去甲肾上腺素或特利加压素联合白蛋白治疗1型肝肾综合征效果及安全性比较的Meta分析

Efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in treatment of type 1 hepatorenal syndrome:A Meta-analysis

目的对去甲肾上腺素、特利加压素联合白蛋白治疗1型肝肾综合征(HRS1)的效果及安全性进行系统评价。方法通过检索PubMed、EMBASE、Medline、Cochrane Library、中国知网、万方和维普等国内外数据库有关去甲肾上腺素或特利加压素联合白蛋白治疗HRS1对比研究的文献。对文献进行质量评价。提取HRS逆转率、病死率、不良事件发生率、平均动脉压、肾功能等指标,应用ReviewManager5.3软件进行数据分析,各研究间的异质性采用χ^2检验判断。二分类变量采用比值比(OR)分析,连续性变量采用加权均数差(WMD)分析,两类变量均计算95%可信区间(95%CI)。结果纳入符合标准的随机对照试验6篇,总样本量298例,其中去甲肾上腺素联合白蛋白和特利加压素联合白蛋白组各149例。Meta分析显示两组的HRS逆转率(OR=0.95,95%CI:0.60~1.49,P=0.81)、病死率(OR=0.84,95%CI:0.51~1.41,P=0.51)、不良事件发生率(OR=0.42,95%CI:0.16~1.07,P=0.07)、平均动脉压(SMD=0.05,95%CI:-0.92~1.03,P=0.92)、肾功能等指标并无明显差异。结论去甲肾上腺素联合白蛋白与特利加压素联合白蛋白治疗HRS1临床效果及安全性一致,临床上需要时可考虑使用去甲肾上腺素替代特利加压素。

Objective To systematically review the efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of type 1 hepatorenal syndrome (HRS1).Methods PubMed,EMBASE,Medline,Cochrane Library,CNKI,Wanfang Data,and VIP were searched for comparative studies on norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of HRS1.Quality assessment was performed for articles.Related indicators were extracted,including hepatorenal syndrome (HRS) reversal rate,mortality rate,incidence of adverse events,mean arterial pressure,and renal function,and Review Manager 5.3 was used for data analysis.The chi-square test was used to determine the heterogeneity between studies.Odds ratio (OR) was used for the analysis of dichotomous variables,weighted mean difference (WMD) was used for the analysis of continuous variables,and 95% confidence interval (CI) was calculated for these two types of variables.Results A total of 6 randomized controlled trials which met the inclusion criteria were included,with a total sample size of 298 patients (149 patients in the norepinephrine+albumin group and 149 in the terlipressin+albumin group).The meta-analysis showed that there were no significant differences between the two groups in HRS reversal rate (OR=0.95,95%CI: 0.6-1.49,P =0.81),mortality rate (OR=0.84,95%CI: 0.51-1.41,P =0.51),incidence rate of adverse events (OR=0.42,95%CI: 0.16-1.07,P =0.07),mean arterial pressure (standardized mean difference=0.05,95%CI:-0.92 to 1.03,P =0.92),and renal function.Conclusion Norepinephrine combined with albumin has similar efficacy and safety as terlipressin combined with albumin in the treatment of HRS1,and terlipressin can be replaced by norepinephrine in clinical practice when necessary.