PDF下载 ( 2626 KB)
Meta-analysis of the efficacy and complications of glucocorticoids in patients with severe hepatitis-related liver failure
-
摘要:
目的采用荟萃分析法评价糖皮质激素治疗重型肝炎肝衰竭的疗效差异、副作用、安全性。方法计算机检索近20年网络、数据库中有关激素治疗重型肝炎肝衰竭的临床随机对照试验。RevMan5.0软件对入选试验进行分析。结果本文纳入29个病例对照研究,共1852例重型肝炎患者。文献质量经改良Jadad评分平均为2.69分。Meta分析:治疗组患者生存率、好转率明显高于对照组;治疗组患者黄疸消退时间、消化道症状消退时间、总胆红素、凝血酶原时间明显低于对照组。治疗组患者继发性感染、消化道出血、肝肾综合征的发生率均低于对照组;两组对比腹水发生率、肝性脑病发生率差异无统计学意义(P>0.05)。结论本文纳入的文章时间跨度大、依照的诊断标准不同、RCT样本量少、部分研究两组患者数量差距大均导致某些分析的统计学同质性差(F>50%),并影响到了结果准确性。故本文Meta分析结论仍需大样本量实验分析验证。
Abstract:Objective To perform a meta-analysis evaluation of the efficacy, safety, and complications of glucocorticoid monotherapy in patients with hepatitis-related liver failure.Methods The databases of Chinese Scientific Journal (VIP) , Chinese Medical Periodical Literature (CMCC) , China Medical Citation (CMCI) , PubMed, and Google Scholar were searched for relevant randomized controlled trials (RCTs) published between January 1991 and February 2012.Meta-analyses were carried out by RevMan 5.0 software.The main outcome measures were survival rate and improvement rate.Secondary measures were jaundice, gastrointestinal symptoms, total bilirubin (TBil) , and prothrombin time (PT) .Hormone therapy side-effects were also assessed.Results Twenty-nine RCTs composed of 1852 severe hepatitis cases were included in the analysis.The average modified Jadad score of these trials was 2.69.Meta-analysis showed that both the survival rate and the improvement rate were significantly higher for glucocorticoid-treated patients than for patients in the control group.In addition, glucocorticoid treatment led to significantly shorter time to regression of jaundice and gastrointestinal symptoms, significantly lower TBil and PT values, and lower rates of secondary infection, gastrointestinal hemorrhage, and hepatorenal syndrome.The glucocorticoid-treated group did not show a significantly different rate of ascites or hepatic encephalopathy, compared with the control group (P>0.05) .Conclusion Glucocorticoid treatment is efficacious and safe for relieving symptoms of liver failure in patients with severe hepatitis.However, more RCTs of high quality and with large case and control populations are required to verify this conclusion.
-
Key words:
- glucocorticoids /
- liver failure /
- meta-analysis
-
