保肝药物预防化疗所致药物性肝损伤的Meta 分析

目的评价预防性使用常用保肝药物对改善肿瘤化疗所致药物性肝损伤的效果。方法在Pubmed、Cochrane Library、Embase、Web of Science、中国知网、万方、维普等数据库中检索在进行抗肿瘤化疗的同时,以异甘草酸镁或双环醇或谷胱甘肽作为预防性保肝药物的临床随机对照研究,检索时间均为从数据库建库至2019年8月。对搜集到的文献进行筛选和数据提取,采用RevMan 5.3软件进行Meta分析。结果本研究共纳入12个随机对照研究,共计2230例研究对象。研究结果显示,预防性使用保肝药物可降低药物性肝损伤率(RR=0.43,95%CI:0.30~0.61,P<0.01),尤其是Ⅲ-Ⅳ度肝损伤的患者(RR=0.33,95%CI:0.25-0.43,P<0.01),并降低ALT水平(MD=-32.03,95%CI:-47.11~-16.95,P<0.01)、AST水平(MD=-25.61,95%CI:-38.15~-13.07,P<0.01)及TBIL水平(MD=-3.82,95%CI:-5.97~-1.67,P<0.01),但对ALP水平(MD=-19.90,95%CI:-54.86~15.06,P=0.26)和DBIL水平(MD=-2.09,95%CI:-5.12~0.95,P=0.18)无明显影响。结论保肝药物可能对预防化疗所致药物性肝损伤产生影响。

Preventive Effects of Hepatoprotective Drugs on Chemotherapy Drug-Induced Liver Injury:A Meta Analysis

Objective To evaluate the effects of hepatoprotective drugs(magnesium isoglycyrrhizinate,glutathione,bicyclol)in preventing drug-induced liver injury of patients with anti-cancer chemotherapy.Methods Databases including PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang and VIP were retrieved to collect clinical randomized controlled trials of prophylactic hepatoprotection with magnesium isoglycyrrhizinate or glutathione or bicyclol in anti-cancer chemotherapy.The retrieval time ranged from the establishment of the databases to August 2019.The collected literatures were screened,and the data were extracted and evaluated.RevMan5.3 software was used to perform the meta-analysis.Results Twelve RCTs were included in this study,totaling 2230 participants.Results showed that prophylactic use of hepatoprotective drugs could significantly reduce the incidence of drug-induced liver injury(RR=0.43,95%CI:0.30~0.61.P<0.01),especially the incidence ofⅢ-Ⅳdegree liver injury(RR=0.33,95%CI:0.25~0.43,P<0.01).The ALT level(MD=-32.03,95%CI:-47.11~-16.95,P<0.01),AST level(MD=-25.61,95%CI:-38.15~-13.07,P<0.01)and TBIL level(MD=-3.82,95%CI:-5.97~-1.67,P<0.01)were also reduced.However,the levels of ALP(MD=-19.90,95%CI:-54.86~15.06,P=0.26)and DBIL(MD=-2.09,95%CI:-5.12~0.95,P=0.18)showed no statistical changes.Conclusion Hepatoprotective drugs may have the preventive effects on drug-induced liver injury caused by chemotherapy.