糖皮质激素治疗重型肝炎有效性及安全性的Meta分析

Efficacy and safety of glucocorticoids on patients with severe viral hepatitis:A Meta-analysis

目的综合评价糖皮质激素治疗重型病毒性肝炎的有效性及安全性。方法计算机检索2000年1月至2010年10月31日Cochrane图书馆、PubMed、OVID循证医学数据库、中国期刊全文数据库、万方数据库的中英文文献,提取糖皮质激素治疗重型病毒性肝炎的病例对照研究。采用RevMan 5.0软件进行Meta分析。结果纳入13个病例对照研究,包括770例重型病毒性肝炎患者。文献质量经改良Jadad评分平均为1.6分,均属于文献质量不高。Meta分析结果显示,糖皮质激素组患者病死率明显低于对照组[RR=0.39,95%CI（0.30~0.49）,P〈0.00001]。除在试验组出现一些能控制的特殊不良反应外,1个研究显示试验组主要并发症如感染、出血、肝性脑病、肝肾综合征发生率明显低于对照组,但因样本量太少,未作Meta分析。结论重型肝炎早期及时合理地应用糖皮质激素治疗,可降低患者病死率。但由于本研究的数量和质量的限制,影响了结果的准确性,尚需要更多高质量的随机对照试验验证。

Objective To evaluate the efficacy and safety of glucocorticoids on severe viral hepatitis.Methods We searched Cochrane Central Register of Controlled Trials（The Cochrane Library,Issue 11,2010）,PubMed,OVID,CNKI and Wanfang Data（2000 to 31 October 2010）to collect case-control trials of glucocorticoids for severe viral hepatitis.The language was confined to English and Chinese.We screened the retrieved studies according to the predefined inclusion and exclusion criteria,evaluated the quality of included studies,and performed Meta-analyses using the Cochrane Collaboration＇s RevMan 5.0 software.Results Thirteen case-control trials involving 770 patients with severe viral hepatitis were included.All included trials were with average 1.6 of modified Jadad scores.Meta-analysis showed that the mortality of the patients in glucocorticoids group was significantly lower than in control group[RR=0.39,95%CI（0.30 to 0.49）,P0.00001].Except for some controllable special adverse events found in some patients in glucocorticoids group,one trial showed that the incidence of major complications,such as infections,hemorrhage,hepatic encephalopathy and hepatorenal syndrome,was significantly lower in glucocorticoids group than in control group,which was not performed Meta-analysis because of too small sample size.Conclusion The patients treated with glucocorticoids in a timely and reasonable manner in the early stage of severe hepatitis could obtain better efficacy,lower mortality and no more incidence of complications.However,the accuracy of the results is weakened by the poor quality and quantity of the included trials.Thus,more randomized controlled trials of high quality are required to verify these conclusions.