聚乙二醇电解质散联合莫沙必利用于结肠镜检查前肠道准备有效性和安全性的Meta分析

背景　肠道清洁对于结肠镜检查的准确性和安全性有重要意义，部分临床随机对照研究认为聚乙二醇电解质散联合莫沙必利可提高结肠镜前肠道准备的清洁效果和安全性，但此类研究结果不一致且存在一定争议性，有必要对此类研究进行系统评价。目的　旨在系统评价聚乙二醇电解质散联合莫沙必利对比单纯应用聚乙二醇电解质散在肠镜检查前行肠道准备的有效性与安全性。方法　计算机检索中国知网（CNKI）、万方数据知识服务平台、中文科技期刊数据库（VIP）、中国生物医学文献数据库（CMB）、PubMed、EMBase、Cochrane Library等数据库，检索时间为建库到2018年6月，全面收集聚乙二醇电解质散联合莫沙必利用于结肠镜检查前肠道准备的临床随机对照试验。由2名研究人员各自独立完成文献阅读，按照文献纳入、排除标准进行文献筛选、资料提取。采用RevMan 5.3软件进行Meta分析，采用GRADE profiler 3.6软件对Meta分析结局指标进行证据分级。结果　共纳入14篇文献，Meta分析结果显示，在肠道准备有效性方面，两亚组观察组肠道准备有效率均高于对照组〔RR=1.15，95%CI（1.06，1.25），P=0.000 8；RR=1.03，95%CI（1.01，1.06），P=0.02〕；在安全性方面，观察组总不良反应发生率〔RR=0.54，95%CI（0.44，0.67），P<0.000 01〕、恶心发生率〔RR=0.48，95%CI（0.39，0.60），P<0.000 01〕、呕吐发生率〔RR=0.46，95%CI（0.32，0.65），P<0.000 1〕、腹胀发生率〔RR=0.36，95%CI（0.26，0.50），P<0.000 01〕均低于对照组。两组腹痛发生率和息肉检出率比较，差异无统计学意义〔RR=0.79，95%CI（0.58，1.08），P=0.14；RR=0.90，95%CI（0.74，1.10），P=0.32〕。结论　聚乙二醇电解质散联合莫沙必利行肠道准备的有效性和安全性均优于单纯应用聚乙二醇电解质散。在未来需要高质量文献纳入以进一步证实本研究结果。

Meta-analysis of the Efficacy and Safety of Polyethylene Glycol Electrolytes Powder with Mosapride as Bowel Preparation before Colonoscopy

Background　Bowel preparations are of great importance to the accuracy and safety of colonoscopy.Some clinical randomized controlled trials（RCTs） suggest that polyethylene glycol electrolytes powder（PEG-EP） combined with mosapride could improve the cleaning effect and safety of bowel preparation before colonoscopy.However，the results of such studies are inconsistent and controversial.So it is necessary to perform a systematic evaluation of these studies.Objective　 To systematically evaluate the efficacy and safety of PEG-EP with mosapride versus single administration of PEG-EP as bowel preparation before colonoscopy.Methods　All RCTs about PEG-EP with mosapride used for bowel preparation before colonoscopy were searched from databases of CNKI，Wanfang Data，VIP，CBM，PubMed，Cochrane Library，and EMBase from inception to June 2018.The review，screening based on the inclusion and exclusion criteria of this study and data extraction were performed by two researchers separately.RevMan 5.3 was used to conduct the Meta-analysis.GRADE profiler 3.6 was used to classify the outcome of Meta-analysis.Results　A total of 14 RCTs were included.The results of Meta-analysis showed that the rate of effective bowel preparation in the control group was lower than that of two subgroups of the observed group 〔RR=1.15，95%CI（1.06，1.25），P=0.000 8；RR=1.03，95%CI（1.01，1.06），P=0.02〕.In terms of safety，the incidence rates of total adverse reactions 〔RR=0.54，95%CI（0.44，0.67），P<0.000 01〕，nausea 〔RR=0.48，95%CI（0.39，0.60），P<0.000 01〕，vomiting 〔RR=0.46，95%CI（0.32，0.65），P<0.000 1〕，and abdominal distention 〔RR=0.36，95%CI（0.26，0.50），P<0.000 01〕 in observed group were lower than those of the control group.There were no significant differences in the incidence of abdominal pain and the detection rate of polyps between the two groups 〔RR=0.79，95%CI（0.58，1.08），P=0.14；RR=0.90，95%CI（0.74，1.10），P=0.32〕.Conclusion　The efficacy and safety of PEG-EP combined with mosapride are better than those of PEG-EP alone for bowel preparation.However，high-quality studies are needed to confirm the results of this study.