多烯磷脂酰胆碱联合二甲双胍治疗非酒精性脂肪性肝病患者疗效和安全性Meta分析

Efficacy and safety ofpolyene phosphatidylcholine combined with metformin in the treatment of patients with non-alcoholic fatty liver disease:a Meta-analysis

目的系统评价应用多烯磷脂酰胆碱联合二甲双胍治疗非酒精性脂肪性肝病(NAFLD)患者的疗效和安全性。方法全面检索知网(CNKI)、万方(WanFang Data)、维普(VIP)、EMbase、PubMed数据库,检索2018年8月前关于应用多烯磷脂酰胆碱联合二甲双胍治疗NAFLD患者的随机对照试验(RCT)研究,采用RevMan 5.3处理软件进行Meta分析。结果纳入18项RCT研究包括1596例患者,其中试验组803例,对照组793例。给予试验组患者多烯磷脂酰胆碱联合二甲双胍治疗,给予对照组其它药物治疗。Meta分析结果显示,试验组在降低胰岛素抵抗指数(HOMA-IR)、空腹血糖(FPG)、AST水平、ALT水平、GGT水平、LDL-C水平、TC水平、TG水平和提高HDL-C水平、超声检查指标改善率和肝/脾CT值比值方面优于对照组,差异有统计学意义(P<0.05);两组在降低空腹胰岛素(FINS)水平和不良反应发生率方面差异无统计学意义(P>0.05)。结论应用多烯磷脂酰胆碱联合二甲双胍治疗NAFLD患者疗效较好,无明显不良反应。由于纳入研究的整体质量不高,仍需多中心和高质量的随机对照试验加以验证。

Objective This study aimed tosystematically evaluate the efficacy and safety of polyene phosphatidylcholine combined with metformin in the treatment of patients with non-alcoholic fatty liver disease(NAFLD).Methods We searched CNKI,WanFang Data,VIP,EMbase and PubMed for retrieving randomized controlled trials(RCT)on application of metformin and polyene phosphatidylcholine combination in treatment of patients with NAFLD before August 2018.The Meta analysis was carried out by using RevMan 5.3 software.Results Eighteen RCTs having 1596 patients with NAFLD were finally included,and 803 in observation received combination and 793 in the control received medicines without anyone of the two combined agents.The results showed that the efficacy in combination group was superior to that in the control as respect to the reduction of the homeostasis model assessment for insulin resistance(HOMA-IR)levels,fasting plasma glucose(FPG)levels,AST levels,ALT levels,GGT levels,LDL-C levels,TC levels,TG levels,increasing HDL-C levels,improving ultrasonic parameters,and liver/spleen CT value ratio(P<0.05);there were no significantly differences in fasting insulin(FINS)levels and incidences of adverse effects between the two groups(P>0.05).Conclusion The efficacy of polyene phosphatidylcholine combined with metformin in the treatment of patients with NAFLD is good without obvious adverse reactions.It is safe and reliable,and needs multi-centre verification as the low-level quality of all the studies included.