中国循证医学杂志

中国循证医学杂志

铝碳酸镁治疗反流性食管炎的 Meta 分析

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目的系统评价铝碳酸镁治疗反流性食管炎(reflux esophagitis,RE)的有效性和安全性。方法计算机检索 CBM、CNKI、WanFang Data、VIP、PubMed、EMbase、The Cochrane Library、Web of Science 和 Scopus 数据库,搜集单用或联用铝碳酸镁治疗 RE 的随机对照试验(RCT),检索时限均从建库至 2017 年 6 月 30 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 15 个 RCT,包括 1 655 例患者。Meta 分析结果显示:治疗 4~8 周后,单用铝碳酸镁与质子泵抑制剂(proton pump inhibitors,PPI)相比,两组内镜下有效率的差异无统计学意义[RR=0.87,95%CI(0.76,1.00),P=0.05]。但联合应用铝碳酸镁与 PPI 在内镜下有效率[RR=1.22,95%CI(1.14,1.31),P<0.001]和症状缓解率[RR=1.36,95%CI(1.12,1.66),P<0.01]方面较单用 PPI 显著提高,差异均有统计学意义。在难治性 RE 人群中,铝碳酸镁与 PPI 联合用药亦显著提高了内镜下有效率[RR=1.16,95%CI(1.08,1.25),P<0.001]与 8 周症状缓解率[RR=1.12,95%CI(1.04,1.20),P<0.01]。此外,单用铝碳酸镁或与 PPI 联用均未增加不良反应发生率。结论联合应用铝碳酸镁与 PPI 治疗 RE 的内镜下有效率及症状缓解率均优于单独应用 PPI,且不增加不良反应发生率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

ObjectivesTo systematically review the efficacy and safety of hydrotalcite in the treatment of reflux esophagitis (RE).MethodsCBM, CNKI, WanFang Data, VIP, PubMed, EMbase, The Cochrane Library, Web of Science and Scopus databases were searched online to collect randomized clinical trials (RCTs) of hydrotalcite or hydrotalcite plus PPI versus PPI alone in the treatment of RE from inception to June 30th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 655 patients were included. The results of meta-analysis showed that: after 4-8 weeks of treatment, there was no significant difference between hydrotalcite vs. PPI regarding RE healing rates (RR=0.87, 95%CI 0.76 to 1.00, P=0.05). However, there were significant increases in RE healing rate (RR=1.22, 95%CI 1.14 to 1.31, P<0.001) and symptom relief rate (RR=1.36, 95%CI 1.12 to 1.66,P<0.01) between hydrotalcite plus PPIvs. PPI alone. Similar increases of RE healing rate (RR=1.16, 95%CI 1.08 to 1.25, P<0.001) and symptom relief rate (RR=1.12, 95%CI 1.04 to 1.20,P<0.01) were seen in patients with refractory RE. No increase of adverse effect rate was shown with hydrotalcite or hydrotalcite plus PPI compared to PPI alone.ConclusionsCompared with PPI alone, hydrotalcite plus PPI confers a statistically significant improvement of healing rate and symptom relief rate, while it does not increase adverse effect rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关键词: 胃食管反流病; 反流性食管炎; 铝碳酸镁; 质子泵抑制剂; Meta 分析; 系统评价; 随机对照试验

Key words: Gastroesophageal reflux disease; Reflux esophagitis; Hydrotalcite; Proton pump inhibitors; Meta-analysis; Systematic review; Randomized clinical trial

引用本文: 杜玄凌, 徐琦坪, 潘独伊, 周继, 陈世耀. 铝碳酸镁治疗反流性食管炎的 Meta 分析. 中国循证医学杂志, 2018, 18(9): 924-930. doi: 10.7507/1672-2531.201805111 复制

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