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高级肠道调节改善便秘患者的肠道准备质量:一项系统评价和网状Meta分析。

Advanced intestinal regulation improves bowel preparation quality in patients with constipation: A systematic review and network meta-analysis.

作者信息

Ding Liang, Duan JinNan, Yang Tao, Jin ChaoQiong, Luo Jun, Ma Ahuo

机构信息

Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.

Department of Infectious Diseases, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.

出版信息

Front Pharmacol. 2023 Jan 24;13:964915. doi: 10.3389/fphar.2022.964915. eCollection 2022.

Abstract

Inadequate bowel preparation (IBP) has a critical influence on the colonoscopy procedure and is associated with significantly lower rates of detection of colorectal lesions. Constipation is an important risk factor of IBP, and some studies have attempted to address the bowel cleansing for constipated patients. However, there is still lack of consensus to guide the clinical work of bowel preparation (BP) for patients with constipation. Therefore, we aimed to perform a network meta-analysis to compare the overall efficacy of various regimens for BP in constipated patients. We performed a comprehensive search of PubMed, MEDLINE, EMBASE, Cochrane, and Web of science to identify randomized controlled trials (RCTs) of bowel preparation regimens in constipated patients, update to January 2021. Two investigators independently evaluated articles and extracted data. The odds ratio (OR) with a 95% confidence interval (CI) was used to combine dichotomous data of the primary outcome which was defined as adequate bowel preparation (ABP). Rank probability was used to exhibit the outcome of the network meta-analysis. Eleven studies that included 1891 constipated patients were identified as suitable for inclusion. The proportion of ABP was associated with the administration of intensive regimen (OR 2.19, 95% CI 1.16-4.17, = .02, I2 = 84%). Moreover, an intensive regimen had a significant efficacy and light heterogeneity when the same basic laxative program was used (OR 4.06, 95% CI 3.04-5.43, < .0001, I2 = 0%). In the network meta-analysis, the protocol of a normal regimen + A (normal regimen plus advanced intestinal regulation) had a significant effect for bowel preparation compared with a normal regimen + IR (normal regimen plus irritating laxative regimen) (OR 5.21, 95% CI 1.18-24.55), H PEG (4L- polyethylene glycol) (OR 8.70, 95% CI 1.75-52.56), and normal regimen (NR) (OR 7.37, 95% CI 2.33-26.39). In the remaining protocols, no significant difference was observed in any comparison. No significant severe adverse events (AEs) associated with bowel preparation were reported in included studies. Intensive regimens could improve bowel cleansing quality for patients with constipation, and advanced intestinal regulation regimens may be superior to others.

摘要

肠道准备不充分(IBP)对结肠镜检查程序有至关重要的影响,且与结直肠病变的检出率显著降低相关。便秘是IBP的一个重要危险因素,一些研究试图解决便秘患者的肠道清洁问题。然而,在指导便秘患者肠道准备(BP)的临床工作方面仍缺乏共识。因此,我们旨在进行一项网状Meta分析,以比较各种BP方案对便秘患者的总体疗效。我们对PubMed、MEDLINE、EMBASE、Cochrane和Web of science进行了全面检索,以确定截至2021年1月的便秘患者肠道准备方案的随机对照试验(RCT)。两名研究人员独立评估文章并提取数据。采用比值比(OR)和95%置信区间(CI)来合并主要结局的二分数据,主要结局定义为充分肠道准备(ABP)。采用排序概率来展示网状Meta分析的结果。11项纳入1891例便秘患者的研究被确定适合纳入。ABP的比例与强化方案的使用相关(OR 2.19,95%CI 1.16 - 4.17,P = 0.02,I² = 84%)。此外,当使用相同的基础泻药方案时,强化方案具有显著疗效且异质性较低(OR 4.06,95%CI 3.04 - 5.43,P < 0.0001,I² = 0%)。在网状Meta分析中,正常方案 + A(正常方案加高级肠道调节)方案与正常方案 + IR(正常方案加刺激性泻药方案)、H PEG(4L - 聚乙二醇)和正常方案(NR)相比,对肠道准备有显著效果(OR 5.21,95%CI 1.18 - 24.55)、(OR 8.70,95%CI 1.75 - 52.56)和(OR 7.37,95%CI 2.33 - 26.39)。在其余方案中,任何比较均未观察到显著差异。纳入研究中未报告与肠道准备相关的显著严重不良事件(AE)。强化方案可改善便秘患者的肠道清洁质量,且高级肠道调节方案可能优于其他方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3a88/9904507/baeba3e221ac/fphar-13-964915-g001.jpg

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