肝脏切除术前单剂应用糖皮质激素临床疗效的Meta分析

Meta-Analysis of the Clinical Efficacy of Single Dose Glucocorticoid before Liver Resection

目的采用分析评价肝脏切除术前单剂应用糖皮质激素的临床价值。方法电子检索、Medline、Embase、Cochrane library、中国生物医学文献数据库(CBM)、维普数据库、万方数据库。收集比较肝脏切除术前单剂应用糖皮质激素与未予糖皮质激素治疗的前瞻性随机对照试验(RCTs)。由2名评价者筛选和提取资料,并用改良Jadad量表评价文章质量。对符合标准的研究采用RevMan5.1软件进行数据分析。结果共纳入5篇随机对照研究,222例患者,文献质量评价均为高质量。荟萃分析结果表明:术前单剂应用糖皮质激素组术后IL-6峰值[MD=-53.70,95%CI(-74.11～-33.29),P<0.01]、总胆红素(TBIL)峰值[MD=-13.77,95%CI(-23.77～-3.78),P<0.01]较对照组显著降低,术后并发症发生例数[OR=0.30,95%CI(0.16～0.57),P<0.01]及平均住院天数[MD=-2.91,95%CI(-4.55～-1.28),P<0.01]较对照组显著减少。2组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)峰值无明显差异(P>0.05)。结论肝脏切除术前单剂应用糖皮质激素能减少术后炎症细胞因子释放及改善患者预后,但对肝脏功能和缺血再灌注损伤的保护作用尚需更进一步研究证实。

Objective To evaluate the clinical value of the single dose glucocorticoid before liver resection using meta analysis. Methods Randomized controlled trials （RCTs） focused on preoperative single dose glucocorticoid in liver resection were identified from Pubmed, Medline, Embase, the Cochrane Library, Chinese Biomedical Literature Database （CBM）, VIP database, and Wanfang database according tO the inclusion and exclusion criteria. All relevant studies were screened and the data were extracted by two independent reviewers.The qualities of the included studies were evaluated by modified Jadad score. Meta analysis was processed by RevMan 5.1. Results Five randomized controlled trials were included in this analysis. These studies included a total of 222 patients. The methodological quality was evaluated and all of the trials were in high quality. The meta analysis revealed that the postoperative peak of interleukin （IL）-6 value [MD=-53.70; 95% CI （-74.11--33.29）;P 〈 0.01 ], peak value of total bilirubin （TBIL）[ MD=-13.77; 95%CI （-23.77--3.78）;P 〈 0.01 ], postoperative complications[OR=0.30; 95% CI （0.16-0.57）; P 〈 0!O1]and the length of hospital stay [ MD=-2.91 ; 95%CI（-4.55-- 1.28）; P 〈 0.01 ]were significantly decreased in glucocorticoid group than those in control group. There were no statistical differences in the peak alanine aminotransferase （ALT） value and peak aspartic transaminase （AST）value between the two groups after operation （P 〉 0.05）. Conclusion These results suggest that the preoperative single dose glucocortieoid could reduce the release of inflammatory cytokines and improve the outcomes in patients undergoing liver resection. Its efficacy on liver function and isehemia-reperfusion （I/R） injury needs further investigation.