人血白蛋白与人工胶体对肝硬化腹水患者引流后疗效比较的Meta分析

目的评估肝硬化合并腹水患者引流后输注白蛋白与人工胶体的疗效差别。方法计算机检索lochrane Library(1993年-2018年2月)、PubMed (1966年-2018年2月)、Embase (1990年-2018年2月)、中国期刊全文数据库(1994年-2018年2月)、中国生物医学文献数据库(1978年-2018年2月)、中文科技期刊数据库(1989年-2018年2月)、中华医学会数字化期刊库(1997年-2018年2月),同时手检相关期刊和会议论文集,纳入有关肝硬化合并腹水患者腹水引流后输注白蛋白与人工胶体的的随机对照试验,按Jadad改良法Cochran系统评价方法提取资料、评价文献质量并进行统计学分析,数据采用RevMan5. 3软件进行Meta分析。结果共纳入7篇随机对照试验,共696例患者,其中人血白蛋白组299例,人工胶体组397例。Meta分析结果显示,白蛋白组低钠血症发生率低于人工胶体组,差异有统计学意义11. 04%vs 20. 4%,相对危险度(RR)=0. 58,95%可信区间(95%CI):0. 40~0. 84,P=0. 004];对于并发症肾损伤、肝性脑病、消化道出血、腹腔感染、住院病死率的发生,差异均无统计学意义(7. 02%vs 7. 81%,RR=0. 93,95%CI:0. 53~1. 65,P=0. 82; 6. 77%vs 7. 45%,RR=0. 87,95%CI:0. 48~1. 55,P=0. 63;3. 91%vs 3. 65%,RR=0. 97,95%CI:0. 43~2. 22,P=0. 95; 5. 22%vs 4. 56%,RR=1. 07,95%CI:0. 52~2. 18,P=0. 86;12. 78%vs 14. 59%,RR=0. 70,95%CI:0. 47~1. 02,P=0. 06)。结论输注人血白蛋白在预防肝硬化腹水患者腹水引流后低钠血症方面有优势。

Clinical effect of human serum albumin versus artificial colloidal fluid in patients with cirrhotic ascites undergoing drainage:A Meta-analysis

Objective To investigate the clinical effect of infusion of albumin versus artificial colloidal fluid after ascites drainage in patients with liver cirrhosis and ascites. Methods Cochrane Library( from 1993 to February 2018) PubMed( from 1966 to February 2018),Embase( from 1990 to February 2018),Chinese Scientific Journal Full-Text Database( from 1994 to February 2018),CBM( from 1978 to February 2018),China Science and Technology Journal Database( from 1989 to February 2018),Chinese Medical Association Digital Periodical Database( from 1997 to February 2018),and related periodicals and conference proceedings were searched for randomized controlled trials( RCTs) on infusion of albumin and artificial colloidal fluid after ascites drainage in patients with liver cirrhosis and ascites. The modified JADAD method and Cochrane systematic review were used for data extraction and literature quality assessment,and a statistical analysis was performed. RevMan 5. 3 was used for the Meta-analysis. Results A total of 7 RCTs with 696 patients were included,with 299 patients in the human serum albumin group and 397 in the artificial colloidal fluid group. The human serum albumin group had a significantly lower incidence rate of hyponatremia than the artificial colloidal fluid group( 11. 04% vs 20. 4%,risk ratio RR]= 0. 58,95% confidence interval CI]: 0. 40-0. 84,P = 0. 004). There were no significant differences between the two groups in the incidence rates of kidney injury( 7. 02% vs 7.81%,RR =0.93,95%CI: 0.53-1.65,P =0.82),hepatic encephalopathy( 6. 77% vs 7. 45%,RR = 0. 87,95% CI: 0. 48-1. 55,P = 0. 63),gastrointestinal bleeding( 3. 91% vs 3. 65%,RR = 0. 97,95% CI: 0. 43-2. 22,P = 0. 95),abdominal infection( 5. 22% vs 4. 56%,RR = 1. 07,95% CI: 0. 52-2. 18,P = 0. 86),and hospital death( 12. 78% vs 14. 59%,RR = 0. 70,95% CI:0. 47-1. 02,P = 0. 06). Conclusion Human albumin has an advantage over artificial colloidal fluid in reducing hyponatremia after ascites drainage in patients with cirrhotic ascites.