五种保肝药物对药物性肝损害的疗效分析:一项网状Meta分析研究

目的:运用网状Meta分析方法比较双环醇、异甘草酸镁等5种保肝药物治疗药物性肝损害的疗效差异。方法:检索中国期刊网数据库(CNKI)、万方数据平台、EMBASE、PubMed数据库,收集相关的临床试验文献,对文献进行质量评价,使用STATA14软件network程序包实现网状meta分析。结果:共纳入20篇文献,1798例DILI患者入选,网状Meta分析结果显示,与还原型谷胱甘肽相比,有效率方面各干预药物无显著性差异。异甘草酸镁在降低ALT水平方面一致性模型的拟合结果(MD=-23.38,95%CI=-35.24,-11.52],P<0.05)显著优于还原型谷胱甘肽。在降低AST水平方面,异甘草酸镁同样显著优于还原型谷胱甘肽(MD=-18.73,95%CI=-29.52,-7.95], P <0.05)。对于TBIL下降程度,一致性模型拟合结果未见显著性差异。概率排序为,有效率由高到低的顺序为:硫普罗宁>双环醇>还原型谷胱甘肽>甘草酸二铵≈异甘草酸镁。降低ALT水平的顺序为:异甘草酸镁>双环醇>硫普罗宁>甘草酸二铵≈还原型谷胱甘肽。降低AST水平的顺序为:异甘草酸镁>硫普罗宁>双环醇>甘草酸二铵≈还原型谷胱甘肽。降低TBIL水平的顺序为:双环醇>硫普罗宁>还原型谷胱甘肽>异甘草酸镁>甘草酸二铵。结论:五种保肝药物中硫普罗宁的有效率最高,异甘草酸镁在降低ALT、AST水平方面的作用强于其他四种药物,双环醇降低TBIL作用最强。可见,异甘草酸镁更擅长调控ALT、AST水平,双环醇更擅长对TBIL的调控。

Efficacy of five hepatoprotective drugs in patients with drug induced liver injury: a network meta-analysis

OBJECTIVE To evaluate the effect of five kinds of hepatoprotective drugs such as bicyclol and magnesium isoglycyrrhizinate in patients with drug induced liver injury.METHODS CNKI, WANFANG, Embase and Pubmed were searched to collect clinical trial literatures. After assessing these literatures, Meta-analysis was conducted by STATA 14.RESULTS Totally 20 clinical trial literatures and 1 798 patients were involved in this network meta-analysis. Results of network Meta-analysis showed that, compared with reduced glutathione, there was no significant difference in effective rate among all intervention drugs. Magnesium isoglycyrrhizinate (MD=-23.38, 95% CI=[-35.24, -11.52], P < 0.05) was superior to reduced glutathione in reducing ALT level. Magnesium glutathione (MD=-18.73, 95%, CI=[-29.52, -7.95], P < 0.05) was also superior to reduced glutathione in reducing AST level. In the degree of TBIL decline, there was no significant difference among all intervention drugs. The probability ranking of effective rate:tiopronin > bicyclol > reduced glutathione > diammonium glycyrrhizinate≈magnesium isoglycyrrhizinate. The probability ranking of the ability to reduce ALT:magnesium isoglycyrrhizinate > bicyclol > tiopronin > diammonium glycyrrhizinate≈reduced glutathione. The probability ranking of the ability to reduce AST:magnesium isoglycyrrhizinate > tiopronin > bicyclol > diammonium glycyrrhizinate≈reduced glutathione. The probability ranking of the ability to reduce TBIL:bicyclol > tiopronin > reduced glutathione > magnesium isoglycyrrhizinate > diammonium glycyrrhizinate.CONCLUSION Tiopronin has the highest efficiency. Magnesium isoglycyrrhizinate significantly decreases the levels of ALT and AST compared with the other four drugs. Bicyclol significantly decreases the level of TBIL.