1 Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Otolaryngol Head Neck Surg. 2019 Jan;160(1):22-35. doi: 10.1177/0194599818797316. Epub 2018 Sep 11.
The aim of this study (PROSPERO ID: CRD42017081952) was to evaluate medical treatment for epistaxis from hereditary hemorrhagic telangiectasia (HHT).
PubMed, Embase, Scopus, and Cochrane Library databases were interrogated from their inceptions to November 2017.
Randomized clinical trials comparing medical treatment with placebo for epistaxis of HHT were included. We used a random-effects model to synthesize overall effects. Heterogeneity was evaluated with the I statistic.
Eight studies were identified after systematic searching. The use of bevacizumab (BV), tranexamic acid, and estrogen, regardless of the route of administration, had no significant influence on frequency of episodes. Tamoxifen was superior to placebo in both frequency and severity of epistaxis. For duration of epistaxis, nasal spray BV, oral or nasal spray tranexamic acid, and nasal spray estrogen had no significant differences versus placebo, but patients receiving submucosal BV showed lower duration of epistaxis (mean difference: -219.00 min/mo, 95% CI: -271.90 to -166.10). Medical treatment for HHT had no significant changes of mean hemoglobin concentration (pooled mean difference: -0.23 mg/dL, 95% CI: -0.65 to 0.20, I = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: -0.16 to 0.30, I = 0%).
Only limited evidence provides a benefit on frequency of epistaxis by treatment with tamoxifen and duration of epistaxis by treatment with submucosal BV among patients with HHT. Mean hemoglobin concentration and quality of life were not influenced by medical treatment.
本研究（PROSPERO 注册号：CRD42017081952）旨在评估遗传性出血性毛细血管扩张症（HHT）所致鼻出血的治疗方法。
从建库至 2017 年 11 月，检索了 PubMed、Embase、Scopus 和 Cochrane Library 数据库。
纳入比较 HHT 鼻出血药物治疗与安慰剂的随机临床试验。我们使用随机效应模型综合总体效果。采用 I2 统计量评估异质性。
系统检索后共确定 8 项研究。贝伐单抗（BV）、氨甲环酸和雌激素无论给药途径如何，对发作频率均无显著影响。与安慰剂相比，他莫昔芬在鼻出血的发作频率和严重程度方面均更优。在鼻出血持续时间方面，BV 鼻喷剂、口服或鼻喷氨甲环酸、雌二醇鼻喷剂与安慰剂相比均无显著差异，但接受黏膜下 BV 治疗的患者鼻出血持续时间更短（平均差：-219.00 分钟/月，95%CI：-271.90 至-166.10）。HHT 的药物治疗对平均血红蛋白浓度（合并均数差：-0.23mg/dL，95%CI：-0.65 至 0.20，I2=0%）或生活质量（合并标准化均数差：0.07，95%CI：-0.16 至 0.30，I2=0%）均无显著影响。
在 HHT 患者中，仅有限的证据表明他莫昔芬治疗可改善鼻出血发作频率，黏膜下 BV 治疗可缩短鼻出血持续时间。药物治疗对平均血红蛋白浓度和生活质量无影响。
