复方甘草酸苷联合还原型谷胱甘肽治疗酒精性肝硬化的系统评价

Systematic Review on Compound Glycyrrhizin Combined with Reduced Glutathione in the Treatment of Alcoholic Cirrhosis

目的:系统评价复方甘草酸苷联合还原型谷胱甘肽治疗酒精性肝硬化的疗效与安全性。方法:以“复方甘草酸苷”“Compound Glycyrrhizin”和“还原型谷胱甘肽”等为检索词,在中国知网、万方数据库、维普数据库、PubMed和the Cochrane Library等数据库中检索复方甘草酸苷联合还原型谷胱甘肽治疗酒精性肝硬化的随机对照试验(randomized controlled trial,RCT),观察组患者的干预措施为在常规治疗基础上联合应用复方甘草酸苷与还原型谷胱甘肽治疗,对照组患者的干预措施为常规治疗或常规治疗联合复方甘草酸苷或常规治疗联合还原型谷胱甘肽;同时,为保证文献的时效性,将检索时间设定为2010年1月至2020年5月;将观察指标设置为肝功能相关指标及肝纤维化相关指标。采用RevMan 5.3软件对符合标准的文献分别进行质量评价和荟萃分析(Meta分析)。结果:共纳入5篇文献,均为RCT,涉及543例患者,其中观察组患者271例,对照组患者272例。经过Meta分析可见(部分指标不符合Meta分析标准,采用描述性分析),观察组患者的疗效优于对照组,其肝功能指标(总胆红素除外)和肝纤维化指标(Ⅲ型前胶原除外)水平均明显低于对照组,差异均有统计学意义(P<0.05)。结论:复方甘草酸苷联合还原型谷胱甘肽治疗酒精性肝硬化疗效明显,但相关RCT仍存在不足,建议未来相关临床RCT增加样本数量,采取一致的评判指标,保证研究质量,增强数据可信度。

OBJECTIVE:To systematically evaluate the efficacy and safety of compound glycyrrhizin combined with reduced glutathione in the treatment of alcoholic cirrhosis.METHODS:Randomized controlled trials on compound glycyrrhizin combined with reduced glutathione in the treatment of alcoholic cirrhosis were retrieved from database of CNKI,Wanfang,VIP,PubMed and Cochrane Library by using“Compound Glycyrrhizin”and“Reduced Glutathione”as search terms,the intervening measures of observation group was compound glycyrrhizin combined with reduced glutathione on the basis of conventional therapy,while that of control group was conventional therapy or conventional therapy combined with compound glycyrrhizin or conventional therapy combined with reduced glutathione;at the same time,the searching time was limited from Jan.2010 to May 2020 to ensure the timeliness of literature;the observation indicator was set as indicators related to liver function and liver fibrosis.RevMan 5.3 was adopted to conduct quality evaluation and Meta-analysis on involved studies.RESULTS:Totally 5 studies were involved,all of which were RCT,covered 543 patients,including 271 patients in the observation group and 272 patients in the control group.Results of Meta-analysis indicated(some indicators do not meet Meta-analysis standards,and descriptive analysis was adopted)that the observation group had better efficacy than the control group,the liver function indicators(except for total bilirubin)and liver fibrosis indicators(except for typeⅢprocollagen)of observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).CONCLUSIONS:The efficacy of compound glycyrrhizin combined with reduced glutathione in the treatment of alcoholic cirrhosis is remarkable,while there are still shortcomings in relevant RCT,it is recommended that relevant clinical RCT in the future increase the number of samples and adopt consistent evaluation indicators to ensure the quality of research and enhance the credibility of data.