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4种蛇毒血凝酶联合质子泵抑制剂用于非静脉曲张上消化道出血疗效和安全性的网状Meta分析
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| 篇名： | 4种蛇毒血凝酶联合质子泵抑制剂用于非静脉曲张上消化道出血疗效和安全性的网状Meta分析 |
| TITLE： | Efficacy and safety of 4 kinds of hemocoagulases combined with proton pump inhibitor for nonvariceal upper gastrointestinal bleeding：a network meta-analysis |
| 摘要： | 目的 系统评价4种临床常用蛇毒血凝酶联合质子泵抑制剂（PPI）在非静脉曲张性上消化道出血（NVUGIB）治疗中止血效果及安全性的差异，为临床决策提供循证依据。方法计算机检索PubMed、WebofScience、万方数据、维普网、中国知网数据库中关于白眉蛇毒血凝酶、尖吻蝮蛇血凝酶、蛇毒血凝酶、矛头蝮蛇血凝酶联合PPI治疗NVUGIB的随机对照试验（RCT）或队列研究，检索时间为建库起至2021年12月；由2位研究人员独立筛选文献、提取资料并评价纳入文献质量后，运用ADDIS1.16.8软件进行贝叶斯网状Meta分析。结果共纳入33项研究，共计3602例患者。网状Meta分析结果显示：在止血有效率方面，与PPI单药治疗比较，4种蛇毒血凝酶类止血药物联合PPI均可显著提高患者的止血有效率（P＜0.05）；但不同蛇毒血凝酶类止血药物两两比较，差异均无统计学意义（P＞0.05）；网状Meta分析的最佳概率排序为白眉蛇毒血凝酶联合PPI＞矛头蝮蛇血凝酶联合PPI＞尖吻蝮蛇血凝酶联合PPI＞蛇毒血凝酶联合PPI＞PPI单药治疗。在不良反应发生率方面，与PPI单药治疗比较，4种不同蛇毒血凝酶类止血药物联合PPI治疗的不良反应发生率差异无统计学意义（P＞0.05），且不同蛇毒血凝酶类止血药物两两比较，差异亦无统计学意义（P＞0.05）；网状Meta分析的最佳概率排序为蛇毒血凝酶联合PPI＞矛头蝮蛇血凝酶联合PPI＞白眉蛇毒血凝酶联合PPI＞尖吻蝮蛇血凝酶联合PPI＞PPI单药治疗。结论与PPI单药治疗相比，4种不同来源的蛇毒血凝酶类止血药物联合PPI用于NVUGIB的疗效更佳，且安全性相当；不同蛇毒血凝酶类止血药物的止血效果、安全性无明显差异。 |
| ABSTRACT： | OBJECTIVE To systematically evaluate the difference of efficacy and safety of four kinds of commonly used haemocoagulases combined with proton pump inhibitor （PPI） for nonvariceal upper gastrointestinal bleeding （NVUGIB）， and to provide evidence-based basis for clinical decision-making. METHODS Retrieved from PubMed， Web of Science， Wanfang data， VIP and CNKI databases， randomized controlled trials （RCTs） or cohort studies about Hemocoagulase agkistrodon blomhoffii， Haemocoagulase agkistrodon， hemocoagulase and Hemocoagulase bothrops atrox combined with PPI were collected during the inception to Dec. 2021. Two researchers independently screened the literature， extracted data and evaluated the quality of included studies. ADDIS 1.16.8 software was used to conduct a Bayesian network meta-analysis. RESULTS A total of 33 studies were included， involving 3 602 patients. Results of network meta-analysis showed that： in terms of hemostatic efficacy， compared with PPI monotherapy， four kinds of haemocoagulases combined with PPI could significantly improve the hemostatic efficacy of patients （P＜0.05）； there was no statistical significance in the pairwise comparison of different hemocoagulases （P＞0.05）. The optimal probabilistic ranking of network meta-analysis was as follows： Hemocoagulase agkistrodon blomhoffii combined with PPI＞ Hemocoagulase bothrops atrox combined with PPI＞Haemocoagulase agkistrodon combined with PPI＞hemocoagulase combined with PPI＞PPI alone. In terms of the incidence of adverse drug reactions （ADR）， compared with PPI monotherapy， there was no statistical difference in the incidence of ADR among four kinds of haemocoagulases combined with PPI （P＞0.05）. There was no statistical significance in the pairwise 88325750。E-mail：fengyufei@126.com comparison of different hemocoagulases （P＞0.05）. The optimal probabilistic ranking of network meta-analysis was as follows： hemocoagulase combined with PPI＞Hemocoagulase bothrops atrox combined with PPI＞Hemocoagulase agkistrodon blomhoffii combined with PPI＞Haemocoagulase agkistrodon combined with PPI＞PPI alone. CONCLUSIONS Compared with PPI monotherapy， four different sources of hemocoagulases combined with PPI have better efficacy and similar safety in the treatment of NVUGIB. There is no significant difference in efficacy and safety among different hemocoagulases. |
| 期刊： | 2023年第34卷第05期 |
| 作者： | 邵千航；刘雪梅；黄琳；封宇飞 |
| AUTHORS： | SHAO Qianhang，LIU Xuemei，HUANG Lin，FENG Yufei |
| 关键字： | 蛇毒血凝酶类止血药物；非静脉曲张上消化道出血；临床疗效；安全性；网状Meta分析 |
| KEYWORDS： | hemocoagulase； nonvariceal upper gastrointestinal bleeding； clinical efficacy； safety； network meta-analysis |
| 阅读数： | 164 次 |
| 本月下载数： | 5 次 |
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