Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T
Service d'Hépato-Gastroentérologie, Hôpital Pitié-Salpêtrière, Paris, France.
Hepatology. 1997 Jan;25(1):63-70. doi: 10.1053/jhep.1997.v25.pm0008985266.
A meta-analysis of 12 selected randomized trials was performed to assess the efficacy of beta-blockers in the prevention of rebleeding and the effect on long-term survival in patients with cirrhosis. Five end points were assessed: rebleeding, variceal rebleeding, death, death from bleeding, and adverse events. Analyses were performed according to the intention-to-treat method. For each end point, heterogeneity and treatment efficacy were assessed by the Der Simonian and Peto methods. When a significant difference was observed, sensitivity analyses were performed by successive stratifications according to treatment duration, cause of initial bleeding, use of placebo, type of beta-blocker, type of publication, certainty of randomization, severity of cirrhosis, interval between index bleed and randomization, and methodological quality. Beta-blockers significantly increased the mean percentage of patients free of rebleeding (21% mean improvement rate, CI 95%: 10%-32%, P < .001, relative risk 1.42), the mean percentage of patients free of variceal rebleeding (20% mean improvement rate, CI 95%: 11%-28%, P < .001), the mean survival rate (5.4% mean improvement rate, CI 95%: 0%-11%, P = .05, relative risk 1.27), the mean percentage of patients free of bleeding death (7.4%, CI 95%: 2%-13%, P < .01, relative risk 1.50). Five patients would need to be treated with beta-blockers to prevent one rebleeding episode, 14 treated to prevent one death, and 13 treated to prevent one death from bleeding. There was no significant heterogeneity among studies by both methods of analysis. In patients with esophageal varices, beta-blockers significantly increase the mean percentage of patients free of rebleeding and the mean survival rate at 2 years.
对12项选定的随机试验进行了荟萃分析，以评估β受体阻滞剂在预防肝硬化患者再出血方面的疗效及其对长期生存的影响。评估了五个终点：再出血、静脉曲张再出血、死亡、出血性死亡和不良事件。根据意向性治疗方法进行分析。对于每个终点，采用Der Simonian和Peto方法评估异质性和治疗效果。当观察到显著差异时，根据治疗持续时间、初始出血原因、安慰剂使用情况、β受体阻滞剂类型、出版物类型、随机化确定性、肝硬化严重程度、指数出血与随机化之间的间隔以及方法学质量进行连续分层，进行敏感性分析。β受体阻滞剂显著提高了无再出血患者的平均百分比（平均改善率21%，95%置信区间：10%-32%，P<.001，相对风险1.42）、无静脉曲张再出血患者的平均百分比（平均改善率20%，95%置信区间：11%-28%，P<.001）、平均生存率（平均改善率5.4%，95%置信区间：0%-11%，P=.05，相对风险1.27）、无出血性死亡患者的平均百分比（7.4%，95%置信区间：2%-13%，P<.01，相对风险1.50）。需要5名患者接受β受体阻滞剂治疗以预防一次再出血事件，14名接受治疗以预防一次死亡，13名接受治疗以预防一次出血性死亡。两种分析方法在研究之间均未发现显著异质性。在食管静脉曲张患者中，β受体阻滞剂显著提高了无再出血患者的平均百分比和2年时的平均生存率。
