熊去氧胆酸对胆道闭锁Kasai术后结局影响的系统评价及Meta分析

Effect of ursodeoxycholic acid on. biliary atresia after Kasai procedure： a systematic review and Meta-analysis

目的评价熊去氧胆酸对胆道闭锁Kasai术后结局的影响。方法检索截至2013年6月公开发表在国内外的有关熊去氧胆酸对胆道闭锁Kasai术后治疗的临床研究，检索数据库包括MEDLINE（PubMed）、EMBASE、Cochrane图书馆、万方数据库、中国学术期刊全文数据库和中国生物医学文献数据库。按照纳入和排除标准进行文献筛选，采用ReviewManager5．2软件对纳入研究进行系统评价。结果检索到相关文献9篇，最终纳入4篇文献，共284例胆道闭锁患儿，其中熊去氧胆酸对胆道闭锁Kasai术后黄疸的改善经敏感性分析显示，试验组优于对照组，差异有统计学意义（OR=7．24，95％CI：2．42～21．68；合并效应的检验Z=3．55，P=0．0004）；熊去氧胆酸对术后生存率的影响经Meta分析显示，试验组与对照组比较差异无统计学意义（OR=5．50，95％凹：0．96—31．64；合并效应的检验Z=1．91，P=0．06）。结论熊去氧胆酸对减轻胆道闭锁Kasai术后黄疸有一定作用，但对改善术后长期的结局较对照组无明显优势。

Objective To assess the effect of ursodeoxycholic acid on postoperative outcomes in biliary atresia （BA） patient undergoing Kasai procedure. Methods Correlative english articles published until Jun. 2013 were searched by computer in Medline （PubMed）, EMBASE, Cochrane library, Wanfang Database, China Knowledge Re- source Integrated Database and China Biology Medicine Database, the output articles were screened according to inclu- sion and exclusion criteria. The selected articles were evaluated with the of Review Manager 5.2 software. Results Nine articles were obtained, but only 4 articles were included,including 284 patients with BA were conformed to the in- clusion and exclusion criteria. The sensitivity analysis indicated that the total effective rate in ursodeoxycholic acid group was superior to that in the control group, and the difference between the 2 groups was notable significant （ OR = 7.24,95 % CI： 2. 42 - 21.68, Z = 3.55, P = 0.0004）. There was no significant difference between ursodeoxycholic acid group and control group in the effect of ursodeoxycholic acid on outcome of patients who had BA（ OR = 5.50,95% CI： 0. 96 - 31.64;Z = 1.91,P = 0. 06）. Conclusions Ursodeoxycholic acid has certain effect on alleviating jaundice after Kasai procedure, but it has no advantage on improving the long outcomes as comparison with control group.