Szilagyi A, Shrier I
Department of Medicine, Division of Gastroenterology, The Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.
Aliment Pharmacol Ther. 2001 Dec;15(12):1889-97. doi: 10.1046/j.1365-2036.2001.01114.x.
Somatostatin and octreotide have multiple effects which make them ideal for treating diarrhoea of different aetiologies. Their use in a variety of conditions with refractory diarrhoea, however, is based on a limited number of studies.
We undertook a systematic review of the available English literature to maximize an evidence-based approach to the treatment of refractory diarrhoea. We tested the hypothesis that efficacy is independent of aetiology.
A Medline and individual article search from 1965 to 2000 was undertaken on the use of somatostatin and octreotide in diarrhoea. All reports containing at least five subjects were included. The percentage response in case series and randomized controlled trials was compared, and a meta-analysis of randomized controlled trials where patient level data were provided was carried out. There were 30 publications found (18 case series, 12 randomized controlled trials). The response percentage was 73% overall in case series and 64% in randomized controlled trials (not significant). A meta-analysis of nine randomized controlled trials revealed significant heterogeneity despite an overall relative risk of 0.5 (95% confidence interval, 0.27-0.91). Subgroup analysis of the largest aetiological groups showed that acquired immunodeficiency syndrome studies were homogeneous, but somatostatin and octreotide were less effective. Post-chemotherapy studies remained heterogeneous and somatostatin and octreotide were highly effective.
While this review strengthens the consensus guidelines on the use of somatostatin and octreotide for refractory diarrhoea, evidence-based support requires additional studies.
生长抑素和奥曲肽具有多种作用，使其成为治疗不同病因腹泻的理想药物。然而，它们在多种难治性腹泻病症中的应用基于数量有限的研究。
我们对现有的英文文献进行了系统综述，以最大限度地采用循证方法治疗难治性腹泻。我们检验了疗效与病因无关的假设。
对1965年至2000年期间使用生长抑素和奥曲肽治疗腹泻的文献进行了Medline检索和单篇文章搜索。纳入所有至少包含5名受试者的报告。比较了病例系列和随机对照试验中的反应百分比，并对提供患者水平数据的随机对照试验进行了荟萃分析。共找到30篇出版物（18个病例系列，12个随机对照试验）。病例系列中的总体反应百分比为73%，随机对照试验中的为64%（无显著性差异）。对9个随机对照试验的荟萃分析显示，尽管总体相对风险为0.5（95%置信区间，0.27 - 0.91），但仍存在显著异质性。对最大病因组的亚组分析表明，获得性免疫缺陷综合征研究具有同质性，但生长抑素和奥曲肽的效果较差。化疗后研究仍存在异质性，生长抑素和奥曲肽非常有效。
虽然本综述加强了关于使用生长抑素和奥曲肽治疗难治性腹泻的共识指南，但循证支持还需要更多研究。
