Imperiale T F, Teran J C, McCullough A J
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Gastroenterology. 1995 Oct;109(4):1289-94. doi: 10.1016/0016-5085(95)90590-1.
BACKGROUND & AIMS: Although sclerotherapy is the current standard therapy for bleeding esophageal varices, the best method for initial control is unclear. The aim of this meta-analysis was to compare the efficacy and toxicity of somatostatin and vasopressin in short-term treatment of hemorrhage from esophageal varices.
Using MEDLINE, all randomized trials comparing somatostatin with vasopressin in subjects with endoscopically documented acute esophageal variceal bleeding were identified. The quality of each study was critically and independently evaluated, and quantitative data for initial cessation of bleeding, sustained control of bleeding, and major adverse effects were abstracted. The relative risk (RR) and number needed to be treated were calculated.
The RR or likelihood of achieving initial control of bleeding with somatostatin vs. vasopressin was 1.62 (95% confidence interval [CI], 1.37-1.93), and the number needed to be treated was 3.7, i.e., between 3 and 4 patients would have to be treated with somatostatin for 1 patient to derive additional benefit over vasopressin. For trials that measured sustained control of bleeding, somatostatin was superior to vasopressin (RR, 1.28 [95% CI, 1.00-1.65]; number needed to be treated, 8.8). The risk of adverse effects was greater for subjects given vasopressin (10% vs. 0%; P = 0.00007).
This meta-analysis suggests that somatostatin is more efficacious in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin.
尽管硬化疗法是目前治疗食管静脉曲张出血的标准疗法，但初始控制的最佳方法尚不清楚。本荟萃分析的目的是比较生长抑素和血管加压素在食管静脉曲张出血短期治疗中的疗效和毒性。
利用医学文献数据库（MEDLINE），确定所有在内镜检查证实为急性食管静脉曲张出血的受试者中比较生长抑素与血管加压素的随机试验。对每项研究的质量进行严格且独立的评估，并提取关于出血初始停止、出血持续控制和主要不良反应的定量数据。计算相对风险（RR）和需治疗人数。
生长抑素与血管加压素相比实现出血初始控制的RR或可能性为1.62（95%置信区间[CI]，1.37 - 1.93），需治疗人数为3.7，即使用生长抑素治疗3至4名患者，其中1名患者相对于使用血管加压素会获得额外益处。对于测量出血持续控制的试验，生长抑素优于血管加压素（RR，1.28[95%CI，1.00 - 1.65]；需治疗人数，8.8）。接受血管加压素治疗的受试者出现不良反应的风险更高（10%对0%；P = 0.00007）。
本荟萃分析表明，生长抑素在控制食管静脉曲张急性出血方面更有效，且与血管加压素相比不良反应风险更低。
