摘要
背景:一些观察性研究显示,肝肾综合征(HRS)患者在经过药物治疗后再行原位肝移植,可以获得与非HRS患者相似的移植效果。方法:检索PubMed、Elsevier、Medline及Cochrane数据库1999年1月1日至2018年2月24日间的相关文献。主要结局指标是HRS的逆转,次要结局指标是血肌酐和血钠的变化。我们基于Bayesian方法学通过网络荟萃分析评估了不同药物治疗方案。结果:共计24篇文献1419例病例纳入分析,评估了7种HRS的药物治疗方案。对于逆转HRS最有效的治疗方案是特利加压素+白蛋白,去甲肾上腺素+白蛋白,以及特利加压素单药治疗,其累计排名曲线下面积(SUCRA)分别为0.086、0.151和0.451。对于降低血肌酐最有效的两种治疗方案是多巴胺+呋塞米+白蛋白(等级概率0.620)和特利加压素+白蛋白(等级概率0.570)。对于提高血钠水平,最理想的治疗方案是奥曲肽+米多君+白蛋白(等级概率0.800),其次是特利加压素+白蛋白(等级概率0.544)。结论:降低HRS患者的血肌酐水平,可优先考虑特利加压素+白蛋白和多巴胺+呋塞米+白蛋白这两种治疗方案;而奥曲肽+米多君+白蛋白则是提高其血钠水平的最有效方案。特利加压素+白蛋白显示出了既能降低血肌酐又能提高血钠的综合疗效。
Background:Observational studies suggest that hepatorenal syndrome(HRS)patients who receive pharmacological therapy before orthotopic liver transplantation display a post-transplant outcome similar to those without HRS.The aim of this study was to comprehensively compare and rank the pharmacological therapies for HRS.Methods:We reviewed PubMed,Elsevier,Medline,and the Cochrane Central Register of Controlled Trials(CENTRAL)for studies that were published between 1 January 1999 and 24 February 2018.The primary endpoint was reversal of HRS.The secondary endpoints were the changes in serum creatinine(Scr)and serum sodium.We evaluated the different therapeutic strategies using network meta-analysis on the basis of Bayesian methodology.Results:The study included 24 articles with 1,419 participants evaluating seven different therapeutic strategies for HRS.The most effective treatments to induce reversal of HRS were terlipressin plus albumin,noradrenaline plus albumin,and terlipressin,which had a surface under the cumulative ranking curve(SUCRA)of 0.086,0.151,and 0.451,respectively.The top two treatments for decreasing Scr were dopamine plus furosemide plus albumin(rank probability:0.620)and terlipressin plus albumin(rank probability:0.570).For increasing serum sodium,the optimal treatment was octreotide plus midodrine plus albumin(rank probability:0.800),followed by terlipressin plus albumin(rank probability:0.544).Conclusions:Terlipressin plus albumin and dopamine plus furosemide plus albumin should be prioritized for decreasing Scr in HRS,and octreotide plus midodrine plus albumin was the most effective at increasing serum sodium.Terlipressin plus albumin showed a comprehensive effect in both decreasing Scr and increasing serum sodium.
基金
supported by the National Natural Science Foundation of China[No.H0517/81560132 and No.81970583]
the Supporting Project for the Foregoers of Main Disciplines of Jiangxi Province[No.20162BCB22023].
