Cheung Ka-Shing, Mok Chiu-Hang, Lam Lok-Ka, Mao Xian-Hua, Mak Lung-Yi, Seto Wai-Kay, Yuen Man-Fung
Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
J Clin Transl Hepatol. 2023 Oct 28;11(5):1143-1149. doi: 10.14218/JCTH.2022.00130S. Epub 2023 Jun 8.
We aimed to perform a network meta-analysis (NWM) to examine comparative effectiveness of non-selective beta blockers (NSBBs) on prophylaxis of gastroesophageal variceal bleeding (GVB) and mortality benefit.
MEDLINE (OVID) and EMBASE databases were searched for eligible randomized clinical trials (RCTs) from inception to July 3, 2021. Outcomes of interest included primary/secondary prophylaxis of GVB, failure to achieve hepatic venous pressure gradient (HVPG) decremental response, liver-related and all-cause mortality. A Bayesian NWM was performed to derive relative risk (RR) with 95% credible intervals (CrIs). The ranking probability of each NSBB was assessed by surface under cumulative ranking curve (SUCRA).
Thirty-three RCTs including 3,188 cirrhosis patients with gastroesophageal varices were included. Compared with placebo, nadolol ranked first for reducing variceal bleeding [RR:0.25, (95% CrI:0.11-0.51); SUCRA:0.898], followed by carvedilol [RR:0.33, (95% CrI: 0.11-0.88); SUCRA:0.692] and propranolol [RR:0.52, (95% CrI:0.37-0.75); SUCRA:0.405]. Carvedilol was more effective than propranolol in achieving HVPG decremental response [RR:0.43, (95% CrI: 0.26-0.69)]. Carvedilol ranked first for reducing all-cause mortality [RR: 0.32, (95% CrI:0.17-0.57); SUCRA:0.963), followed by nadolol [RR:0.48, (95% CI:0.29-0.77); SUCRA:0.688], and propranolol [RR:0.77, (95% CI:0.58-1.02); SUCRA: 0.337]. Similar findings were observed for liver-related mortality. Carvedilol ranked the safest. The RR of adverse events was 4.38, (95% CrI:0.33-161.4); SUCRA:0.530, followed by propranolol [RR: 7.54, (95% CrI:1.90-47.89); SUCRA:0.360], and nadolol [RR: 18.24, (95% CrI:91.51-390.90); SUCRA:0.158].
Carvedilol is the preferred NSBB with better survival benefit and lower occurrence of adverse events among patients with gastroesophageal varices.
我们旨在进行一项网状Meta分析（NWM），以研究非选择性β受体阻滞剂（NSBBs）预防食管胃静脉曲张出血（GVB）的相对疗效及对死亡率的益处。
检索MEDLINE（OVID）和EMBASE数据库，纳入从数据库建立至2021年7月3日的符合条件的随机临床试验（RCT）。感兴趣的结局包括GVB的一级/二级预防、未能实现肝静脉压力梯度（HVPG）下降反应、肝脏相关死亡率和全因死亡率。进行贝叶斯网状Meta分析以得出相对风险（RR）及95%可信区间（CrIs）。通过累积排名曲线下面积（SUCRA）评估每种NSBB的排名概率。
纳入了33项RCT，共3188例患有食管胃静脉曲张的肝硬化患者。与安慰剂相比，纳多洛尔在减少静脉曲张出血方面排名第一[RR：0.25，（95%CrI：0.11 - 0.51）；SUCRA：0.898]，其次是卡维地洛[RR：0.33，（95%CrI：0.11 - 0.88）；SUCRA：0.692]和普萘洛尔[RR：0.52，（95%CrI：0.37 - 0.75）；SUCRA：0.405]。在实现HVPG下降反应方面，卡维地洛比普萘洛尔更有效[RR：0.43，（95%CrI：0.26 - 0.69）]。卡维地洛在降低全因死亡率方面排名第一[RR：0.32，（95%CrI：0.17 - 0.57）；SUCRA：0.963]，其次是纳多洛尔[RR：0.48，（95%CI：0.29 - 0.77）；SUCRA：0.688]，普萘洛尔[RR：0.77，（95%CI：0.58 - 1.02）；SUCRA：0.337]。肝脏相关死亡率也有类似发现。卡维地洛安全性最高。不良事件的RR为4.38，（95%CrI：0.33 - 161.4）；SUCRA：0.530，其次是普萘洛尔[RR：7.54，（95%CrI：1.90 - 47.89）；SUCRA：0.360]，纳多洛尔[RR：18.24，（95%CrI：91.51 - 390.90）；SUCRA：0.158]。
对于食管胃静脉曲张患者，卡维地洛是首选的NSBB，具有更好的生存获益和更低的不良事件发生率。
