复方甘草酸苷在抗结核治疗中减少肝损伤发生率的Meta分析

Meta-analysis of Compound Glycyrrhizin in Reducing the Incidence of Liver Injury in Anti Tuberculosis Treatment

目的:采用Meta分析方法评价预防性使用复方甘草酸苷在标准抗结核治疗中是否可以减少肝损伤的发生率,以及其疗效及安全性。方法:检索the Cochrane Library、Pub Med、Sino Med、CNKI、VIP和Wan Fang Data中关于抗结核治疗及预防性使用复方甘草酸苷的随机对照试验(RCTs),检索时限为各数据库建库至2018年2月7日,由两名研究员根据纳入标准和排除标准分别独立筛选文献,提取资料并进行方法学质量评价,采用Rev Man 5.3软件进行Meta分析。结果:最终纳入7项研究,均为RCTs,共纳入2 018例患者,其中观察组1 034例,对照组984例。观察组在标准抗结核治疗同时加用复方甘草酸苷,对照组仅使用标准抗结核治疗或加用葡醛内酯片作为安慰剂。Meta分析结果表明:观察组的肝损伤发生率明显小于对照组,差异有统计学意义[RR=0.30,95%CI(0.22,0.39),P<0.000 01],无明显不良反应。结论:在结核病患者的标准抗结核治疗中,预防性使用复方甘草酸苷可明显减少抗结核药物性肝损伤的发生率,无明显不良反应。

Objective： To systematically evaluate the efficacy and safety of the preventive use of compound glycyrrhizin in the treatment of standard anti tuberculosis drugs to reduce the incidence of liver injury. Methods： Searched the Cochrane Library,Pub Med,Sino Med,CNKI,VIP and Wan Fang Data,the retrieved documents were related to the anti tuberculosis treatment and the preventive use of compound glycyrrhizin. The retrieval time was limited to the database of each database to February 7,2018. According to inclusion criteria and exclusion criteria,two searsears independently screened literatures,extracted data and evaluated their methodological quality,and Meta-analysis was performed using Rev Man 5. 3 software. Results： 7 studies were included,all were randomized controlled trials,and 2 018 cases were included in the study,of which 1 034 cases were observed in the observation group and 984 cases in the control group. The observation group was treated with standard anti tuberculosis treatment plus compound glycyrrhizin,while the control group was only treated with standard anti tuberculosis therapy or with glucurolactone tablets as a placebo. The results of Meta-analysis showed： the incidence rate of liver injury in observation groups was significantly lower than that in the control group,and the difference was statistically significant [RR = 0. 30,95% CI（ 0. 22,0. 39）,P〈0. 000 01 ],and there was no obvious adverse reaction. Conclusion： In the standard anti tuberculosis treatment of tuberculosis patients,the prophylactic use of compound glycyrrhizin could significantly reduce the incidence rate,and no significant adverse reactions.