吡格列酮治疗非酒精性脂肪肝有效性及安全性的Meta分析

Meta-analysis of the Efficacy and Safety of Pioglitazone in the Treatment of Non-alcoholic Fatty Liver

目的对吡格列酮治疗非酒精性脂肪肝是否有效及安全进行系统评价。方法电子检索截至2019年8月之前公开发表在万方数据库、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、PubMed、Cochrane Library的随机对照试验,包括使用任何方案的吡格列酮与安慰剂的非酒精性脂肪肝患者的比较。主要结局包括肝脏病理、肝脏生化、胰岛素抵抗、不良反应。结果最终纳入10篇文献,共有723例患者。Meta分析结果显示,吡格列酮可以减轻非酒精性脂肪肝患者肝脂肪变性(OR=0.26,95%CI:0.14~0.46)、肝气球样变(OR=0.38,95%CI:0.24~0.60)、肝小叶炎症(OR=0.33,95%CI:0.21~0.50)、肝纤维化(OR=0.57,95%CI:0.37~0.88),改善ALT(MD=10.33,95%CI:3.27~17.38)、AST(MD=9.51,95%CI:3.03~15.99)、空腹血糖(MD=0.47,95%CI:0.20~0.75)、胰岛素抵抗指数(HOMA-IR)(MD=1.17,95%CI:0.82~1.51)等指标,与对照组比较,差异有统计学意义(P<0.05)。结论吡格列酮可有效治疗非酒精性脂肪肝,尤其在改善肝组织学、肝功能、改善胰岛素抵抗等方面有较为明显优势。不良反应主要为肌肉酸痛,总体不良反应较少且均较轻。

Objective To systematically evaluate whether pioglitazone is effective and safe in the treatment of non-alcoholic fatty liver.Methods Electronic retrieval as of August 2019.Randomized controlled trials published in Wanfang database,Chinese Journal Full-text Database(CNKI),Chinese Biomedical Literature Database(CBM),Chinese Science and Technology Journal Full-text Database(VIP),PubMed,Cochrane Library,Including comparison of pioglitazone with placebo in nonalcoholic fatty liver patients.The main outcomes include liver pathology,liver biochemistry,insulin resistance,and adverse reactions.Results Finally,10 articles were included,with a total of 723 patients.Meta analysis results showed that pioglitazone can reduce hepatic steatosis(OR=0.26,95%CI:0.14~0.46),hepatic balloon-like degeneration(OR=0.38,95%CI:0.24~0.60),liver Lobular inflammation(OR=0.33,95%CI:0.21~0.50),liver fibrosis(OR=0.57,95%CI:0.37~0.88),improve ALT(MD=10.33,95%CI:3.27-17.38),AST(MD=9.51,95%CI:3.03~15.99),fasting blood glucose(MD=0.47,95%CI:0.20~0.75),insulin resistance index(HOMA-IR)(MD=1.17,95%CI:0.82~1.51)and other indicators,compared with the control group,the difference was statistically significant(P<0.05).Conclusion Pioglitazone can effectively treat non-alcoholic fatty liver,especially in improving liver histology,liver function and insulin resistance.The adverse reactions were mainly muscle aches,and the overall adverse reactions were few and mild.