特利加压素治疗急性静脉曲张出血：随机对照试验的系统评价和荟萃分析
Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials.
作者信息
Zhou Xinmiao, Tripathi Dhiraj, Song Tingxue, Shao Lichun, Han Bing, Zhu Jia, Han Dan, Liu Fufang, Qi Xingshun
机构信息
Meta-Analysis Interest Group & Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area.
Postgraduate College, Jinzhou Medical University, Jinzhou.
出版信息
Medicine (Baltimore). 2018 Nov;97(48):e13437. doi: 10.1097/MD.0000000000013437.
BACKGROUND AND AIM
Acute variceal bleeding (AVB) is life-threatening. We aimed to systematically review the current evidence regarding the efficacy and safety of terlipressin for AVB in liver cirrhosis.
METHODS
We searched the PubMed, EMBASE, and Cochrane Library databases. The reference list was also hand-searched. Using a random-effect model, we combined the data obtained according to the different time points when the events developed. Odds ratio (OR) and weighted mean difference (WMD) were calculated. Quality of evidence was evaluated by the GRADE methodology.
RESULTS
Thirty randomized controlled trials with 3344 patients were included. Compared with no vasoactive drug, terlipressin significantly improved the control of bleeding within 48 hours (OR = 2.94, P = .0008) and decreased the in-hospital mortality (OR = 0.31, P = .008). Compared with somatostatin, terlipressin had a significantly higher risk of complications (OR = 2.44, P = .04). Compared with octreotide, terlipressin had a significantly inferior control of bleeding within 24 hours (OR = 0.37, P = .007). Compared with vasopressin, terlipressin had a significantly lower risk of complications (OR = 0.15, P = .02). Compared with terlipressin combined with endoscopic variceal ligation, terlipressin alone had significantly higher 5-day treatment failure (OR = 14.46, P = .01) and transfusion requirements within 49 to 120 hours (WMD = 1.20, P = .002). No outcome was significantly different between terlipressin and sclerotherapy. Compared with balloon tamponade, terlipressin significantly decreased the 30-day rebleeding (OR = 0.05, P = .001) and transfusion requirements (WMD = -2.70, P = .02). Quality of evidence was very low to moderate.
CONCLUSION
Our findings were in accordance with the current recommendations regarding terlipressin for the treatment of AVB in cirrhosis. However, due to low quality of evidence, further studies are recommended.
背景与目的
急性静脉曲张出血（AVB）危及生命。我们旨在系统评价特利加压素治疗肝硬化患者AVB的有效性和安全性的现有证据。
方法
检索PubMed、EMBASE和Cochrane图书馆数据库。同时手工检索参考文献列表。采用随机效应模型，根据事件发生的不同时间点合并所得数据。计算比值比（OR）和加权平均差（WMD）。采用GRADE方法评估证据质量。
结果
纳入30项随机对照试验，共3344例患者。与未使用血管活性药物相比，特利加压素显著改善48小时内的出血控制（OR = 2.94，P = 0.0008），并降低院内死亡率（OR = 0.31，P = 0.008）。与生长抑素相比，特利加压素的并发症风险显著更高（OR = 2.44，P = 0.04）。与奥曲肽相比，特利加压素在24小时内对出血的控制显著较差（OR = 0.37，P = 0.007）。与血管加压素相比，特利加压素的并发症风险显著更低（OR = 0.15，P = 0.02）。与特利加压素联合内镜下静脉曲张结扎术相比，单独使用特利加压素的5天治疗失败率显著更高（OR = 14.46，P = 0.01），且在49至120小时内的输血需求量更大（WMD = 1.20，P = 0.002）。特利加压素与硬化疗法之间的任何结局均无显著差异。与气囊压迫相比，特利加压素显著降低30天再出血率（OR = 0.05，P = 0.001）和输血需求量（WMD = -2.70，P = 0.02）。证据质量为极低至中等。
结论
我们的研究结果与目前关于特利加压素治疗肝硬化患者AVB的建议一致。然而，由于证据质量较低，建议进一步开展研究。
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