糖皮质激素与己酮可可碱治疗重症酒精性肝病效果的Meta分析

Clinical effect of glucocorticoids versus pentoxifylline in patients with severe alcoholic liver disease: A Meta-analysis

目的评估重症酒精性肝病患者单独以及联合应用糖皮质激素与己酮可可碱的临床疗效。方法计算机检索PubMed、Embase、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、中华医学会数字化期刊库自建库至2018年11月中英文文献,同时手检相关期刊和会议论文集,对糖皮质激素与对照、糖皮质激素与己酮可可碱、糖皮质激素联合己酮可可碱与糖皮质激素进行分析。评估二者单独或联用对重症酒精性肝病患者28d生存率和肝肾综合征的影响。应用比值比(OR)和95%可信区间(CI)评价结局指标。数据采用RevMan5.3软件进行分析。结果共纳入22项研究的1956例患者,单用糖皮质激素的28d病死率为25.12%,低于对照组的30.67%,差异有统计学意义(OR=0.71,95%CI:0.55~0.93,P=0.01)。亚组分析显示,糖皮质激素与己酮可可碱28d病死率比较差异有统计学意义(OR=0.68,95%CI:0.48~0.97,P=0.03);糖皮质激素联合己酮可可碱与糖皮质激素28d病死率比较,差异无统计学意义(OR=0.92,95%CI:0.66~1.29,P=0.64)。糖皮质激素和己酮可可碱联合应用可以降低肝肾综合征的发生率(3.94%),优于糖皮质激素单独治疗组(8.03%),差异有统计学意义(OR=0.45,95%CI:0.24~0.83,P=0.01)。漏斗图显示无发表偏倚。结论糖皮质激素和己酮可可碱联合治疗可降低重症酒精性肝病患者肝肾综合征的发病率。

Objective To systematically review the clinical effect of glucocorticoids used alone or in combination with pentoxifylline in patients with severe alcoholic liver disease. Methods PubMed,Embase,Chinese Scientific Journal Full-Text Database,CBM,China Scientific Journal Database,and Chinese Medical Association Digital Journal Database were searched for related articles published up to November 2018,and related journals and collected papers from conferences were searched manually. The clinical effect of glucocorticoids versus placebo,glucocorticoids versus pentoxifylline,and glucocorticoids combined with glucocorticoids versus glucocorticoids alone was analyzed.The effect of glucocorticoids and pentoxifylline used alone or in combination on 28-day survival rate and hepatorenal syndrome in patients with severe alcoholic liver disease was assessed. Odds ratio( OR) and 95% confidence interval( CI) were used to evaluate outcome indicators. RevMan 5. 3 software was used for data analysis. Results A total of 22 studies were included,with 1956 patients in total. The glucocorticoid group had a significantly lower 28-day mortality rate than the control group( 25. 12% vs 30. 67%,OR = 0. 71,95% CI: 0. 55-0. 93,P = 0. 01). Subgroup analysis showed that there was a significant difference in 28-day mortality rate between the glucocorticoid group and the pentoxifylline group( OR = 0. 68,95% CI: 0. 48-0. 97,P = 0. 03),while there was no significant difference between the glucocorticoid + pentoxifylline group and the glucocorticoid group( OR = 0. 92,95% CI: 0. 66-1. 29,P = 0. 64). Compared with the glucocorticoid group,the glucocorticoid + pentoxifylline group had a significantly lower incidence rate of hepatorenal syndrome( 3. 94% vs8. 03%,OR = 0. 45,95% CI: 0. 24-0. 83,P = 0. 01). Funnel plots showed no publication bias. Conclusion Glucocorticoids combined with pentoxifylline can reduce the incidence rate of hepatorenal syndrome in patients with severe alcoholic liver disease.