Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials.
Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials.
复制标题
特利加压素治疗急性静脉曲张出血：随机对照试验的系统评价和荟萃分析。
DOI：
10.1097/md.0000000000013437
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发表时间：
2018-11
期刊：
影响因子：
1.6
通讯作者：
Qi X
中科院分区：
文献类型：
--
作者：
Zhou X;Tripathi D;Song T;Shao L;Han B;Zhu J;Han D;Liu F;Qi X
补充数字内容可在文本《急性静脉曲张出血 (AVB) 危及生命》中找到。我们的目的是系统地回顾有关特利加压素治疗 AVB 治疗肝硬化的有效性和安全性的现有证据。我们检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库。参考文献列表也是手工检索的。我们使用随机效应模型，结合了根据事件发生的不同时间点获得的数据。计算优势比（OR）和加权平均差（WMD）。证据质量通过 GRADE 方法进行评估。纳入了 30 项随机对照试验，涉及 3344 名患者。与未使用血管活性药物相比，特利加压素显着改善了48小时内出血的控制（OR = 2.94，P = .0008），并降低了院内死亡率（OR = 0.31，P = .008）。与生长抑素相比，特利加压素的并发症风险显着较高（OR = 2.44，P = .04）。与奥曲肽相比，特利加压素在24小时内的出血控制效果明显较差（OR = 0.37，P = .007）。与加压素相比，特利加压素的并发症风险显着降低（OR = 0.15，P = .02）。与特利加压素联合内镜下静脉曲张结扎术相比，单独使用特利加压素的5天治疗失败率（OR = 14.46，P = .01）和49至120小时内的输血需求（WMD = 1.20，P = .002）显着更高。特利加压素和硬化疗法之间的结果没有显着差异。与球囊填塞相比，特利加压素显着降低了30天再出血（OR = 0.05，P = .001）和输血需求（WMD = −2.70，P = .02）。证据质量非常低到中等。我们的研究结果与目前关于特利加压素治疗肝硬化 AVB 的建议一致。然而，由于证据质量低，建议进一步研究。
Supplemental Digital Content is available in the text Acute variceal bleeding (AVB) is life-threatening. We aimed to systematically review the current evidence regarding the efficacy and safety of terlipressin for AVB in liver cirrhosis. We searched the PubMed, EMBASE, and Cochrane Library databases. The reference list was also hand-searched. Using a random-effect model, we combined the data obtained according to the different time points when the events developed. Odds ratio (OR) and weighted mean difference (WMD) were calculated. Quality of evidence was evaluated by the GRADE methodology. Thirty randomized controlled trials with 3344 patients were included. Compared with no vasoactive drug, terlipressin significantly improved the control of bleeding within 48 hours (OR = 2.94, P = .0008) and decreased the in-hospital mortality (OR = 0.31, P = .008). Compared with somatostatin, terlipressin had a significantly higher risk of complications (OR = 2.44, P = .04). Compared with octreotide, terlipressin had a significantly inferior control of bleeding within 24 hours (OR = 0.37, P = .007). Compared with vasopressin, terlipressin had a significantly lower risk of complications (OR = 0.15, P = .02). Compared with terlipressin combined with endoscopic variceal ligation, terlipressin alone had significantly higher 5-day treatment failure (OR = 14.46, P = .01) and transfusion requirements within 49 to 120 hours (WMD = 1.20, P = .002). No outcome was significantly different between terlipressin and sclerotherapy. Compared with balloon tamponade, terlipressin significantly decreased the 30-day rebleeding (OR = 0.05, P = .001) and transfusion requirements (WMD = −2.70, P = .02). Quality of evidence was very low to moderate. Our findings were in accordance with the current recommendations regarding terlipressin for the treatment of AVB in cirrhosis. However, due to low quality of evidence, further studies are recommended.