熊去氧胆酸治疗新生儿高胆红素血症的文献分析

Literature analysis of ursodeoxycholic acid treatment for neonatal hyperbilirubinemia

目的Meta分析熊去氧胆酸(ursodeoxycholic acid,UDCA)治疗新生儿高胆红素血症的临床疗效。方法在中国知网、万方、维普、Pub Med/MEDLINE及Scopus等中英文数据库中检索,筛选出2010—2023年期间有关UDCA用于高胆红素血症新生儿治疗的随机对照试验,对文献质量评价,提取相关文献研究资料,采用Review Manager 5.4统计软件对筛选出的文献进行Meta分析,以探讨UDCA联合蓝光治疗新生儿高胆红素血症的临床疗效。结果筛出符合研究的6篇随机临床试验文献,包括1篇中文与5篇英文文献。文献中的对照组新生儿总计371例,均行蓝光照射疗法;试验组总计439例,均行UDCA+蓝光照射疗法。文献的I2值均>50%且P值均<0.10时,表示存在异质性,采用随机效应模型;经Meta分析,试验组新生儿在治疗后不同时间段的总胆红素水平均明显低于对照组(P<0.05);且试验组光疗持续时间也明显短于对照组(MD=-19.15,95%CI:-20.80~-17.50,P<0.01)。结论相较于传统的蓝光疗法,联合UDCA治疗能进一步促进高胆红素血症患儿的胆红素水平下降,缩短光疗时间。

Objective To meta-analyze the clinical efficacy of ursodeoxycholic acid(UDCA)in the treatment of neonatal hyperbilirubinemia.Methods Studies from Chinese and English databases such as CNKI,Wanfang,VIP,PubMed/MEDLINE,and Scopus were retrived,randomized controlled trials of UDCA for the treatment of hyperbilirubinemia in newborns from 2010 to 2023 were selected.The quality of the literature was evaluated and relevant research data were extracted.Review Manager 5.4 statistical software was used to perform a meta-analysis on the selected literature to explore the clinical efficacy of UDCA combined with phototherapy in the treatment of neonatal hyperbilirubinemia.Results A total of 6 RCT articles that met the requirements were screened out in this study,including 1 Chinese article and 5 English articles.The control group in all the literature consisted of a total of 371 neonates who were treated with blue light irradiation,while the experimental group consisted of a total of 439 neonates who were treated with UDCA plus blue light irradiation.Heterogeneity analysis showed that when the I2 value of the literature was greater than 50%and the P value was less than 0.10,heterogeneity was present,and a random effects model was used for analysis.The results of the meta-analysis showed that the total bilirubin levels in the experimental group neonates were significantly lower than those in the control group neonates at 12,24,48,and 72 hours after treatment(P<0.05);and the duration of phototherapy in the experimental group neonates was also significantly shorter than that in the control group(MD=-19.15,95%CI:-20.80,-17.50,P<0.01).Conclusions Compared with traditional blue light irradiation for neonatal hyperbilirubinemia,combined with UDCA treatment can further promote the reduction of total bilirubin level and reduce the time of phototherapy.