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Fatality and adverse event rates of prostaglandin E in treating acute liver failure: a meta- analysis
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摘要:
目的评价前列腺素E(PGE)与安慰剂治疗急性肝衰竭(ALF)的病死率及不良反应的发生率。方法计算机检索Cochrane Library、MEDLINE、EMBASE、VIP、CNKI、CBM等数据库,查找比较PGE和安慰剂治疗ALF的随机对照试验,检索时间从建库截止2012年4月,无语言和出版物限制。对符合条件的随机对照试验,由两位研究者独立进行资料提取和质量评价后,采用RevMan5.1软件进行Meta分析,并采用GRADE系统对证据质量和等级推荐进行分级。结果共2项随机对照临床试验包括59例患者符合纳入标准。Meta分析结果显示与安慰剂相比,PGE不能降低病死率,(RR=0.99,95%CI:0.62~1.57,P=0.96)。不良事件均轻微,但未具体报道发生率。GRADE系统评价结果显示,证据水平为低级,推荐等级为弱推荐。结论此系统评价结果显示,PGE不能降低ALF的病死率。鉴于该系统评价为二次研究,纳入分析的原始文献质量不一,而且评价过程也可能存在偏倚,上述结论尚需进一步开展大规模、高质量的基础和临床研究来验证。
Abstract:Objective To evaluate the fatality and adverse event rates of prostaglandin E ( PGE) versus placebo in treating acute liver failure ( ALF) . Methods A search was performed using Cochrane Library, MEDLINE, EMBASE, VIP, CNKI, CBM, and other electronic databases to select randomized controlled trials ( RCTs) for comparing PGE and placebo in treating ALP published up to April 2012. There were no limits to language and publication. Data extraction and quality evaluation were performed independently by two researchers for the RCTs meeting inclusion criteria; a meta- analysis was performed with RevMan 5. 1 software, and the GRADE system was used to grade the quality of evidence and strength of recommendation. Results Two RCTs involving 59 cases met the inclusion criteria. Compared with the placebo, PGE could not reduce the fatality rate ( RR = 0. 99; 95% CI: 0. 62- 1. 57; P = 0. 96) , as demonstrated by the meta- analysis.Both interventions caused slightly adverse events, but no incidence rate was reported. Based on the GRADE system, the quality of evidence was low ( 2C) , and the strength of recommendation was weak. Conclusion PGE cannot reduce the fatality of ALF, according to the systematic review. Large- scale, high- quality basic and clinical researches should be performed to confirm the conclusion because the systematic review is secondary study, the literature included has low quality of evidence, and there may be bias in review.
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Key words:
- live failure, acute /
- prostaglandins E /
- Meta-analysis
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