前列腺素E_1治疗重型病毒性肝炎的Meta分析

Meta-analysis on Prostaglandin E_1 for Liver Failure of Viral Hepatitis

【目的】综合评价前列腺素E1治疗重型病毒性肝炎的疗效。【方法】收集有关前列腺素E1治疗重型病毒性肝炎的随机或半随机病例对照研究,根据纳入和排除标准纳入文献并进行质量评价,资料进行Meta分析,并对结果作敏感性分析和偏倚分析。【结果】纳入20篇文献均属于低质量文献。Meta分析结果提示前列腺素E1能降低重型病毒性肝炎的病死率[比值比(oddratio,OR)=0.27,95%CI(0.22,0.34)],但仅对早期重型肝炎有效[OR=0.24,95%CI(0.09,0.59)],对晚期重型肝炎病死率的影响无统计学意义[OR=0.63,95%CI(0.26,1.53)],且前列腺素E1治疗对感染发生率的影响无统计学意义[OR=0.95,95%CI(0.56,1.62)]。这些结果通过敏感性分析未出现结果逆转,偏倚分析提示结果的偏倚较小;前列腺素E1对肝性脑病、消化道出血、肝肾综合征发生率的影响不能明确。【结论】尽管Meta分析提示前列腺素E1能降低重型病毒性肝炎的病死率和不影响感染发生率,但由于文献的质量较低,影响了结果的准确性,因此,其疗效仍有待高质量的随机对照试验来评价。

[Objective] To evaluate the effect of prostaglandin E1 (PGE1) on liver failure of viral hepatitis. [Method] Randomized or semi-randomized controlled trials on PGE1 for liver failure of viral hepatitis were collected and screened according to the criteria of inclusion and exclusion. The quality of each trial was evaluated and then meta-analysis was performed. The results of meta-analysis were assessed by the analyses of sensitivity and bias. [Result] Twenty included trials all had poor quality. The results of meta-analysis showed that PGE1 reduced the mortality of liver failure [OR =0.27,95%CI(0.22,0.34)]. This effect existed in the early stage of liver failure [OR=0.24,95%CI(0.09,0.59)], but it was of no statistical significance in the late stage [OR=0.63,95%CI(0.26,1.53)]. The effect of PGE1 on the rate of secondary infection was not statistically significant [OR=0.95,95%CI(0.56,1.62)]. These results were not reversed in the analysis of sensitivity, and the analysis of bias showed little bias of them. The effect of PGE1 on the morbidity of hepatic encephalopathy, bleeding in digestive tract and hepatorenal syndrome were unclear. [Conclusion] Although the result of meta-analysis showed that PGE1 could reduce the mortality of liver failure of viral hepatitis but had no effect on the morbidity of secondary infection, the accuracy of the result is low due to the poor quality of the included trials. Thus, the effect of PGE1 on liver failure of viral hepatitis need to be further evaluated through randomized controlled trial of high quality.