目的:评价甲泼尼龙治疗乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者的临床效果及安全性。方法:运用计算机检索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、PubMed、EMbase与Cochrane Library,纳入甲泼尼龙治疗HBV-ACLF的随机对照试验(RCTs),检索截止日期为2022年2月。Meta分析采用RevMan5.4软件进行。结果:共纳入9项研究,合计727例患者。Meta分析结果显示:①试验组的血清总胆红素[MD=-60.61,95％ CI(-90.33~-30.89),P<0.05]、凝血酶原活动度[MD=13.59,95％ CI(8.15~19.04),P<0.05]、病死率[RR=0.79,95％ CI(0.63~1.00),P=0.05]和临床有效率[RR=1.21,95％ CI(1.09~1.35),P<0.05]均优于对照组;②试验组的丙氨酸氨基转移酶[MD=-201.49,95％ CI(-424.78~-21.79),P>0.05]、HBV DNA转阴率[RR=1.01,95％ CI(0.89~1.14),P>0.05]和并发症发生率[RR=0.54,95％ CI(0.25~1.18),P>0.05]与对照组比较差异无统计学意义。结论:甲泼尼龙可以有效治疗HBV-ACLF患者,促进总胆红素消退,提高凝血酶原活动度及降低短期病死率,且未增加并发症发生风险,但并不能有效改善丙氨酸氨基转移酶和HBV DNA转阴率。
Abstract
Objective:To estimate the clinical efficacy and safety of methylprednisolone therapy in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF). Methods:The published literature concerning randomized controlled trials (RCTs) of methylprednisolone therapy in patients with HBV-ACLF was retrieved from CNKI, CBM, WanFang database, PubMed, Embase, and Cochrane Library by computer before the deadline of February 2022. Meta-analysis was conducted by RevMan5.4 software. Results:A total of nine RCTs including 727 patients with HBV-ACLF were enrolled. The meta-analysis demonstrated that: firstly, the serum total bilirubin [MD=-60.61.03,95% CI (-90.33,-30.89),P<0.05], prothrombin time activity [MD=13.59,95% CI(8.15,19.04),P<0.05], fatality rate [RR=0.79,95％ CI (0.63,1.00),P=0.05] and clinical effective rate [RR=1.21,95％ CI (1.09,1.35),P<0.05] of patients in experimental group were superior to those of control group with significant differences; secondly, there were no significant differences in alanine aminotransferase [MD=-201.49,95％ CI (-424.78,-21.79),P>0.05], negative conversion rate of HBV DNA [RR=1.01,95% CI (0.89,1.14),P>0.05] and complications rate [RR=1.01,95% CI(0.89,1.14),P>0.05] between experimental group and control group. Conclusion:The current evidence shows that methylprednisolone has a better effect in treatment of patients with HBV-ACLF than that of the control group, and it can promote the total bilirubin regression, raise the prothrombin time activity and reduce short-term fatality rate without increasing the risk of complications, and does not improve the alanine aminotransferase and negative conversion rate of HBV DNA.
关键词
慢加急性肝衰竭 /
甲泼尼龙 /
乙型肝炎病毒 /
随机对照试验 /
Meta分析
{{custom_keyword}} /
Key words
methylprednisolone /
acute-on-chronic liver failure /
hepatitis B virus /
randomized controlled trials /
Meta-analysis
{{custom_keyword}} /
中图分类号：
R575
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版)[J].中华临床感染病杂志,2018,11(6):401-410.
[2] Guadalu P ,Garcia T.Acute-on-chronic liver failure: An old entity in search of clarity [J].HePatol Commun,2018,2(12):1421-1424.
[3] Gustot T.Beneficial role of G-CSF in acute-on-chronic liver failure: effects on liver regeneration inflammation/immunoParalysis or both[J]？ Liver Int,2014,34(4):484-486.
[4] Tang WL,Zhao GD,Dong ZX,et al.Prognostic risk factors and Prognosis model for liver failure[J].Infect Dis Info,2011,24(3):159-162.
