熊去氧胆酸对原发性硬化性胆管炎疗效的meta分析

目的　基于循证药学方法系统评价熊去氧胆酸（ursodesoxycholic acid，UDCA）对原发性硬化性胆管炎（primary sclerosing cholangitis，PSC）的疗效。方法　纳入国内外有关UDCA治疗PSC的试验，根据标准进行筛选，提取满足条件的高质量文献，采用Q检验及I²检验对纳入研究进行质量评价，用Stata 13.0进行分析。检索文献截止时间限定至2019年5月30日。结果　纳入5篇文献，共364例患者。与安慰剂组相比，UDCA组肝功能指标［碱性磷酸酶（ALP）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、白蛋白（ALB）和总胆红素（TBIL）］得到明显改善（SMD=-0.43，95%CI -0.65～-0.22，P<0.001；SMD=-0.90，95%CI -1.24～-0.56，P<0.001；SMD=-0.01，95%CI -0.28～0.27，P<0.001；SMD=0.00，95%CI -0.20～0.21，P<0.001；SMD=-0.31，95%CI -0.52～-0.10，P=0.001）。在免疫球蛋白（Ig）方面，UDCA能显著改善IgA（SMD=-0.02，95%CI -0.28～0.25，P=0.013），但对IgG（SMD=-0.17，95%CI -0.44～0.09，P=0.399）和IgM（SMD=0.16，95%CI -0.11～0.42，P=0.715）无明显影响。结论　UDCA可显著改善PSC患者肝功能指标，但对免疫学相关指标无明显影响。

Evaluation of ursodeoxycholic acid for primary sclerosing cholangitis: a meta-analysis

Objective　To evaluate the efficacy of ursodeoxycholic acid (UDCA) for primary sclerosing cholangitis (PSC) by the evidence-based pharmaceutical method. Methods　The trials of UDCA in the treatment of PSC published at home and abroad were collected, and high-quality literatures meeting the standards were screened and used for meta-analysis. The quality of the included studies was evaluated by Q test and I² test and analyzed by Stata 13.0. The deadline for literature publishing was May 30, 2019. Results　Five studies with a total of 364 patients were included. Liver function indexes alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), and total bilirubin (TBIL)] were significantly improved in the UDCA group compared with those in the placebo group (SMD=-0.43, 95%CI -0.65, -0.22], P<0.001; SMD=-0.90, 95%CI -1.24, -0.56], P<0.001; SMD=-0.01, 95%CI -0.28, 0.27], P<0.001; SMD=0.00, 95%CI -0.20, 0.21], P<0.001; SMD=-0.31, 95%CI -0.52, -0.10], P=0.001). In terms of immunoglobulin (Ig), UDCA significantly improved IgA (SMD=-0.02, 95%CI -0.28, 0.25], P=0.013), but had no significant effects on IgG (SMD=-0.17, 95%CI -0.44, 0.09], P=0.399) and IgM (SMD=0.16, 95%CI -0.11, 0.42], P=0.715). Conclusion　UDCA can significantly improve the liver function indexes in PSC patients, but has no significant effects on the immunological indexes.