特利加压素联合白蛋白治疗Ⅰ型肝肾综合征疗效的荟萃分析

Terlipressin plus albumin for treatment of type 1 hepatorenal syndrome: A meta-analysis

目的收集中英文相关随机对照试验(randomized controlled trial,RCT)的研究结果进行Meta分析,对特利加压素联合白蛋白对肝肾综合征(hepatorenal syndrome,HRS)的疗效进行评价.方法采用Cochrane系统评价方法,检索PubMed,The Cochrane Library,Web of Science and LILACS,Medline,EMBASE,中国生物医学文献数据库,维普中文科技期刊数据库,中国CNKI学术总库,万方数据资源系统等数据库,检索截止2016-07以前的所有公开发表文献.结果 6篇RCT共542例患者纳入本荟萃分析,特利加压素联合白蛋白在HRS治疗中较单独应用白蛋白可明显提高HRS缓解率(OR=5.25,95%CI:2.77-6.52);提高生存率(OR=2.33,95%CI:1.11-4.88);同时可降低血肌酐水平,升高平均动脉压,但对尿量的影响无明显差异.其不良反应包括由于体循环充血及外周循环收缩导致的症状,如腹痛、肢体末端紫绀等,但无致死性不良反应报道.结论特利加压素联合白蛋白对改善HRS较单独应用白蛋白有较好的作用,可提高临床缓解率和生存率,且无明显严重不良反应,安全性好.

AIM To assess the efficacy of terlipressin plus albumin in the treatment of hepatorenal syndrome（HRS）.METHODS Cochrane strategy was used to identify randomized controlled trials published before July 2016 by searching PubMed,The Cochrane Library,Web of Science and LILACS,Medline,EMBASE,Chinese Biomedical Literature Database,Chongqing VIP Information Co.,Ltd,China National Knowledge Internet Database,and Wanfang Data.RESULTS Six randomized controlled trials involving 542 cases were selected for this meta-analysis.The HRS remission rate and the survival rate were increased by terlipressin plus albumin,with OR = 5.25（95%CI：2.77-6.52） and 2.33（95%CI：1.11-4.88） compared with albumin alone,respectively.Blood creatinine was decreased by the combination treatment,and mean arterial pressure was increased significantly,while there was no difference in urine output.Side effects due to systemic circulation congestion and peripheral vasoconstriction were reported,such as stomach ache and extremity cyanosis.No fatal side effect was reported.CONCLUSION Compared with albumin alone,terlipressin plus albumin is effective in the treatment of HRS,as demonstrated by increased remission rate and survival rate and no occurrence of fatal side effect.