内镜套扎术与套扎联合药物预防食管静脉曲张破裂再出血疗效比较的Meta分析

目的:分析比较内镜套扎术(EVL)与EVL联合非选择性β受体阻滞剂在食管静脉曲张破裂出血二级预防中的疗效。方法:运用Meta分析检索与EVL和EVL联合药物预防食管静脉曲张破裂再出血相关的临床随机对照试验(RCT)。选用Jadad评分≥3分的文献,以RevMan 5.0软件进行相关指标OR值及其95%可信区间(CI)分析,绘制漏斗图判断有无发表偏倚。结果:符合标准的RCT文献共3篇,病例总数270例,随访时间为16-21个月。EVL与EVL联合药物应用后再发出血率(OR=0.29,95%CI=0.16-0.54;P<0.01)、明确是食管静脉曲张破裂再出血率(OR=0.36,95%CI=0.18-0.97;P<0.01)、治疗相关的不良事件(OR=3.69,95%CI=1.54-8.82;P<0.01),上述比较差异有统计学意义;总死亡率(OR=0.56,95%CI=0.30-1.06;P>0.05)、出血死亡率(OR=0.45,95%CI=0.16-1.30;P>0.05)则无统计学意义,但相对于EVL组,EVL联合药物组的死亡率要低。漏斗图显示对称性较低,提示可能存在一定的发表偏倚。结论:EVL联合药物治疗可比EVL明显的降低再出血率,虽然两组的总死亡率无明显差异,但相对于EVL组,EVL联合药物组的死亡率要低,故EVL联合药物可作为预防食管静脉曲张破裂再出血的首选治疗方案。

Endoscopic Variceal Ligation (EVL) Versus EVL Plus Drug in Prevention of Esophageal Variceal Rebleeding: A Meta-Analysis

Objective: To compare the therapeutic effect of endoscopic variceal ligation(EVL) and EVL plus drug in prevention of esophageal variceal rebleeding.Methods: Randomized clinical trials(RCTs) on EVL and EVL plus drug for the prevention of esophageal variceal rebleeding were searched,and only the results with Jadad score higher than 3 were evaluated with RevMan 5.0 software for odds ratio(OR) with 95% confidence intervals(95% CI).The publication bias was investigated with funnel plots.Results: Three trials matched the criteria were recruited including 270 cases with a follow-up from 16 to 21 months.There was significant difference in rates of rebleeding(OR = 0.29,95% CI = 0.16-0.54;P < 0.01),rebleeding due to esophageal varices(OR = 0.36,95% CI = 0.18-0.97;P < 0.01),therapy related adverse effects(OR = 3.69,95% CI = 1.54-8.82;P < 0.01) between EVL and EVL plus drug; there was no significant difference in rates of overall mortality(OR = 0.56,95% CI = 0.30-1.06;P > 0. 05) and rebleeding related mortality(OR = 0.45,95% CI = 0.16-1.30;P > 0.05) between the two groups.Symmetric funnel plots showed there may be publication bias.Conclusion: EVL plus medicine shows higher efficacy for the prevention of esophageal variceal rebleeding than EVL.Though there was no significant difference in overall mortality,there is a trend towards lower bleeding-related mortality and overall mortality in EVL plus drug therapy.Thus EVL plus drug therapy can be used as the first choice for prophylaxis of re-bleeding of esophageal varices.