不同剂量异甘草酸镁治疗ALT升高慢性肝病疗效的meta分析

Efficacy of different doses of magnesium isoglycyrrhizinate in the treatment of chronic liver disease with elevated ALT: a meta-analysis

目的:探讨不同剂量异甘草酸镁治疗丙氨酸转氨酶(ALT)升高的慢性肝病的疗效和安全性。方法:计算机检索中国知网、万方、PubMed数据库文献,检索时间为数据库成立至2023年2月。筛选文献、提取资料后,采用Cochrane偏倚风险评估工具对纳入文献进行质量评价,采用RevMan 5.4软件和Stata 15.0软件对ALT水平、天冬氨酸转氨酶(AST)水平、总胆红素(TBil)水平、总有效率、不良事件发生率进行分析。结果:最终纳入10篇文献,共包括1522例患者。所有纳入研究质量较好,偏倚风险较低。Meta分析结果显示,与100 mg/d异甘草酸镁注射液相比,200 mg/d异甘草酸镁注射液可显著降低患者的ALT[平均差(MD)=-30.73,95%可信区间(CI):-52.52~-8.94,Z=2.76,P=0.006;I^(2)=98%,P<0.001]、AST(MD=-34.30,95%CI:-57.78~-10.82,Z=2.86,P=0.004;I^(2)=99%,P<0.001)和TBil(MD=-15.37,95%CI:-27.66~-3.09),Z=2.45,P=0.01;I^(2)=98%,P<0.001)水平,差异均有统计学意义。7篇文献报道的总有效率,各研究间无异质性(I^(2)=0,P=0.98)。200 mg/d异甘草酸镁注射液的总有效率高于100 mg/d异甘草酸镁注射液(OR=3.49,95%CI:2.05~5.95,Z=4.59,P<0.001),且不良反应发生率比较,差异无统计学意义。结论:200 mg/d异甘草酸镁注射液可更快、更有效地改善慢性肝病患者的ALT、AST和TBil水平,总有效率增加,安全性好。

Objective To investigate the efficacy and safety profile of different doses of magnesium isoglycyrrhizinate in the treatment of chronic liver disease with elevated alanine aminotransferase(ALT).Methods Computer retrieval of literature was conducted in the CNKI,Wanfang,and PubMed databases from the establishment of the databases until February 2023.The Cochrane risk of bias assessment tool was used to evaluate the quality of the included literature after screening the literature and extracting the data.RevMan 5.4 and Stata 15.0 software were used to analyze the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),total effective rate,and incidence of adverse events.Results Finally,10 articles were selected,including a total of 1522 cases.All the included studies were of good quality and at low risk of bias.Meta-analysis results showed that compared with 100 mg/d magnesium isoglycyrrhizinate injection,200 mg/d magnesium isoglycyrrhizinate injection had significantly reduced patients'ALT[MD=-30.73,95%confidence interval(CI):-52.52~-8.94,Z=2.76,P=0.006;I^(2)=98%,P<0.001],AST(MD=-34.30,95%CI:-57.78~-10.82,Z=2.86,P=0.004;I^(2)=99%,P<0.001)and TBil(MD=-15.37,95%CI:-27.66~-3.09),Z=2.45,P=0.01;I^(2)=98%,P<0.001)levels.The total effective rate reported in seven articles showed no heterogeneity among the studies(I^(2)=0.0%,P=0.98).The total effective rate was higher in 200 mg/d magnesium isoglycyrrhizinate injection than that of 100 mg/d magnesium isoglycyrrhizinate injection(OR=3.49,95%CI:2.05~5.95,Z=4.59,P<0.001),and there was no statistically significant difference in adverse reactions.Conclusion 200 mg/d magnesium isoglycyrrhizinate injection can more rapidly and effectively improve the levels of ALT,AST,and TBil in patients with chronic liver disease,with an increased total effective rate and a good safety profile.