Meta-analysis of β-blockers for the primary prevention of liver cirrhosis with clinically significant portal hypertension with no or small esophageal varices
10.3760/cma.j.cn501113-20210330-00150
- VernacularTitle:β受体阻滞剂对肝硬化伴临床显著性门静脉高压无或小食管静脉曲张一级预防的Meta分析
- Author:
Xin SU
1
;
Wenjie LI
;
Zhe CHEN
;
Qibiao WU
;
Minhao YIN
;
Xu HAN
;
Danping ZHANG
;
Xiqiao ZHOU
;
Hong ZHU
Author Information
1. 南京医科大学第一附属医院消化内科，南京 210029
- Keywords:
Non-selective beta-blocker;
Liver cirrhosis;
Portal hypertension;
Esophageal varices;
Primary prevention
- From:
Chinese Journal of Hepatology
2022;30(11):1237-1245
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore whether NSBB is suitable for the primary prevention of liver cirrhosis accompanied by CSPH with no or small esophageal varices.Methods:Relevant literatures were retrieved from Cochrane library, PubMed, EMBASE, SinoMed, CNKI and Wanfang databases until December 12, 2020. All randomized controlled trials (RCTs) on NSBB use for primary prevention of cirrhosis accompanied by CSPH with no or small esophageal varices were collected. The literature was strictly screened according to the established inclusion and exclusion criteria, odds ratio (OR), and 95% confidence interval (CI) combined effect size. The development of esophageal varices and the initial upper gastrointestinal bleeding were the primary outcome measures. Death (with a maximum average follow-up of about five years) and adverse events (adverse drug reactions, etc.) were the secondary outcome measures.Results:A total of 9 RCTs with 1396 cases were included. Meta-analysis results showed that, compared with placebo, NSBB significantly reduced the incidence of liver cirrhosis accompanied by CSPH with no or small esophageal varices to large esophageal varices progression ( OR=0.51, 95% CI: 0.29-0.89, P=0.02), and mortality (with maximum average follow-up of about five years) ( OR=0.64, 95% CI: 0.44-0.92, P=0.02); however, there was no statistically significant difference in the initial upper gastrointestinal bleeding rate between the two groups ( OR=0.82, 95% CI: 0.44-1.52, P=0.53). Adverse event incidence was greater in the NSBB than the placebo group ( OR=1.74, 95% CI: 1.27-2.37, P=0.0005). Conclusions:NSBB use cannot reduce the initial upper gastrointestinal bleeding rate or adverse event incidence in patients with liver cirrhosis accompanied by CSPH with no or small esophageal varices, but it can delay the progression of gastroesophageal varices and reduce patient mortality.