[1]Tillmann HL, Zachou K, Dalekos GN.Management of severe a-cute to fulminant hepatitis B:to treat or not to treat or when totreat?[J]Liver Int, 2012, 32 (4) :544-553. [2]Lee WM.Acute liver failure[J].Semin Respir Crit Care Med, 2012, 33 (1) :36-45. [3]李梦东, 聂青和.糖皮质激素治疗重型肝炎的临床及实验研究[J].实用肝脏病杂志, 2005, 8 (1) :1-6. [4]聂青和.重型肝炎综合治疗进展的临床教学实践及体会[J].实用肝脏病杂志, 2006, 9 (2) :104-106. [5]甘苏琴, 龙尧.糖皮质激素治疗重型乙型肝炎的研究进展[J].医学综述, 2011, 17 (12) :1856-1858. [6] 中华医学会传染病与寄生虫病学分会及肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志, 1985, 3 (3) :192. [7]第五次全国传染病与寄生虫病学术会议.病毒性肝炎防治方案[J].中华内科杂志, 1995, 3 (4) :788. [8]中华医学会传染病与寄生虫病学分会及肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329. [9]聂青和.临床荟萃分析的特点及应用价值[J].中国实用内科学杂志, 2006, 26 (7) :544-546. [10]程良斌, 晏雷生, 张赤志.激素对重型肝炎患者血清TNFα和slL-2R的影响[J].世界华人消化杂志, 2000, 8 (11) :1322. [11]刘艳丽.糖皮质激素治疗重型肝炎临床分析[J].中国实用医药, 2008, 3 (1) :116. [12]陈从新, 刘波, 郭顺明.应用糖皮质激素治疗慢性乙型肝炎重度患者阻断坏死性肝炎的发生[J].热带病与寄生虫学, 2004, 2 (2) :68-74, 105. [13]李伟红, 吴莹.激素冲击疗法治疗亚急性重型肝炎疗效观察[J].中国基层医药, 2006, 13 (1) :163-164. [14]杨钢, 李梦东, 顾长海.糖皮质激素治疗重型肝炎的临床研究[J].四川医学, 1991, 12 (4) :198-200. [15]许宏旺.糖皮质激素治疗重症肝炎50例临床观察[J].医学文选, 1995, 16 (3) :203-204. [16]龚诗.小剂量糖皮质激素治疗早期重症肝炎的疗效观察[J].中国热带医学, 2011, 11 (3) :377-378. [17]顾锡炳, 刘海肃, 曹立森.糖皮质激素与强力宁对重型肝炎患者T细胞亚群的影响及临床意义[J].临床肝胆病杂志, 2004, 20 (5) :297-298. [18]李映菊, 汪煜华, 彭忠田.糖皮质激素治疗早期重型肝炎最佳方案初探[J].南华大学学报医学版, 2010, 38 (1) :80-83. [19]程峰涛, 程朝辉.糖皮质激素治疗中老年重型肝炎30例疗效分析[J].中国临床药理学与治疗学杂志, 1997, 2 (2) :153-154. [20]吴樟其.糖皮质激素治疗重型肝炎的疗效分析[J].中国乡村医生杂志, 1999, 15 (8) :38-39. [21]梁艳丽, 梅存金, 程辉.糖皮质激素治疗重型肝炎的疗效评价[J].淮海医药, 2008, 26 (3) :200-201. [22]杨文龙, 刘武, 李涛.小剂量糖皮质激素治疗早期重型肝炎临床疗效观察[J].国外医学流行病学传染病学册, 2005, 32 (5) :265-266. [23]严俊, 茹仁萍.甲泼尼龙治疗重型肝炎前期31例[J].临床医药, 2008, 17 (3) :42-43. [24]周先珊, 万谟彬, 薛建亚.抗病毒基础上应用糖皮质激素治疗慢性重型乙型肝炎临床分析[J].临床肝胆病杂志, 2008, 24 (2) :101-103. [25]丁虹, 董峰.拉米夫定与糖皮质激素治疗慢性重型肝炎的疗效观察[J].肝脏, 2008, 13 (1) :93-94. [26]李丽军, 李铭, 李卫.使用激素治疗重型肝炎价值的再探讨[J].实用肝脏病杂志, 2006, 9 (3) :163-164. [27]侯丽.糖皮质激素在慢性重型肝炎早期的应用评价[J].四川医学, 2005, 26 (10) :1160. [28]善财仁, 徐成芬, 崔尧丽.糖皮质激素治疗32例慢性重型肝炎前期疗效观察[J].寄生虫病与感染性疾病, 2006, 4 (2) :390. [29]邰立慧.糖皮质激素治疗早期重型肝炎疗效观察[J].右江医学, 2003, 31 (4) :390. [30]陈效鹏, 陈兰翠, 吴同生.糖皮质激素治疗重型肝炎57例疗效分析[J].中国医师杂志, 1999, 1 (10) :46. [31]孙勤.糖皮质激素治疗早期肝衰竭的临床观察与护理[J].中国医药指南, 2009, 7 (20) :145-146. [32]凌晓芳.腺苷蛋氨酸联合甲基泼尼松龙治疗肝衰竭的疗效观察[J].中国民族民间医药, 2009, 18 (12) :55-55, 58. [33]戴玮玮.腺苷蛋氨酸联合泼尼松龙治疗肝衰竭患者的临床分析[J].中国现代医药杂志, 2008, 10 (11) :65-66. [34]谭善忠, 徐乾, 杨觉民.足三里穴位注射小剂量地塞米松治疗肝衰竭早期疗效分析[J].中西医结合肝病杂志, 2009, 19 (4) :241-243. [35]刘波, 董静, 杨家宏.糖皮质激素联合生长激素治疗慢加亚急性肝衰竭临床观察[J].实用肝病学杂志, 2009, 12 (5) :350-351, 354. [36]吴锦瑜, 黎明, 张华.糖皮质激素治疗对早期肝衰竭患者转归的影响[J].南方医科大学学报, 2011, 31 (3) :554-556. [37]吴广利, 王伟, 刘同刚.糖皮质激素治疗非感染性亚急性肝衰竭的临床观察[J].实用肝病学杂志, 2010, 15 (1) :68-69. [38]陈国春, 童学成, 巢为农.糖皮质激素治疗早、中期肝衰竭临床疗效观察[J].中国血液流变学杂志, 2010, 20 (4) :600-601, 605. [39]陈从新, 郭顺明, 刘波, 等.糖皮质激素阻断慢性乙型肝炎肝衰竭发生的临床对照观察[J].中华肝脏病杂志, 2003, 11 (1) :37-40. [40] 聂青和.糖皮质激素在肝衰竭治疗中的地位[J].中华肝脏病杂志, 2012, 20 (6) :414-415. -
本文二维码
计量
- 文章访问数: 2492
- HTML全文浏览量: 12
- PDF下载量: 824
- 被引次数: 0
下载:
