己酮可可碱对非酒精性脂肪肝治疗疗效与安全性的Meta分析

Effects and safety of pentoxifylline on nonalcoholic fatty liver disease: a meta-analysis

目的系统评价己酮可可碱对非酒精性脂肪性肝治疗的临床疗效和安全性。方法检索PubMed、Embase、The Cochrane library、中国知网(CNKI)、万方(VIP)、维普中收录的2017年12月前发表的关于己酮可可碱治疗非酒精性脂肪性肝病的随机对照试验。评价所纳入的文献质量并使用Revman 5.3对其疗效和安全性进行Meta分析。结果最终纳入7篇随机对照实验,共222例非酒精性脂肪肝患者,在使用己酮可可碱3～12个月后,其组织学特征得到显著改善,并且降低患者血清中的谷丙转氨酶、谷草转氨酶[加权均差数(WMD)=-19.60,95%CI:-32.78～-5.34,P=0.006;WMD=-9.73,95%CI:-17.02～-2.44,P=0.009],降低空腹血糖水平[WMD=-10.30,95%CI:-15.22～-5.39,P<0.0001],改善肝组织学炎症指数、纤维化程度[WMD=-1.18,95%CI:-1.47～-0.89,P<0.00001;WMD=-0.44,95%CI:-0.78～-0.11,P=0.009],但并不能降低患者的血清中甘油三酯和总胆固醇水平[WMD=5.16,95%CI:-10.82～21.14,P=0.53;WMD=0.49,95%CI:-0.37～1.35,P=0.26]、体质指数[WMD=-0.48,95%CI:-0.97～0.00,P=0.05]、肿瘤坏死因子-α和白细胞介素-6 [WMD=-0.98,95%CI:-1.66～-0.29,P=0.005,WMD=7.48,95%CI:-9.13～24.09,P=0.38],以及不能改善胰岛素抵抗[WMD=-3.15,95%CI:-10.52～4.21,P=0.40]。结论己酮可可碱可对非酒精性脂肪肝患者有一定的治疗效果,且不良反应较少。

Objective To evaluate the efficacy and safety of pentoxifylline in the treatment of non-alcoholic fatty liver disease（NAFLD）. Methods Randomized controlled trials（RCTs） that evaluated the efficacy of pentoxifylline for NAFLD treatment were searched in multiple databases, including Pubmed, Embase, the Cochrane library, CNKI,Wanfang database and VIP, from inception to December 2017. Literature identification and data extraction were based on the inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis. Results A total of 7 RCTs with 222 patients of NAFLD were included. Improved liver histology improved level of alanine aminotransferase and aspartate aminotransferase（WMD=-19.60, 95%CI：-32.78 to-5.34, P=0.006; WMD=-9.73, 95%CI：-17.02 to-2.44, P=0.009）, reduced glucose levels（WMD=-10.30, 95%CI：-15.22 to-5.39, P〈0.0001）, and improved the activity score and fibrosis score（WMD=-1.18, 95% CI：-1.47 to-0.89, P〈0.00001; WMD=-0.44, 95% CI：-0.78 to-0.11, P=0.009） were seen after 3 to 12 months pentoxifylline treatment. However, pentoxifylline could not decrease the level of serum cholesterol and triglyceride（WMD=5.16, 95%CI：-10.82 to 21.14, P=0.53; WMD=0.49, 95%CI：-0.37 to 1.35, P=0.26）, body mass index（WMD=-0.48, 95%CI：-0.97 to 0.00, P=0.05）, tumor necrosis factor-α and interleukin 6（WMD=-0.98, 95%CI：-1.66 to-0.29, P=0.005; WMD=7.48, 95%CI：-9.13 to 24.09, P=0.38）, and homeostasis model assessment-insulin resistance（WMD=-3.15, 95% CI：-10.52 to 4.21, P=0.40）. Conclusion Pentoxifylline has confirmed therapeutic effect on NAFLD with less adverse reactions.