Cheng Jin-Wei, Zhu Liang, Gu Ming-Jun, Song Zhe-Ming
Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
World J Gastroenterol. 2003 Aug;9(8):1836-9. doi: 10.3748/wjg.v9.i8.1836.
To assess the effects of propranolol as compared with placebo on gastrointestinal hemorrhage and total mortality in cirrhotic patients by using meta analysis of 20 published randomized clinical trials.
A meta analysis of published randomized clinical trials was designed. Published articles were selected for study based on a computerized MEDLINE and a manual search of the bibliographies of relevant articles. Data from 20 relevant studies fulfilling the inclusion criteria were retrieved by means of computerized and manual search. The reported data were extracted on the basis of the intention-to-treat principle, and treatment effects were measured as risk differences between propranolol and placebo. Pooled estimates were computed according to a random-effects model. We evaluated the pooled efficacy of propranolol on the risk of gastrointestinal hemorrhage and the total mortality.
A total of 1,859 patients were included in 20 trials, 931 in the propranolol groups and 928 as controls. Among the 652 patients with upper gastrointestinal tract hemorrhage, 261 patients were treated with propranolol, and 396 patients were treated with placebo or non-treated. Pooled risk differences of gastrointestinal hemorrhage were -18 % [95 % CI, -25 %, -10 %] in all trials, -11 % [95 % CI, -21 %, -1 %] in primary prevention trials, and -25 % [95 % CI, -39 %, -10 %] in secondary prevention trials. A total of 440 patients died, 188 in propranolol groups and 252 in control groups. Pooled risk differences of total death were -7 % [95 % CI, -12 %, -3 %] in all trials, -9 % [95 % CI, -18 %, -1 %] in primary prevention trials, and -5 % [95 % CI, -9 %, -1 %] in secondary prevention trials.
Propranolol can markedly reduce the risks of both primary and recurrent gastrointestinal hemorrhage, and also the total mortality.
通过对20项已发表的随机临床试验进行荟萃分析，评估普萘洛尔与安慰剂相比对肝硬化患者胃肠道出血和总死亡率的影响。
设计一项已发表随机临床试验的荟萃分析。基于计算机检索MEDLINE以及手动检索相关文章的参考文献来选择用于研究的已发表文章。通过计算机和手动检索获取了20项符合纳入标准的相关研究的数据。根据意向性分析原则提取报告的数据，并将治疗效果衡量为普萘洛尔与安慰剂之间的风险差异。根据随机效应模型计算合并估计值。我们评估了普萘洛尔对胃肠道出血风险和总死亡率的合并疗效。
20项试验共纳入1859例患者，普萘洛尔组931例，对照组928例。在652例上消化道出血患者中，261例接受普萘洛尔治疗，396例接受安慰剂治疗或未接受治疗。所有试验中胃肠道出血的合并风险差异为-18%[95%可信区间，-25%，-10%]，一级预防试验中为-11%[95%可信区间，-21%，-1%]，二级预防试验中为-25%[95%可信区间，-39%，-10%]。共有440例患者死亡，普萘洛尔组188例，对照组252例。所有试验中总死亡的合并风险差异为-7%[95%可信区间，-12%，-3%]，一级预防试验中为-9%[95%可信区间，-18%，-1%]，二级预防试验中为-5%[95%可信区间，-9%，-1%]。
普萘洛尔可显著降低原发性和复发性胃肠道出血的风险以及总死亡率。
