efficacy of endoscopic varices ligation(EVL)andβ-blocker for prophylaxis of oesophageal-gastric varices bleeding.

Methods

PubMed/Medicine, Chinese biomedical literature service system and other databases were searched for relevant clinical randomized controlled trials about EVL andβ-blocker for prophylaxis of oesophageal-gastric varices bleeding published before April 2016.Two authors independently assessed study quality and extracted data.Stata12.0 software was used to statistically analyze the data.

Results

Fourteen studies including 1 441 cases were included.This Meta-analysis results were as follows: bleeding rate for the first time: EVL vs.propranolol(RR=0.78, 95% CI: 0.59-1.03, I2=11%, P=0.34), EVL vs.carvedilol(RR=1.54, 95% CI: 0.69-3.42, I2=38.8%, P=0.20); bleeding related mortality: EVL vs.propranolol(RR=0.83, 95% CI: 0.52-1.34, I2=0%, P=0.954), EVL vs.carvedilol(RR=0.84, 95% CI: 0.29-2.46, I2=0%, P=0.770); total mortality: EVL vs.propranolol(RR=1.08, 95% CI: 0.88-1.32, I2=0%, P=0.837), EVL vs.carvedilol(RR=0.91, 95% CI: 0.58-1.42, I2=25.2%, P=0.248); adverse effects rate: EVL vs.β-blocker(RR=1.19, 95% CI: 0.81-1.77, I2=87.3%, P=0).

Conclusions

There are no significant differences on preventing for the primary varices bleeding in first bleeding rate, bleeding related mortality, total mortality and adverse effects rate between EVL andβ-blocker.But considering the cost and compliance, we recommend the best choice for preventing on the primary bleeding isβ-blocker.

Key words: Esophageal and gastric varices, Endoscopic varices ligation, β-receptor blocker, Propranolol, Carvedilol, Prevention
图1 EVL组与PPL和CAR组比较预防静脉曲张首次出血率的比较
图2 不同地区分布人群EVL组与β-受体阻滞剂组比较预防静脉曲张首次出血率的比较
图3 EVL组与PPL和CAR组比较预防静脉曲张出血相关死亡率的比较
图4 EVL组与PPL和CAR组比较预防静脉曲张出血总死亡率的比较
图5 EVL组与β-受体阻滞剂组比较预防静脉曲张出血不良反应的比较
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