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目的系统评价奥曲肽和垂体后叶素治疗肝硬化上消化道出血的临床疗效及安全性。方法计算机检索国内外比较奥曲肽和垂体后叶素治疗肝硬化上消化道出血的临床疗效及安全性的随机对照试验(RCT)文献。根据改良后的JADAD量表进行评价文献质量,采用Rev Man 5.3.1软件进行Meta分析。结果共纳入73个RCT,相较于垂体后叶素治疗肝硬化上消化道出血,奥曲肽更能显著地升高总有效率(RR=1.31,95%CI:1.27,1.35,P<0.00001),降低开始显效时间(MD=-8.21,95%CI:-12.91,-3.51,P=0.0006),降低止血时间(MD=-10.36,95%CI:-12.72,-8.01,P<0.00001),降低2周内再出血率(RR=0.24,95%CI:0.15,0.40,P<0.00001),降低不良反应RR=0.26,95%CI:0.22,0.31,P<0.00001),病死率(RR=0.23,95%CI:0.09,0.57,P=0.002)。而复发率2组间差异无统计学意义。结论 Meta分析结果显示,奥曲肽治疗肝硬化上消化道出血效果优于垂体后叶素,但鉴于纳入数量有限且文献质量中等,还应采取大规模规范化的多中心RCT论证。
Objective To evaluate the clinical efficacy and safety of octreotide and pituitrin in the treatment of upper gastrointestinal hemorrhage with cirrhosis. Methods The computer-controlled randomized controlled trials (RCTs) were performed to compare the clinical efficacy and safety of octreotide and pituitrin in the treatment of upper gastrointestinal bleeding in cirrhosis at home and abroad. The quality of the literature was evaluated on the basis of the modified JADAD scale and Meta analysis was performed using Rev Man 5.3.1 software. Results A total of 73 RCTs were included. Octreotide significantly increased the total effective rate (RR = 1.31, 95% CI: 1.27, 1.35, P <0.00001) compared with pituitrin in the treatment of cirrhosis and upper gastrointestinal bleeding. (MD = -8.21, 95% CI: -12.91, -3.51, P = 0.0006), decreased the time to stop bleeding (MD = -10.36,95% CI: -12.72, -8.01, P <0.00001) Rebleeding rate within 2 weeks (RR = 0.24, 95% CI: 0.15, 0.40, P <0.00001), adverse reaction RR = 0.26,95% CI: 0.22,0.31, P <0.00001) , 95% CI: 0.09, 0.57, P = 0.002). The recurrence rate was no significant difference between the two groups. Conclusions Meta-analysis showed that octreotide was superior to vasopressin in the treatment of liver cirrhosis with upper gastrointestinal hemorrhage. However, given the limited number of cases and the medium quality of literature, large-scale standardized multi-center RCT should be adopted.