糖皮质激素治疗重型肝炎肝衰竭患者的疗效及并发症临床荟萃分析

Meta-analysis of the efficacy and complications of glucocorticoids in patients with severe hepatitis-related liver failure

目的采用荟萃分析法评价糖皮质激素治疗重型肝炎肝衰竭的疗效差异、副作用、安全性。方法计算机检索近20年网络、数据库中有关激素治疗重型肝炎肝衰竭的临床随机对照试验。RevMan5.0软件对入选试验进行分析。结果本文纳入29个病例对照研究,共1852例重型肝炎患者。文献质量经改良Jadad评分平均为2.69分。Meta分析:治疗组患者生存率、好转率明显高于对照组;治疗组患者黄疸消退时间、消化道症状消退时间、总胆红素、凝血酶原时间明显低于对照组。治疗组患者继发性感染、消化道出血、肝肾综合征的发生率均低于对照组;两组对比腹水发生率、肝性脑病发生率差异无统计学意义(P>0.05)。结论本文纳入的文章时间跨度大、依照的诊断标准不同、RCT样本量少、部分研究两组患者数量差距大均导致某些分析的统计学同质性差(F>50%),并影响到了结果准确性。故本文Meta分析结论仍需大样本量实验分析验证。

Objective To perform a meta - analysis evaluation of the efficacy, safety, and complications of glucoeorticoid monotherapy in patients with hepatitis -related liver failure. Methods The databases of Chinese Scientific Journal （VIP）, Chinese Medical Periodical Literature （ CMCC ）, China Medical Citation （CMCI） , PubMed, and Google Scholar were searched for relevant randomized controlled trials （RCTs） published between January 1991 and February 2012. Meta - analyses were carried out by RevMan 5.0 software. The main outcome measures were survival rate and improvement rate. Secondary measures were jaundice, gastrointestinal symptoms, total bilirnbin （TBil） , and prothrombin time （PT）. Hormone therapy side - effects were also assessed. Results Twenty - nine RCTs composed of 1852 severe hepatitis cases were included in the analysis. The average modified Jadad score of these trials was 2.69. Meta - analysis showed that both the survival rate and the improvement rate were significantly higher for glucocorticoid - treated patients than for patients in the control group. In addition, glucoeorticoid treatment led to significantly shorter time to regression of jaundice and gastrointestinal symptoms, significantly lower TBil and PT values, and lower rates of secondary infection, gastrointestinal hemorrhage, and hepatorenal syndrome. The glueoeortieoid - treated group did not show a significantly different rate of aseites or hepatic encephalopathy, compared with the control group （ P 〉 0.05 ）. Conclusion Glucoeorticoid treatment is efficacious and safe for relieving symptoms of liver failure in patients with severe hepatitis. Howev- er, more RCTs of high quality and with large case and control populations are required to verify this conclusion.