Terlipressin for the treatment of acute variceal bleeding
Terlipressin for the treatment of acute variceal bleeding
复制标题
特利加压素治疗急性静脉曲张出血
作者：
Xinmiao Zhou;D. Tripathi;Tingxue Song;Lichun Shao;B. Han;Jia Zhu;Dan Han;Fufang Liu;X. Qi
背景和目的：急性静脉曲张出血（AVB）是危及生命的。我们的目的是系统地回顾目前关于特利加压素治疗肝硬化AVB的有效性和安全性的证据。方法：我们检索PubMed、EMBASE和科克伦图书馆数据库。参考文献清单也是手工搜索的。使用随机效应模型，我们根据事件发展的不同时间点合并了获得的数据。计算比值比（OR）和加权平均差（WMD）。通过GRADE方法评价证据质量。结果：共纳入30个随机对照试验，共3344例患者。与无血管活性药物相比，特利加压素显著改善了48小时内出血控制（OR = 2.94，P =.0008），降低了住院死亡率（OR = 0.31，P =.008）。 与生长抑素相比，特利加压素的并发症风险显著更高（OR = 2.44，P = 0.04）。 与奥曲肽相比，特利加压素在24小时内对出血的控制明显较差（OR = 0.37，P = 0.007）。 与加压素相比，特利加压素的并发症风险显著降低（OR = 0.15，P = 0.02）。 与特利加压素联合内镜下静脉曲张结扎术相比，特利加压素单独治疗的5天治疗失败率（OR = 14.46，P = 0.01）和49至120小时内的输血需求（WMD = 1.20，P = 0.002）显著较高。 特利加压素和硬化剂治疗的结果无显著差异。与球囊填塞相比，特利加压素显著降低了30天再出血（OR = 0.05，P =.001）和输血需求（WMD =-2.70，P =.02）。 证据质量为非常低至中等。结论：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。但是，由于证据质量低，建议进一步研究。
Background and aim: 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. Methods: 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. Results: 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. Conclusion: 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.