Wei Chunhui
Otolaryngology-Head Neck Surgery, Beijing Friendship Hospital Attached of Capital Medical University, No. 95, Yongan Road, Xicheng Road, Beijing, 100050, China.
Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3795-3801. doi: 10.1007/s00405-016-4142-y. Epub 2016 Jun 16.
We aimed to systematically review the randomized controlled trials (RCTs) regarding the therapeutic efficiency of proton pump inhibitor (PPI) therapy for laryngopharyngeal reflux (LPR). Randomized and placebo-controlled trials regarding the therapeutic efficacy of PPIs on LPR patients were systematically searched from MEDLINE, Cochrane Library, and EMBASE. Data were extracted from eligible studies meeting the inclusion criteria. Heterogeneity among these eligible studies was evaluated by the Q-statistic and I test, based on which a fixed- or random-effects model was performed to pooled relative risks (RRs) for the response rate and standardized mean differences (SMDs) for reflux symptom index (RSI) and the reflux finding score (RFS). Potential publication bias was evaluated by trim and fill method. Totally, 13 RCTs including 831 LPR patients were eligible for this meta-analysis. Pooled results demonstrated that the total RSI significantly improved for patients who received PPI therapy by comparing with those receiving placebo (SMD = 3.65; 95 % CI 1.56-5.75), though no significant difference was found in response rate (RR = 0.04, 95 % CI -0.06 to 0.14) and RFS (SMD = 0.91; 95 % CI -0.53 to 2.35) between these two groups of patients. No publication bias was found among eligible studies. PPI treatment could significantly improve reflux symptoms in LPR patients and, therefore, should be taken into consideration for LPR management with other strategies, such as lifestyle modification.
我们旨在系统评价质子泵抑制剂（PPI）治疗喉咽反流（LPR）的疗效的随机对照试验（RCT）。从MEDLINE、Cochrane图书馆和EMBASE中系统检索关于PPI对LPR患者治疗效果的随机和安慰剂对照试验。从符合纳入标准的合格研究中提取数据。通过Q统计量和I²检验评估这些合格研究之间的异质性，在此基础上采用固定效应或随机效应模型对缓解率的合并相对风险（RRs）以及反流症状指数（RSI）和反流发现评分（RFS）的标准化平均差（SMDs）进行汇总。通过修剪和填充法评估潜在的发表偏倚。共有13项RCT（包括831例LPR患者）符合本荟萃分析的条件。汇总结果表明，与接受安慰剂的患者相比，接受PPI治疗的患者的总RSI有显著改善（SMD = 3.65；95%CI 1.56 - 5.75），尽管两组患者在缓解率（RR = 0.04，95%CI -0.06至0.14）和RFS（SMD = 0.91；95%CI -0.53至2.35）方面未发现显著差异。在合格研究中未发现发表偏倚。PPI治疗可显著改善LPR患者的反流症状，因此，在LPR管理中应与其他策略（如生活方式改变）一起考虑使用。
