论文部分内容阅读
本研究旨在系统评价促动力药联合质子泵抑制剂与单独质子泵抑制剂治疗胃食管反流疾病的疗效,为临床用药提供循证参考.通过检索PubMed和Embase英文数据库,收集促动力药联合质子泵抑制剂与单独使用质子泵抑制剂治疗胃食管反流疾病的随机对照研究,采用RevMan 5.3偏倚风险评分工具对纳入研究进行质量评估并按预先设定的数据收集表提取相关资料.使用RevMan 5.3和Stata 12.0统计软件进行分析,连续变量采用均差(Mean difference,MD)表示,分类变量采用相对比(Relative ratio,RR)表示.共纳入13个随机对照研究1388例患者,Meta分析结果显示:与质子泵抑制剂单药治疗相比,联合促动力药显著提高总有效率(RR= 1.15,95％CI:(1.07,-1.24),P＜0.001),胃食管反流问卷GERD-Q评分(MD =-1.38,95％CI:(-2.12,-0.64),P＜0.001),胃食管反流症状频率量表FSSG评分(MD = 2.11,95％CI:(1.68,2.54),P＜0.001)和直观模拟评分(MD =-0.69,95％CI:(-0.93,-0.45),P＜0.001),具有显著统计学差异.而两组内镜响应(RR = 1.08,95％CI:(0.99,1.18),P= 0.10)和症状响应(RR= 1.22,95％CI:(0.94,1.59),P = 0.13)比较无显著统计学差异.因此,对于胃食管反流患者,联合促动力药能明显提高总有效率(内镜响应和/或症状响应)及生活质量评分,但不能改善单独的内镜响应或症状响应.但考虑到本文纳入研究样本量较小,且合并一些混杂因素,因此期待大样本高质量的随机对照研究验证本文观点.“,”In the present study,we aimed to systematically evaluate the efficacy of the combination therapy of prokinetics and proton pump inhibitors(PPIs)in patients with gastroesophageal reflux disease(GERD),and to provide an evidence-based reference for clinical use.The pertinent randomized controlled trials(RCTs)were retrieved from PubMed and Embase.The quality of included studies was evaluated using the“risk of bias”tool for RCTs using the RevMan 5.3.Related data were extracted according to the preset data collection forms.Meta-analysis was performed using RevMan 5.3 and Stata 12.0 statistical software.Mean difference(MD)was used to describe the continuous variables,and relative ratio(RR)was used for classification variables.A total of 13 RCTs involving 1388 patients were included.Results of the meta-analysis showed that compared with PPI monotherapy,the combination therapy significantly improved the total response rate(RR =1.15,95％confidence interval(CI):(1.07,-1.24),P＜0.001),gastroesophageal reflux disease questionnaire(GERD-Q)score(MD =-1.38,95％CI:(-2.12,-0.64),P＜0.001),the frequency scale for the symptoms of gastroesophageal reflux(FSSG)score(MD = 2.11,95％CI:(1.68,2.54),P＜0.001)and visual analogue scale(MD =-0.69,95％CI:(-0.93,-0.45),P＜0.001).However,the endoscopic response(RR = 1.08,95％CI:(0.99,1.18),P = 0.10)and symptomatic response(RR = 1.22,95％CI:(0.94,1.59),P = 0.13)were not significantly different between the two groups.For patients with GERD,the combination therapy could markedly improve the total response rate(symptomatic response and/or endoscopic response)and quality of life,while no benefits were found in symptomatic and endoscopic response.In view of the small number of participants included and some confounding factors in this study,the conclusion made in this study needs to be further confirmed by including a large number of participants and performing high-quality RCTs.