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目的评价食管静脉曲张套扎术(EVL)和β-受体阻滞剂(BB)预防肝硬化初次静脉破裂出血的有效性和安全性。方法计算机检索Cochrane临床对照试验资料库(2006年第4期)、MEDLINE(1966年至2006年11月)、EMBASE(1985年至2006年11月)和中国期刊全文数据库(1994—2006年),并辅以手工检索有关EVL和BB预防食管静脉曲张初次破裂出血的随机对照临床试验,按Cochrane协作网推荐的方法进行Meta分析。结果共纳入8个随机对照试验(RCT)。Meta分析结果显示,EVL和BB比较,EVL可降低肝硬化初次静脉破裂出血的发生率[相对危险度(RR)=0.63,95%可信区间(CI):0.46~0.85;P=0.003;相对危险度减少(RRR)=0.37,需要治疗的患者数(NNT)为12例]和严重副反应发生率(RR=0.23,95%CI:0.12~0.43;P<0.01;RRR=0.77,NNT为8例);但二者对总病死率的影响差异无显著性意义(RR=1.03,95%CI:0.81~1.31;P=0.82)。结论预防肝硬化初次静脉破裂出血EVL比BB更有效和安全。
Objective To evaluate the efficacy and safety of esophageal variceal ligation (EVL) and β-blocker (BB) in preventing primary venous rupture of liver cirrhosis. Methods The Cochrane Central Register of Controlled Trials (No. 4 of 2006), MEDLINE (1966 to November 2006), EMBASE (from 1985 to November 2006) and Chinese Journal Full-text Database (1994-2006) were searched by computer. Supplemented by manual retrieval of EVL and BB prevention of esophageal varices initial rupture of a randomized controlled clinical trial, according to the Cochrane Collaboration recommended meta-analysis. Results A total of 8 randomized controlled trials (RCTs) were included. Meta-analysis showed that EVL decreased the incidence of primary venous rupture with cirrhosis compared with EVL compared with BB [relative risk (RR) = 0.63, 95% confidence interval (CI): 0.46-0.85; P = 0.003; Risk reduction (RRR) = 0.37, number of patients requiring treatment (NNT), and incidence of serious adverse events (RR = 0.23, 95% CI: 0.12-0.43; P <0.01; RRR = 8 cases). However, there was no significant difference in the overall mortality (RR = 1.03, 95% CI: 0.81-1.31; P = 0.82). Conclusion Prevention of primary venous rupture in liver cirrhosis with EVL is more effective and safe than BB.