异甘草酸镁与多烯磷脂酰胆碱治疗脂肪肝疗效与安全性的Meta分析

Efficacy and Safety of Magnesium Isoglycyrrhetate Andpolyene Phosphatidylcholine in the Treatment of Fatty Liver Disease:A Meta Analysis

目的系统评价异甘草酸镁与多烯磷脂酰胆碱治疗脂肪肝的疗效与安全性。方法计算机检索PubMed、Medline、EMbase、The Cochrane Library、Ovid、中国知网、VIP Date、万方数据库、SinoMed、中国临床试验注册中心、美国国家医学图书馆临床试验注册数据等数据库,纳入异甘草酸镁和多烯磷脂酰胆碱治疗脂肪肝患者效果对比的随机对照研究与临床试验,检索时限均为建库至2023年3月15日。由2名研究者独立筛查文献、提取资料并评价纳入研究的偏倚风险,采用Revman 5.4软件进行Meta分析。结果经筛选最终纳入文献24篇,合计2303例患者。Meta分析结果显示:在改善脂肪肝患者肝功能与血脂方面异甘草酸镁显示出更好的疗效,丙氨酸氨基转移酶〔MD=-18.45,95%CI(-20.45,-16.44),P<0.00001〕、天冬氨酸氨基转移酶〔MD=-19.39,95%CI(-21.84,-16.94),P<0.00001〕、总胆红素〔MD=-9.08,95%CI(-10.15,-8.00),P<0.00001〕、谷氨酰转移酶〔MD=-5.23,95%CI(-7.09,-3.38),P<0.00001〕、总胆固醇〔MD=-2.63,95%CI(-3.07,-2.20),P<0.00001〕、甘油三酯〔MD=-0.92,95%CI(-0.97,-0.87),P<0.00001〕。在治疗脂肪肝的总有效率方面异甘草酸镁效果更好〔RR=1.23,95%CI(1.19,1.27),P<0.00001〕。安全性方面:纳入研究显示异甘草酸镁不良反应发生率更低〔RR=0.41,95%CI(0.26,0.66),P=0.0002〕。结论异甘草酸镁在降低脂肪肝患者肝功能指标与血脂指标方面显示出更加好的效果,且不良反应发生可能性更低。异甘草酸镁与多烯磷脂酰胆碱治疗脂肪肝的疗效尚需设计结局判定更为合理、质量高的大样本、多中心、随机双盲的试验验证。

Objective To evaluate the efficacy and safety of magnesium isoglycyrrhetinic acid and polyene phosphatidylcholine in the treatment of fatty liver.Methods PubMed,Medline,EMbase,the Cochrane Library,Ovid,CNKI,the VIP database,Wanfang Data,SinoMed,China Clinical Trial Registration Center,National Library of Medicine Clinical Trial Registration Data and other databases were searched for randomized controlled studies and clinical trials published by March 15,2023 that compared the efficacy of magnesium isoglycyrrhizinate and polyene phosphatidylcholine in treating patients with fatty liver.Two researchers independently screened the literature,retrieved the data,and evaluated the risk of bias included in the study.Meta-analysis was conducted using Revman 5.4 software.Results After screening,24 articles were included,involving a total of 2303 patients.Meta analysis results showed that magnesium isoglycyrrhetinic acid showed better efficacy in improving liver function and blood lipids in patients with fatty liver disease,as evidenced by levels of alanine aminotransferase〔MD=-18.45,95%CI(-20.45,-16.44),P<0.00001〕,aspartate aminotransferase〔MD=-19.39,95%CI(-21.84,-16.94),P<0.00001〕,total bilirubin〔MD=-9.08,95%CI(-10.15,-8.00),P<0.00001〕glutamyltransferase〔MD=-5.23,95%CI(-7.09,-3.38),P<0.00001〕,total cholesterol〔MD=-2.63,95%CI(-3.07,-2.20),P<0.00001〕and triglycerides〔MD=-0.92,95%CI(-0.97,-0.87),P<0.00001〕.In terms of safety,the incidence of adverse reactions was lower with magnesium isoglycyrrhetinic acid〔RR=0.41,95%CI(0.26,0.66),P=0.0002〕.Conclusion Agnesium isoglycyr-rhetinic acid shows a better effect in reducing liver function indicators and blood lipid indicators in patients with fatty liver,and the odds of adverse reactions are lower.The efficacy of agnesium isoglycyrrhetinic acid and polyene phosphatidylcholine in the treatment of fatty liver needs to be verified by large-sample,multi-center,randomized and double-blind trials that are better-designed.