He Y, Chan E W, Leung W K, Anand S, Wong I C K
Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong.
Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Aliment Pharmacol Ther. 2015 Jun;41(12):1246-55. doi: 10.1111/apt.13211. Epub 2015 Apr 21.
Due to their potential anti-platelet effect, it is suggested that calcium channel blockers (CCBs) are associated with gastrointestinal bleeding (GIB). However, results from previous studies are conflicting.
To conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies to clarify the association between CCBs and GIB.
We conducted a systematic search of PubMed, EMBASE, Cochrane library and Trial Register databases up to January 2015. Studies that evaluated exposure to CCBs reporting GIB outcomes were included in the meta-analysis. The inverse variance method with random effects model was used to calculate the pooled estimates.
Seventeen studies (four RCTs, eleven case-control and two cohort studies) were included in the meta-analysis. The summary risk ratio (RR) for GIB was 1.17 (95% CI 1.01-1.36) for CCB users vs. non-users. Subgroup analysis showed that CCB use was associated with a moderately higher risk of lower GIB (RR = 1.83, 95% CI 1.17-2.84) but not upper GIB. However, data from four RCTs did not support association between CCBs and GIB (RR = 0.93, 95% CI 0.82-1.05). Subgroup analyses further showed that the increased risk of GIB among CCB users was only observed in studies that failed to adjust for prior history of GIB (RR = 1.67, 95% CI 1.34-2.08) or use of anti-ulcer drugs (RR = 1.40, 95% CI 1.19-1.65).
Our meta-analysis showed a marginal association between calcium channel blocker use and the risk of gastrointestinal bleeding. This association is of dubious clinical significance, as the effects of different comparators or adjustment for confounding factors render this association nonsignificant.
由于钙通道阻滞剂（CCB）具有潜在的抗血小板作用，有人提出其与胃肠道出血（GIB）有关。然而，既往研究结果相互矛盾。
对随机对照试验（RCT）和观察性研究进行系统评价和荟萃分析，以阐明CCB与GIB之间的关联。
我们对截至2015年1月的PubMed、EMBASE、Cochrane图书馆和试验注册数据库进行了系统检索。纳入报告GIB结局的评估CCB暴露情况的研究进行荟萃分析。采用随机效应模型的逆方差法计算合并估计值。
荟萃分析纳入了17项研究（4项RCT、11项病例对照研究和2项队列研究）。CCB使用者与非使用者相比，GIB的汇总风险比（RR）为1.17（95%CI 1.01 - 1.36）。亚组分析显示，使用CCB与较低部位GIB风险适度升高相关（RR = 1.83，95%CI 1.17 - 2.84），但与较高部位GIB无关。然而，4项RCT的数据不支持CCB与GIB之间存在关联（RR = 0.93，95%CI 0.82 - 1.05）。亚组分析进一步显示，仅在未对GIB既往史进行校正（RR = 1.67，95%CI 1.34 - 2.08）或未使用抗溃疡药物（RR = 1.40，95%CI 1.19 - 1.65）的研究中观察到CCB使用者中GIB风险增加。
我们的荟萃分析显示，使用钙通道阻滞剂与胃肠道出血风险之间存在微弱关联。这种关联的临床意义存疑，因为不同比较组的效应或对混杂因素的校正使这种关联无统计学意义。
