糖皮质激素治疗重型肝炎疗效的荟萃分析

Efficacy of glucocorticoids in treatment of severe hepatitis： a Meta-analysis

目的通过荟萃分析评价糖皮质激索治疗重型肝炎的疗效。方法检索PubMed（1966—2011年）、EMCC（西文生物医学期刊文献服务系统1995--2011年）、Springer全文数据库、CNKI全文数据库、万方数据库、中国生物医学文献数据库中公丌发表的中、英文文献，并对相关的参考文献严格按照文献纳入和排除标准进行筛选。采用RevMan5．0软件进行荟萃分析，病死率采用相对危险度（RR）进行评估，总胆红素（TBi｜）、ALT和凝札酶原活动度（PTA）采用加权均数差值（WMD）和95％可信区间（C1）进行评估，并应用森林图、漏斗图对判定指标进行发表偏倚检验和敏感性分析。结果共纳入23篇文献，1457例病例。与对照组相比，应用糖皮质激素治疗组患者的病死率明显降低（RR=0．39，95％CI：0．32～0．47，Z=9．75，P〈0．01），TBil（WMD=-88．03，95％CI：-112．80～-63．26，Z=6．97，P〈0．01），ALT（WMD=-25．04，95％CI：-42．23～-7．84，Z=2．85，P〈0．01）和PTA（WMD=21．56，95％CI：6．52～36．60，Z=2．81，P〈0．01）明显改善。结论应娟糖皮质激素治疗重型肝炎能够明显改善患者的ALT、TBil和PTA水平，降低患者的病死率。

Objective To evaluate the clinical efficiency of glucocorticoids in treatment of severe hepatitis. Methods A systematic review on the efficacy of glueoeorticoids in treatment of severe hepatitis was conducted. Relevant literatures were searched in PubMed （ 1966 - 2011 ）, EMCC （ 1995 - 2011 ）, Springer, CNKI, Wanfang Database and CBM. The retrieved literatures were screened according to the predefined inclusion and exclusion criteria. RevMan 5.0 statistical software was used for Meta-analysis. The mortality was evaluated by relative risk （RR）, while the total bilirubin （TBil）, ALT and prothrombin activity （PTA） were evaluated by weighted mean difference （WMD） and 95% confidential interval （CI）. The publication bias and sensitivity about the data were measured by forest plot and thnnel plot. Results Twenty-three papers involving a total of 1457 patients were included in the study. Compared to control group, the mortality in glucocorticoids-treated group was lower （ RR = 0.39, 95% CI： O. 32 - 0.47, Z = 9.75, P〈0.01）; and theTBil （WMD= -88.03, 95%C1： -112.80-63.26, Z=6.97, P〈0.01）, ALT （WMD= -25.04,95%C1： -42.23-7.84, Z=2.85, P〈0.01） and PTA levels （WMD=21.56, 95% CI： 6.52 -36.60, Z =2.81, P 〈0.01 ） in glucocorticoids-treated group were improved. Conclusion Glucocorticoids can effectively improve TBil, ALT and PTA levels, and reduce the mortality of patients with severe hepatitis.