血管紧张素Ⅱ受体拮抗药对肝纤维化患者血清学指标影响的Meta分析

Meta-analysis of Angiotensin Ⅱ Receptor Blockers against Serum Makers of Hepatic Fibrosis Patients

目的:系统评价血管紧张素Ⅱ受体拮抗药(ARBs)对肝纤维化患者血清学指标的影响。方法:计算机检索PubMed、中国期刊全文数据库及万方数据库中关于ARBs治疗肝纤维化的临床随机对照试验(RCT),对符合纳入标准的临床研究进行评估与资料提取后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入9项RCT,合计457例患者。Meta分析结果表明,ARBs可以显著降低肝纤维化患者血清玻璃酸(HA)[WMD=-66.31,95%CI(-102.80,-29.82),P=0.000]、层黏蛋白(LN)[WMD=-44.49,95%CI(-70.28,-18.69),P=0.000]、血清Ⅳ型胶原(CⅣ)[WMD=-36.40,95%CI(-61.84,-10.95),P=0.005]、血清Ⅲ型前胶原氨基端肽(pⅢp)[WMD=-41.29,95%CI(-74.57,-8.02),P=0.02]水平。结论:在常规治疗基础上,加服ARBs治疗肝纤维化,能够明显改善患者血清HA、LN、CⅣ及pⅢp等相关指标。由于纳入研究的质量不高,此结论有待更多高质量、大样本的RCT加以验证。

OBJECTIVE： To evaluate the effect of angiotensin 1/ receptor blockers （ARBs） on serum markers of hepatic fibrosis patients. METHODS： PubMed, Chinese Journals Full-text Database and Wanfang Database, RCTs about ARBs in the treatment of hepatic fibrosis were researched. Statistical analysis was performed by Meta-analysis using Rev Man 5.2 software. RESULTS ： A total of 9 RCTs were included, involving 457 patients. Meta-analysis showed that ARBs could significantly decrease the levels of serum HA [WMD= - 70.85,95% CI （ - 105.74, - 35.96）, P〈0.000], LN[WMD= - 44.49,95% CI （ - 70.28, - 18.69）, P=0.000], CIV [WMD= -30.40,95%CI（ -50.89, -9.91）, P=0.005] and plllp [WMD=-37.22,95%CI（ --66.66, --7.79）, P=0.02]. CONCLUSIONS ： On the basis of conventional treatment, ARBs for hepatic fibrosis can improve therapeutic efficacy and have good safety. Due to low quality of included studies, more high quality and large scale RCTs are required for further study.