内镜下微量射频治疗难治性胃食管反流病疗效的meta分析

doi:10.3877/cma.j.issn.2095-2015.2021.06.008

目的

对内镜下微量射频治疗难治性胃食管反流病（GERD）的疗效进行meta分析。

方法

通过计算机检索Medline、Embase、Cochrane Library、Elsevier、万方数据库、维普数据库及中国知网数据库，收集有关难治性GERD内镜下微量射频治疗疗效的文献，经纳入和排除标准筛选文献，提取入选文献的数据资料，采用RevMan 5.3软件进行meta分析。

结果

共纳入9篇文献，均为队列研究。Meta分析结果显示，内镜下微量射频治疗GERD可以明显降低患者烧心（平均差值-2.21，P<0.000 01）、反流（平均差值-3.85，P<0.000 01）、胸痛（平均差值-2.92，P<0.000 01）、咳嗽（平均差值-3.87，P<0.000 01）、哮喘（平均差值-4.15，P<0.000 01）等症状评分，降低胃食管反流病相关生活质量量表（GERD-HRQL）评分（平均差值-19.84，P<0.000 01），减少质子泵抑制剂（PPI）的使用（99.9% vs 41.2%，P<0.000 01），减轻食管炎（62.3% vs 34.0%，P<0.000 01）。治疗前后患者满意度评分有所提高（平均差值2.46，P<0.000 01），但满意人数差异无统计学意义（20.0% vs 87.9%，P=0.28）。

结论

内镜下微量射频治疗GERD可以明显缓解患者烧心、反流、胸痛、咳嗽、哮喘等症状，提高生活质量，减少PPI使用，减轻食管炎。

关键词: Meta分析, 内镜, 射频, 难治性胃食管反流病

Objective

To determine the efficacy of the endoscopic microradiofrenquency in the treatment of patients with refractory gastroesophageal reflux disease (GERD) using meta-analysis.

Methods

Medline, Embase, Cochrane Library, Elsevier, Wanfang, VIP and CNKI were searched by computer to collect literatures on the efficacy of endoscopic microradiofrenquency for refractory GERD. The literatures were screened by inclusion and exclusion criteria, and the data of the selected literatures were extracted. Meta analysis was performed using RevMan 5.3 software.

Results

A total of 9 studies were enrolled, all of which were cohort studies. The meta-analysis results showed that endoscopic microradiofrenquency could reduce the heartburn (mean difference -2.21, P<0.000 01), regurgitation (mean difference -3.85, P<0.000 01), chest pain (mean difference -2.92, P<0.000 01), cough (mean difference -3.87, P<0.000 01) and asthma score (mean difference -4.15, P<0.000 01). The procedure also reduced GERD-health related quality of life (GERD-HRQL) score (mean difference -19.84, P<0.000 01), the use of proton pump inhibitor (PPI) (99.9% vs 41.2%, P<0.000 01) and esophageal inflammation (62.3% vs 34.0%, P<0.000 01). After treatment, the satisfaction score of patients were improved (mean difference 2.46, P<0.000 01), but the difference in the number of satisfied patients was not statistically significant (20.0% vs 87.9%, P=0.28).

Conclusion

Endoscopic microradiofrenquency can significantly relieve patients' heartburn, regurgitation, chest pain, cough, asthma and other symptoms, improve the quality of life, reduce the use of PPI, and relieve esophageal inflammation.

Key words: Meta-analysis, Endoscope, Radiofrequency, Refractory gastroesophageal reflux disease

表1 纳入文献的基本信息

文献来源	国别	入组人数	性别（男性/女性）	年龄（岁，±s）	食管外症状[例（%）]	随访时间（年）
Noar等^[9]	美国	217	88/129	50.0±14.0	-	10
Liang等^[11]	中国	138	59/79	52.1±13.0	87（63.0）	5
Reymun等^[12]	美国	83	65/18	-	-	4
Hu等^[13]	中国	57	19/39	47.3±13.3	57（100）	3
Liu等^[14]	中国	90	57/33	51.0±13.0	-	1
Liang等^[15]	中国	60	25/35	47.4±10.7	-	3
Mavrelis等^[16]	美国	32	-	-	-	2.5
Noar等^[17]	美国	109	62/47	51.0±13.0	-	4
Viswanath等^[18]	英国	50	15/35	52.3±13.9	15（30）	2.1

表1 纳入文献的基本信息

文献来源	国别	入组人数	性别（男性/女性）	年龄（岁，±s）	食管外症状[例（%）]	随访时间（年）
Noar等^[9]	美国	217	88/129	50.0±14.0	-	10
Liang等^[11]	中国	138	59/79	52.1±13.0	87（63.0）	5
Reymun等^[12]	美国	83	65/18	-	-	4
Hu等^[13]	中国	57	19/39	47.3±13.3	57（100）	3
Liu等^[14]	中国	90	57/33	51.0±13.0	-	1
Liang等^[15]	中国	60	25/35	47.4±10.7	-	3
Mavrelis等^[16]	美国	32	-	-	-	2.5
Noar等^[17]	美国	109	62/47	51.0±13.0	-	4
Viswanath等^[18]	英国	50	15/35	52.3±13.9	15（30）	2.1

表2 纳入文献质量评价（分）

文献来源	对象选择	可比性	结局/暴露	总分
Noar等^[9]	4	2	2	8
Liang等^[11]	4	2	2	8
Reymun等^[12]	4	1	2	7
Hu等^[13]	3	2	2	7
Liu等^[14]	4	2	1	7
Liang等^[15]	4	2	3	8
Mavrelis等^[16]	4	0	2	6
Noar等^[17]	4	2	2	8
Viswanath等^[18]	4	2	2	8

表2 纳入文献质量评价（分）

文献来源	对象选择	可比性	结局/暴露	总分
Noar等^[9]	4	2	2	8
Liang等^[11]	4	2	2	8
Reymun等^[12]	4	1	2	7
Hu等^[13]	3	2	2	7
Liu等^[14]	4	2	1	7
Liang等^[15]	4	2	3	8
Mavrelis等^[16]	4	0	2	6
Noar等^[17]	4	2	2	8
Viswanath等^[18]	4	2	2	8

图1 内镜下微量射频治疗难治性胃食管反流病症状评分的森林图

图2 烧心症状评分倒漏斗图

图3 内镜下微量射频治疗难治性胃食管反流病相关生活质量量表评分的森林图

图4 内镜下微量射频治疗难治性胃食管反流病质子泵抑制剂使用情况的森林图

图5 质子泵抑制剂使用情况倒漏斗图

图6 内镜下微量射频治疗难治性胃食管反流病满意度评分的森林图

图7 内镜下微量射频治疗难治性胃食管反流病满意人数的森林图

图8 内镜下微量射频治疗难治性胃食管反流病食管炎的森林图

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Efficacy of endoscopic microradiofrequency in the treatment of refractory gastroesophageal reflux disease: a meta-analysis

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Efficacy of endoscopic microradiofrequency in the treatment of refractory gastroesophageal reflux disease: a meta-analysis