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泮托拉唑与奥美拉唑治疗十二指肠溃疡的系统评价

Systematic Review of the Efficacy and Safety of Pantoprazole and Omeprazole in Treatment of Duodenal Ulcer

DOI：

中文关键词: 泮托拉唑奥美拉唑十二指肠溃疡药物经济学 Meta分析随机对照试验

英文关键词:Pantoprazole Omeprazole Duodenal ulcer Pharmacoeconomics Meta analysis Randomized controlled trial

基金项目:

作者	单位
许亚李国栋朱颖朱晓筱	徐州市中心医院药剂科江苏徐州 221009

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中文摘要:

摘要目的：系统评价泮托拉唑与奥美拉唑治疗十二指肠溃疡的有效性、安全性及经济性。方法：计算机检索PubMed、the Cochrane Library、CNKI、WanFang Data、VIP、SinoMed数据库，收集关于泮托拉唑与奥美拉唑治疗十二指肠溃疡的随机对照试验（RCTs），检索时限均为2006~2017年，由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.2软件对文献统计的数据进行Meta分析，并选择决策树模型进行成本效果分析。 结果：纳入11个RCTs，共计1 116例患者，Meta分析结果显示，泮托拉唑的2周溃疡治愈率优于奥美拉唑[OR=2.60，95%CI（1.17，5.78），P=0.02]，两种药物4周的溃疡治愈率相当[OR=1.41，95%CI（0.69，2.88），P=0.34]，泮托拉唑的腹痛消失时间要短于奥美拉唑[SMD=-0.74，95%CI（-0.89，-0.59），P<0.05]；与奥美拉唑比较，泮托拉唑的3 d后疼痛消失率更能有效低缓解十二指肠溃疡的疼痛症状[OR=2.04，95%CI（1.09，3.84），P=0.03]；泮托拉唑不良反应发生率与奥美拉唑相当[OR=0.50，95%CI（0.24~1.02，P=0.06]；但按经济学结果可见奥美拉唑较泮托拉唑更具优势。结论：当前证据表明，泮托拉唑与奥美拉唑治疗十二指肠溃疡的溃疡治愈基本相当；腹痛缓解、疼痛症状消失泮托拉唑更优；泮托拉唑的安全性与奥美拉唑相当，泮托拉唑的治疗费用高于奥美拉唑，对于肝肾功能不全患者禁止使用；选用何种药物可根据患者实际情况进行选择。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。

英文摘要:

ABSTRACT Objective: To evaluate the efficacy, safety and economy of pantoprazole and omeprazole in treating duodenal ulcer. Methods:PubMed, the Cochrane Library, CNKI, WanFang Data, VIP and SinoMed were electronically searched to collect randomized controlled trials (RCTs) of pantoprazole and omeprazole for duodenal ulcers from 2006 to 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta analysis was performed by RevMan 5.2 software, and the decision tree model was selected for cost benefit analysis. Results:A total of 11 RCTs involving 1 116 patients were included. The results of Meta analysis showed that pantoprazole had a better cure rate for 2 week ulcers than omeprazole (OR=2.60, 95%CI 1.17 to 5.78, P=0.02), and two drugs had a similar cure rate for 4 weeks (OR=1.41, 95%CI 0.69 to 2.88, P=0.34), pantoprazole’s abdominal pain loss time was shorter than omeprazole (SMD=-0.74, 95%CI -0.89 to -0.59, P<0.05); the pain disappearance rate of pantoprazole after 3 days was more effective in relieving the pain symptoms of duodenal ulcer (OR=2.04, 95%CI 1.09 to 3.84, P=0.03), which was more effective than omeprazole; the incidence of adverse reactions showed that pantoprazole had adverse reactions (OR=0.50, 95%CI 0.24 to 1.02, P=0.06), and the safety was comparable to that of omeprazole. However, according to economic results, omeprazole was more advantageous than tolozole. Conclusion:Current evidence showed that the curative effect and adverse drug reaction rate of pantoprazole and omeprazole in treating duodenal ulcer was basically equal. Pantoprazole can improve abdominal pain relief and pain symptoms disappear. Pantoprazole was prohibited for patients with hepatic and renal insufficiency. The treatment cost of pantoprazole was higher than that of omeprazole. Which drugs could be chosen according to the actual situation of the patient. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

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