莫沙必利治疗功能性消化不良的系统评价

目的系统评价莫沙必利治疗功能性消化不良(FD)的疗效和安全性。方法电子检索Cochrane图书馆(2006年第2期)、MEDLINE(1978-2006．6)、EMbase(1978-2006．6)、ISI(2000-2006．6)、OVID(1978-2006．6)、中国生物医学文献数据库(1978-2006．6)、维普中刊数据库(1989-2006．6)、中国期刊全文数据库(1994-2006．6)、万方学位论文数据库(1978-2006．6)。手工检索《中华消化杂志》等4种相关中文期刊、相关会议论文集及所有检索到试验的参考文献。纳入莫沙必利治疗FD的所有随机对照试验,并逐个进行质量评价和资料提取。统计学分析采用RevMan4．2．8软件处理。结果共纳入到18个随机对照试验(共2929例)。Meta分析结果显示:(1)总体症状缓解率:莫沙必利优于胃复安[RR 1．66,95％CI(0．82,3．35)]及多潘立酮[RR 1．23,95％CI(1．12,1．34)];(2)单个症状的缓解率:1)上腹胀缓解率:莫沙必利优于多潘立酮[RR 1．35,95％CI(1．14,1．60)],不优于西沙必利[RR 0．95,95％CI(0．78,1．15)];2)餐后饱胀缓解率:莫沙必利优于多潘立酮[RR 2．72,95％CI(2．02,3．66)],不优于西沙必利[RR 0．99,95％CI(0．82,1．1 8)]; 3)上腹痛缓解率:莫沙必利优于多潘立酮[RR 1．27,95％CI(1．07,1．49)],不优于西沙必利[RR 0．94,95％CI(0．75,1．17)];4)早饱缓解率:莫沙必利优于多潘立酮[RR 1．42,95％CI(1．15,1．76)],不优于西沙必利[RR 0．98,95％CI(0．82, 1．1 7)];5)恶心缓解率:莫沙必利不优于西沙必利[RR 1．07,95％CI(0．82, 1．39)]及多潘立酮[RR 1．12,95％CI(0．97,1．28)];6)呕吐缓解率:莫沙必利不优于西沙必利[P=0．80]及多潘立酮[RR 1．02,95％CI(0．87,1．18)];7)嗳气缓解率:莫沙必利优于多潘立酮[RR 1．41,95％CI(1．17,1．70)],不优于西沙必利[RR 0．85,95％CI(0．68,1．05)];8)纳差缓解率:莫沙必利优于多潘立酮[RR 1．22,95％CI(1．20,1．44)],不优于西沙必利[RR 0．88,95％CI(0．64,1．19)];9)反酸缓解率:莫沙必利不优于多潘立酮[P=0．64]及西沙必利[P=0．32];10)烧心缓解率:莫沙必利不优于多潘立酮[RR 0．97,95％CI(0．96,1．10)]及西沙必利[RR 1．05,95％CI(0．90,1．21)];11)上腹不适缓解率:莫沙必利不优于西沙必利[P=0．64];(3)药物不良反应发生率:莫沙必利少于多潘立酮[RR 0．64, 95％CI(0．47,0．85)]。结论现有有限的证据表明:在改善FD患者总体症状方面,莫沙必利优于胃复安、多潘立酮;在改善FD患者单个症状方面:莫沙必利在改善上腹胀、早饱、餐后饱胀、嗳气及纳差症状优于多潘立酮,改善恶心、呕吐、反酸、烧心症状与多潘立酮相似,在改善各种单一症状方面与西沙必利相似。此外,莫沙必利的副作用较少。

Mosapride for Functional Dyspepsia: A Systematic Review

Objective To determine the effectiveness and safety of mosapride in patients with functional dyspepsia. Methods Trials were located through electronic searches of the Cochrane Central Register of Controlled Trails (CENTRAL) (Issue 2, 2006), MEDLINE (1978 to Jun. 2006), EMbase (1978 to Jun.2006), ISI (2000 to Jun.2006), OVID Database (1978 to Jun.2006), Chinese Biological Medicine Database (1978 to Jun.2006), Chinese VIP Database (1994 to Jun.2006) and WANFANG Database ( 1978 to Jun.2006). We also checked the bibliographies of retrieved articles and handsearched four kinds of important journals. Results Total of 18 trials involving 2 929 patients were included in the meta-analyses. These showed: (1) remission rate of global symptoms: Mosapride was not superior to placebo (RR 2.72, 95%CI 0.87 to 8.46), but was superior to metoclopramide (RR 1.66, 95%CI 0.82 to 3.35) and domperidone (RR 1.23, 95%CI 1.12 to 1.34); (2) remission rate of individual symptoms: 1) upper abdominal flatulence: Mosapride was superior to domperidone (RR 1.35, 95%CI 1.14 to 1.60), but was not superior to cisapride (RR 0.95, 95%CI 0.78 to 1.15); 2) postprandial fullness: Mosapride was superior to domperidone (RR 2.72, 95? 2.02 to 3.66), but was not superior to cisapride (RR 0.99, 95%CI 0.82 to 1.18); 3) upper abdominal pain: Mosapride was superior to domperidone (RR 1.27, 95%CI 1.07 to 1.49), but was not superior to cisapride (RR 0.94, 95%CI 0.75 to 1.17); 4) early saciety: Mosapride was superior to domperidone (RR 1.42, 95%CI 1.15 to 1.76), but was not superior to cisapride (RR 0.98, 95%CI 0.82 to 1.17); 5) nausea: Mosapride was not superior to cisapride (RR 1.07, 95%CI 0.82 to 1.39) and domperidone (RR 1.12 ,95%CI 0.97 to 1.28); 6) vomitting: Mosapride was not superior to cisapride (P=0.80) and domperidone (RR 1.02, 95%CI 0.87 to 1.18); 7) eructation: Mosapride was superior to domperidone (RR 1.41, 95%CI 1.17 to 1.70), but was not superior to cisapride (RR 0.85, 95%CI 0.68 to 1.05); 8) anorexia: Mosapride was superior to domperidone (RR 1.22, 95%CI 1.20 to 1.44), but was not superior to cisapride (RR 0.88, 95%CI 0.64 to 1.19); 9) sour regurgitation: Mosapride was not superior to domperidone (P=0.64) and cisapride (P=0.32); 10) heartburn: Mosapride was not superior to domperidone (RR 0.97, 95%CI 0.96 to 1.10) and cisapride (RR 1.05, 95%CI 0.90 to 1.21); 11) upper abdominal discomfort: Mosapride was not superior to cisapride (P =0.64); (3) adverse event rate: Mosapride had a good safety profile. Conclusions The limited current evidence shows that, mosapride is not superior to placebo in relieving global symptoms, but is superior to domperidone in relieving upper abdominal flatulence, postprandial fullness, upper abdominal pain, early saciety, erutation and anorexia. Mosapride has a good safety profile.