高风险水的NSBB,EBL或组合疗法:系统审查和元分析
Sreeram Pannala1, Anjali Byale2, Tan Yu Bin3
1Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA.
概括
与单独使用非选择性β阻塞剂 (NSBB) 或内镜带绑定 (EBL) 相比,联合治疗显著减少高风险的食道静脉出血. 这种方法为水出血提供了更安全的初级预防策略.
科学领域:
- 胃肠病学 胃肠病学
- 肝病学 肝病学是一种肝病学.
- 临床医学 临床医学
背景情况:
- 非选择性β抑制剂 (NSBB) 是高风险食道变节的初级预防的标准.
- 内镜带绑定 (EBL) 通常只适用于不耐受NSBB的患者.
- 需要进一步调查NSBB,EBL和组合治疗的比较有效性.
研究的目的:
- 为了比较NSBB,EBL和联合治疗的临床结果,用于高风险食道静脉的初级预防.
- 评估联合治疗在预防水出血和相关死亡率方面的疗效.
- 为管理高风险食道变节的临床指南提供信息.
主要方法:
- 通过主要数据库 (MedLine,Embase,Cochrane图书馆) 识别的随机对照试验 (RCT) 的系统元分析.
- 纳入标准侧重于比较联合治疗与单独NSBB和单独EBL的研究.
- 用于元分析的随机效应模型,通过I2统计评估异质性.
主要成果:
- 包括6个RCT,涉及1011名参与者 (302个NSBB,300个EBL,409个组合).
- 与单独使用NSBB (RR 0.39) 和单独使用EBL (RR 0.46) 相比,联合疗法显著减少了水出血的第一个发作.
- 组合治疗的血液流出率为9.4%,NSBB为28.2%,EBL为13.9%. 与出血相关的死亡率在联合治疗中也较低.
结论:
- 结合疗法在高度瘤的初级预防中表现出卓越的疗效,显著降低了瘤出血风险.
- 这些发现支持将组合疗法纳入临床实践和未来指导方针.
- 结合疗法提供了一个比单独的NSBB或EBL更有效的策略,用于预防食道的水出血.
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