内镜下套扎术联合β―受体阻滞剂预防肝硬化食管静脉曲张再出血Meta分析.docVIP

内镜下套扎术联合β―受体阻滞剂预防肝硬化食管静脉曲张再出血Meta分析 　　[摘要] 目的 评价食管静脉曲张套扎术（EVL）联合β-受体阻滞剂与单独套扎术对肝硬化食管静脉破裂再出血二级预防的疗效。 方法 计算机检索Cochrane library、Pubmed、Ovid、Embase，中国生物医学文献数据库（CBM）及中国期刊全文数据库（CNKI），检索时间从建库至2014年8月，并辅以手工检索有关EVL和β-受体阻滞剂预防食管静脉曲张破裂再出血的随机对照临床试验（RCT），按Cochrane协作网推荐的方法，采用Revman 5.2.5版软件进行Meta分析。 结果 共纳入7篇文献，共计600例患者，其中试验组301例，对照组299例。试验组使用EVL联合β-受体阻滞剂治疗，对照组单独使用EVL治疗。Meta分析结果显示，试验组与对照组比较，试验组可明显降低肝硬化食管静脉曲张破裂再出血的发生率[OR = 0.29，95%CI（0.16，0.54），P 0.0001]；随访期内两组总病死率比较差异无统计学意义[OR = 0.67，95%CI：（0.43，1.06），P = 0.09]。同时，再出血发生率及总病死率的漏斗图均比较对称，说明存在发生偏倚的可能性较小。 结论 EVL联合β-受体阻滞剂预防肝硬化食管静脉曲张再出血疗效优于单独采用EVL治疗。 　　[关键词] 肝硬化；食管静脉曲张破裂再出血；食管静脉曲张套扎术；β-受体阻滞剂；Meta分析 　　[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-7210（2015）01（b）-0074-05 　　[Abstract] Objective To evaluate the prophylactic efficacy of endoscopic variceal ligation （EVL） with β-blockers and EVL alone in decreasing the rate of secondary esophageal variceal bleeding in patients with cirrhosis. Methods Cochrane library， Pubmed， Ovid， Embase， CMB and CNKI Database from database foundation to August 2014 were searched by computer and the related journals to identify randomized controlled trials （RCT） about EVL with β-blockers and EVL alone for prevention of secondary variceal bleeding in cirrhotic patients were searched by hand. Meta-analysis was conducted by using Revman 5.2.5 software recommended by the Cochrane Collaboration. Results Seven RCTs were included. Among all 600 patients involved in， 301 patients were in the test group， while the other 299 patients were in the control group. The results of Meta-analysis showed a significant reduction in the test group in the rate of secondary variceal hemorrhage [OR = 0.29， 95%CI （0.16， 0.54）， P 0.0001]. But there was no statistically significant difference in the total mortalities between the two groups [OR = 0.67， 95%CI： （0.43， 1.06）， P = 0.09]. The funnel plots drawn according to the data on the rates of secondary variceal hemorrhage and the total mortalities in the two groups all showed symmetrical r