维生素E治疗非酒精性脂肪性肝病的Meta分析

Meta-analysis of Vitamin E in the Treatment of Non-alcoholic Fatty Liver Disease

目的:系统评价维生素E治疗非酒精性脂肪性肝病(NAFLD)的治疗效果及安全性。方法:计算机检索PubMed、Embase、the Cochrane Library、CNKI、WanFang Data、VIP、SinoMed数据库,搜集有关维生素E治疗NAFLD的随机对照试验(RCT)。检索时限从建库至2020年10月。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入13个RCT,包括患者908例。Meta分析结果显示,与安慰剂比较,维生素E可以显著改善空腹血糖水平[MD=-7.38,95%CI(-13.59,-1.18),P=0.02],但对患者的ALT、AST、γ-谷氨酰胺转肽酶、体重指数、三酰甘油、总胆固醇改善的差异均无统计学意义(P>0.05);口服维生素E后肝纤维化比安慰剂有所改善,但差异无统计学意义(P>0.05)。安全性方面,与安慰剂组比较,维生素E组不良反应未见增多。结论:维生素E可以显著改善NAFLD患者的空腹血糖,在改善NAFLD患者的肝脏生化指标方面优势不明显,且安全性高。由于受纳入研究数量和质量限制,上述结论尚需更高质量的随机双盲对照研究予以验证。

Objective:To systematically evaluate the efficacy and safety of vitamin E in the treatment of non-alcoholic fatty liver disease(NAFLD). Methods:Databases including PubMed, Embase, the Cochrane Library, CNKI, WanFang Data, VIP, SinoMed were searched to collect randomized controlled trials(RCTs) about the clinical efficacy and safey of vitamin E in the treatment of NAFLD from inception to October 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, Meta-analyses were performed using the RevMan 5.3 software. Results:A total of 13 RCTs involving 908 patients were included. The result of Meta-analysis showed that vitamin E could significantly improve fasting blood glucose levels(MD=-7.38, 95%CI-13.59 to-1.18, P=0.02), but the effects of ALT, AST, γ-glutamine transpeptidase, body mass index, triglyceride, total cholesterol had no statistical difference(P>0.05). Liver fibrosis after oral administration of vitamin E could be improved compared with placebo, but there was no statistical difference. For safety, there was no increase in adverse reactions in the vitamin E compared with the placebo group. Conclusion: Vitamin E can significantly improve fasting blood glucose in NAFLD patients, but has no significant advantage in improving liver biochemical indicators, with high safety. Due to the limited quantity and quality of the included studies, the above conclusions need to be verified by much more higher quality randomized double-blind controlled studies.