维生素E治疗儿童非酒精性脂肪性肝病效果的Meta分析

Clinical effect of vitamin E in treatment of nonalcoholic fatty liver disease in children:A Meta-analysis

目的评估维生素E对儿童非酒精性脂肪性肝病(NAFLD)的治疗效果。方法检索2019年12月前发表的关于维生素E治疗儿童NAFLD疗效的文章,检索范围包括Pub Med、Web of Science、The Cochran Library、Embase、OVID/NEJM、中国知网、万方数据库。分析数据包含BMI、肝酶水平(ALT、AST)、血脂水平(TG、TC、LDL、HDL)、肝脂肪变性缓解率共8个参数。使用REVMAN5. 3进行Meta分析。连续变量选择标准化均数差(SMD)和95%可信区间(CI)计算和分析干预前后参数的差异,分类变量选择风险差(RD)和95%CI进行分析。非异质性数据采用固定效应模型,否则采用随机效应模型。发表偏倚的评估通过漏斗图完成。结果共检索到599篇文章,其中9篇纳入Meta分析,受试者607例。维生素E显著改善了患儿的ALT水平(SMD=-0. 27,95%CI:-0. 48^-0. 06,P=0. 01),但是对患儿的BMI水平(SMD=-0. 09,95%CI:-0. 28~0. 10,P=0. 34)、AST水平(SMD=-0. 20,95%CI:-0. 42~0. 02,P=0. 07)、TG水平(SMD=-0. 19,95%CI:-0. 51~0. 12,P=0. 22)、TCHO水平(SMD=-0. 11,95%CI:-0. 31~0. 08,P=0. 24)、HDL(SMD=-0. 02,95%CI:-0. 27~0. 23,P=0. 88)、LDL水平(SMD=-0. 04,95%CI:-0. 27~0. 19,P=0. 72)、肝脂肪变性缓解率(RD=0. 06,95%CI:-0. 05~0. 17,P=0. 29)无显著改善。结论维生素E能够显著改善儿童NAFLD患者的ALT水平,可考虑作为临床辅助用药。

Objective To investigate the clinical effect of vitamin E in the treatment of nonalcoholic fatty liver disease( NAFLD) in children. Methods PubMed,Web of Science,The Cochran Library,Embase,OVID/NEJM,CNKI,and Wanfang Data were searched for the articles on vitamin E in the treatment of NAFLD in children published up to December 2019. The data of 8 parameters were analyzed,i. e.,body mass index( BMI),liver enzymes [alanine aminotransferase( ALT) and aspartate aminotransferase( AST) ],blood lipid levels [triglyceride( TG),total cholesterol( TC),low-density lipoprotein( LDL),and high-density lipoprotein( HDL) ],and remission rate of hepatic steatosis. RevMan 5. 3 was used to perform a Meta-analysis. Continuous variables were analyzed by standardized mean difference( SMD) and 95% confidence interval( CI),and the changes after intervention were analyzed;categorical variables were analyzed by risk difference( RD) and 95% CI. A fixed effects model was used for homogeneous data,and a random effects model was used for heterogeneous data. Funnel plots were used to evaluate publication bias. Results A total of 599 articles were retrieved,among which 9 were included in the Meta-analysis,with 607 subjects in total. Vitamin E significantly improved the level of ALT( SMD =-0. 27,95% CI:-0. 48 to-0. 06,P = 0. 01),but it did not improve the levels of BMI( SMD =-0. 09,95% CI:-0. 28 to 0. 10,P = 0. 34),AST( SMD =-0. 20,95% CI:-0. 42 to 0. 02,P = 0. 07),TG( SMD =-0. 19,95% CI:-0. 51 to 0. 12,P = 0. 22),TCHO( SMD =-0. 11,95% CI:-0. 31 to 0. 08,P = 0. 24),HDL( SMD =-0. 02,95% CI:-0. 27 to 0. 23,P = 0. 88),LDL( SMD =-0. 04,95% CI:-0. 27 to0. 19,P = 0. 72),and the remission rate of hepatic steatosis( RD = 0. 06,95% CI:-0. 05 to 0. 17,P = 0. 29). Conclusion Vitamin E can significantly improve the level of ALT in children with NAFLD and can be considered as an adjuvant drug for clinical treatment.