标准剂量和双倍剂量质子泵抑制剂对中到重度反流性食管炎内镜治愈率的网状Meta分析

摘要

目的 系统评价标准剂量和高剂量质子泵抑制剂对中到重度反流性食管炎的有效性,为临床合理用药提供科学依据.方法 计算机检索PubMed、Embase、CENTRAL、CBM、CNKI、WanFang Data,收集标准剂量和双倍剂量PPI治疗中到重度反流性食管炎随机对照试验(RCT),检索时限从建库至2016年6月14日,同时追溯纳入研究的参考文献.由两名研究者根据纳入和排除标准独立进行文献筛选、资料提取、质量评价并交叉核对后,采用RevMan 5.3和Stata 14.0软件以内镜治愈率为结局指标进行统计分析.结果 最终纳入20篇文献,21个RCT,共8 277例患者,涉及7种不同治疗方法,治疗周期均为8周.网状Meta分析共产生11个直接比较和10个间接比较,其中4个比较有统计学意义.埃索美拉唑40 mg比兰索拉唑30 mg、泮托拉唑40 mg、奥美拉唑20 mg显示出更好的治疗效果[OR=1.65,95％ CI(1.22,2.24);OR=1.71,95％ CI(1.16,2.52);OR=1.87,95％ CI(1.37,2.55)].疗效排序为:埃索美拉唑40 mg、右兰索拉唑60 mg、泮托拉唑80 mg、奥美拉唑40 mg、兰索拉唑30 mg、泮托拉唑40 mg、奥美拉唑20 mg.结论 标准剂量质子泵抑制剂中,埃索美拉唑优于兰索拉唑、泮托拉唑和奥美拉唑.基于现有研究的局限性,埃索美拉唑40 mg与右兰索拉唑60 mg和其他双倍剂量质子泵抑制剂的效果比较需要进一步研究.%Objective To compare the effectiveness of standard and double dose of proton pump inhibitors (PPIs) for moderate to severe reflux esophagitis and to offer a scientific basis for rational use of drug in clinical practice.Methods We electronically searched databases,including PubMed,Embase,CENTRAL,CBM,CNKI and WanFang Data from their establishment date to June 14,2016,to collect randomized controlled trials about standard and double dose of PPIs for moderate to severe reflux esophagitis.Relevant references were searched manually at the same time.Two reviewers independently screened literatures,extracted data,evaluated quality and cross checked according to strict inclusive and exclusive criteria.Meta-analysis of healing rate conformed by endoscope was conducted using RevMan 5.3 and Stata 14.0 software.Results A total of 20 RCTs involving 8 277 patients receiving 8 weeks of treatment were included,in which 7 different doses of PPIs were investigated.Network Meta-analysis yielded 11 direct and 10 indirect comparisons,among which 4 were demonstrated statistically significant.The healing rate of esomeprazole (40 mg) was higher than lansoprazole (30 mg),pantoprazole (40 mg) and omeprazole (20 mg):odds ratios OR =1.65,95％ CI(1.22,2.24);OR =1.71,95 ％ CI(1.16,2.52);OR =1.87,95 ％ CI(1.37,2.55) respectively.The results of efficacy from high to low were esomeprazole (40 mg),dexlansoprazole (60 mg),pantoprazole (80 mg),omeprazole (40 mg),lansoprazole (30 mg),pantoprazole (40 mg) and omeprazole (20 mg).Conclusion For standard dose of PPIs,the effectiveness of esomeprazole is better than lansoprazole,pantoprazole and omeprazole.Due to the limitation of the present studies,the effectiveness comparison of esomeprazole (40 mg) with dexlansoprazole (60 mg) and other PPIs of double dose needs further investigation.