糖皮质激素治疗肝衰竭疗效及安全性的Meta分析

目的 系统评价糖皮质激素治疗肝衰竭患者的疗效和安全性。方法 计算机检索PubMed、Cochrane Library、中国期刊全文数据库 （CNKI）、中国生物医学文献数据库（CBM）万方数据库和中文科技期刊全文数据库（VIP）发表的以糖皮质激素为干预措施治疗肝衰竭患者的随机对照试验,检索时间截止2015年1月。由两名研究者按照纳入标准独立筛选文献、提取资料、评价质量并交叉核对,采用RevMan 5.2软件进行Meta分析。结果 共纳入16篇文献,包括1148例肝衰竭患者。Meta分析结果显示,与一般对症支持治疗比,糖皮质激素可以明显提高治疗有效率RR=1.42,95%CI（1.27,1.58）,P<0.00001]、降低TBILMD=-84.36, 95%CI（-115.70,-53.02）,P<0.00001]、升高PTAMD=16.96, 95%CI（3.46,30.47）,P=0.01]、降低早期肝衰竭患者的病死率RR=0.29, 95%CI（0.20,0.43）,P<0.00001],但在降低ALT、感染、出血发生率方面无统计学差异;漏斗图结果示图形对称性一般,可能存在发表偏倚。结论 糖皮质激素治疗肝衰竭较一般治疗疗效好,可减少早期肝衰竭患者的病死率,合理使用激素不增加不良反应发生率。

Efficacy and safety of glucocorticoids in treatment of patients with hepatic failure:A Meta-analysis

Objective To systematically review the clinical efficacy and safety of glucocortioids in treatment of patients with hepatic failure. Methods Databases including PubMed,The Cochrane Library,CNKI,VIP,WanFang Data were searched for the studies on glucocorticoids for the treatment of patients with hepatic failure from inception to January 1st,2015. Two reviewers independently screened literatures,extracted data and evaluated methodological quality. Then meta-analysis was conducted by using RevMan 5.2 software. Results A total of 16 studies involving 1148 patients were included. The Results of meta-analysis showed that the glucocorticoids can significantly improve the total curative effect RR=1.42,95%CI（1.27,1.58）,P<0.00001],reduce serum bilirubin levels MD=-84.36,95%CI（-115.70,-53.02）,P<0.00001],improve PTA MD=16.96,95%CI（3.46,30.47）,P=0.01], and significantly reduced mortality RR=0.29,95%CI（0.20,0.43）,P<0.00001];The adverse events such as infections and bleedings had not significantly increased;Funnel plot showed the graph was symmetrical and might exist publication bias. Conclusions Gorticosteroids is more effective than the general supporting treatment for patients with hepatic failure, as it can reduce the mortality rate without increasing the adverse events.