[5] 韩英,崔丽娜,郭冠亚.慢加急性肝衰竭的免疫治疗[J].临床肝胆病杂志,2017,33(9):1677-1682.
[6] 纪宇欣,李树臣.应用糖皮质激素治疗肝衰竭临床疗效研究进展[J].实用肝脏病杂志,2020,23(1):10-13.
[7] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华肝脏病杂志,2013,21(3):177-183.
[8] 戴小灵,钟远辉.恩替卡韦联合甲基强的松龙冲击治疗乙型肝炎慢加急性肝衰竭的临床效果[J].河北医药,2013,35(7):1031-1032.
[9] 丁雷,韩永峰.恩替卡韦联合糖皮质激素在早期乙型肝炎相关肝衰竭中的应用[J].胃肠病学和肝病学杂志,2015,24(12):1505-1508.
[10] 龙云,刘云华,邓兰,等.糖皮质激素递减疗法治疗乙型肝炎肝衰竭患者的疗效及安全性分析[J].实用肝脏病杂志,2016,19(3):297-300.
[11] 苏日嘎.探讨小剂量糖皮质激素治疗HBV相关慢加急性肝衰竭的临床疗效[J].智慧健康,2019,5(14):152-153.
[12] 余春启.甲泼尼龙与恩替卡韦联用对乙型肝炎患者急慢性肝衰竭的临床疗效评价[J].抗感染药学,2019,16(2):345-347.
[13] 何莹,韩鑫,蔺咏梅,等.糖皮质激素联合抗病毒治疗HBV相关早期慢加急性肝衰竭的价值[J].肝脏,2020,25(6):643-645.
[14] 石协桐.小剂量糖皮质激素对乙肝相关慢加急性肝衰竭早期或重症倾向肝炎治疗效果[J].数理医药学杂志,2020,33(12):1834-1835.
[15] Zhao J,Zhang JY,Yu HW,et al.Improved survival ratios correlate with myeloid dendritic cell restoration in acute-on-chronic liver failure Patients receiving methylprednisolone therapy[J].Cell Mol Immunol,2012,9(5):417-422.
[16] Jia L,Xue R,Zhu Y,et al.The efficacy and safety of methylprednisolone in the Patitis B virus-related acute-on-chronic liver failure: a prospective multi-center clinical trial[J].BMC Med,2020,18(1):383.
[17] Liu J,Liang W,Jing W,et al.Countdow to 2030: eliminating hePatitis B disease,China[J].Bull World Health Organ,2019,97(3):230-238.
[18] 中华医学会感染病学分会,中华医学会肝病学分会.慢性乙型肝炎防治指南(2019年版)[J].中华传染病杂志,2019,37(12):711-736.
[19] Zhao RH,Shi Y,Wu W,et al.Acute-on-chronic liver failure in chronic hePatitis B: an uPdate [J].Expert Rev Gastroenterol Hepatol,2018,12(4):341-350.
[20] 黄湛镰,高志良.肝衰竭的三重打击及治疗策略[J].内科急危重症杂志,2014,20(3):154-156.
[21] Chen JF,Wang KW,Zhang SQ,et al.Dexamethasone in outcome of Patients with hePatitis B virus-related acute-on-chronic liver failu-re[J].J Gastroenterol Hepatol,2014,29(4):800-806.
[22] 董金玲,贾琳,杨君,等.HBV相关慢加急性肝衰竭患者糖皮质激素受体表达特征及其与疗效的关系[J].临床肝胆病杂志,2020,36(6):1252-1257.
[23] 杨君,胡中杰,侯维,等.糖皮质激素联合核苷(酸)类似物治疗对乙型肝炎病毒相关肝衰竭临床疗效的Meta分析[J].中国肝脏病杂志(电子版),2020,12(2):52-59.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
基金
*绵阳市中心医院2022年度孵化课题(No.2022FH014)
{{custom_fund}}
PDF(3841 KB)
