实用肝脏病杂志
實用肝髒病雜誌
실용간장병잡지
JOURNAL OF CLINICAL HEPATOLOGY
2013年
5期
436-438
,共3页
肝硬化%食管静脉曲张%内镜套扎%普萘洛尔%Meta 分析%疗效
肝硬化%食管靜脈麯張%內鏡套扎%普萘洛爾%Meta 分析%療效
간경화%식관정맥곡장%내경투찰%보내락이%Meta 분석%료효
Cirrhosis%Esophageal varices%Endoscopic variceal ligation%Propranolol%Meta-Analysis%Therapeu-tic efficacy
目的比较内镜下套扎术（EVL）和普萘洛尔预防肝硬化食管静脉曲张首次出血的疗效和安全性。方法计算机检索1999至2012年12月31日PubMed、EBMBASE、万方数据库中关于EVL和普萘洛尔预防肝硬化食管静脉曲张首次出血的随机对照试验，同时追索纳入文献的参考文献。使用RevMan 5.1专业Meta分析软件对治疗后首次出血率，出血病死率，总病死率和不良反应发生率进行Meta分析。结果纳入6个随机对照试验，包括EVL组280例和普萘洛尔组301例患者。文献的Cochrane质量评价均为B级，属于较高质量文献。Meta分析结果显示，EVL在预防肝硬化食管静脉曲张患者的首次出血率、出血病死率、总病死率和不良反应发生率分别为16.4%、4.3%、22.5%和25.0%，与普萘洛尔组的21.6%（P=0.07）、6.3%（P=0.27）、20.9%（P=0.56）和31.9%（P=0.33）相比均无显著性差异；漏斗图存在不对称的现象，提示可能存在发表性偏倚；敏感性分析表明纳入研究具有稳定性。结论EVL与普萘洛尔在预防肝硬化食管静脉曲张破裂的效能无显著性差异。
目的比較內鏡下套扎術（EVL）和普萘洛爾預防肝硬化食管靜脈麯張首次齣血的療效和安全性。方法計算機檢索1999至2012年12月31日PubMed、EBMBASE、萬方數據庫中關于EVL和普萘洛爾預防肝硬化食管靜脈麯張首次齣血的隨機對照試驗，同時追索納入文獻的參攷文獻。使用RevMan 5.1專業Meta分析軟件對治療後首次齣血率，齣血病死率，總病死率和不良反應髮生率進行Meta分析。結果納入6箇隨機對照試驗，包括EVL組280例和普萘洛爾組301例患者。文獻的Cochrane質量評價均為B級，屬于較高質量文獻。Meta分析結果顯示，EVL在預防肝硬化食管靜脈麯張患者的首次齣血率、齣血病死率、總病死率和不良反應髮生率分彆為16.4%、4.3%、22.5%和25.0%，與普萘洛爾組的21.6%（P=0.07）、6.3%（P=0.27）、20.9%（P=0.56）和31.9%（P=0.33）相比均無顯著性差異；漏鬥圖存在不對稱的現象，提示可能存在髮錶性偏倚；敏感性分析錶明納入研究具有穩定性。結論EVL與普萘洛爾在預防肝硬化食管靜脈麯張破裂的效能無顯著性差異。
목적비교내경하투찰술（EVL）화보내락이예방간경화식관정맥곡장수차출혈적료효화안전성。방법계산궤검색1999지2012년12월31일PubMed、EBMBASE、만방수거고중관우EVL화보내락이예방간경화식관정맥곡장수차출혈적수궤대조시험，동시추색납입문헌적삼고문헌。사용RevMan 5.1전업Meta분석연건대치료후수차출혈솔，출혈병사솔，총병사솔화불량반응발생솔진행Meta분석。결과납입6개수궤대조시험，포괄EVL조280례화보내락이조301례환자。문헌적Cochrane질량평개균위B급，속우교고질량문헌。Meta분석결과현시，EVL재예방간경화식관정맥곡장환자적수차출혈솔、출혈병사솔、총병사솔화불량반응발생솔분별위16.4%、4.3%、22.5%화25.0%，여보내락이조적21.6%（P=0.07）、6.3%（P=0.27）、20.9%（P=0.56）화31.9%（P=0.33）상비균무현저성차이；루두도존재불대칭적현상，제시가능존재발표성편의；민감성분석표명납입연구구유은정성。결론EVL여보내락이재예방간경화식관정맥곡장파렬적효능무현저성차이。
Objective To compare the efficacy and safety of endoscopic variceal ligation and propranolol administration for primary prophylaxis of variceal bleeding in cirrhotics. Methods We searched randomized con-trolled trials (RCT)data from PubMed,EBMBASE,Wanfang Database and CNKI database (1999 to 31 October, 2012)to compare endoscopic variceal ligation with propranolol administration for primary prophylaxis of variceal bleeding in cirrhotics,and performed a Meta-analysis using the Cochrane Collaboration’s RevMan 5.1 software. Results Six RCT involving 581 patients(variceal banding in 280 and propranolol in 301)with cirrhotics were in-cluded in this study. All included trials had high quality for their grade B Cochrane quality evaluation. No dif-ferences were seen on first variceal bleeding rate (EVL/PPL=16.4%/21.6%,P=0.07),bleeding-related death rate (EVL/PPL=4.3%/6.3%,P=0.27),overall mortality (EVL/PPL=22.5%/20.9%,P=0.56)and adverse events rate(EVL/PPL=25.0%/31.9%,P=0.33)between the two groups;Publication bias was present with asymmetric funnel plot,but included studies remained stable after sensitivity analyses. Conclusion There are no significant differences in first esophageal variceal bleeding,mortality of bleeding,total mortality and adverse events between endoscopic variceal ligation and propranolol for prevention of primary variceal bleeding in cirrhotics.
