糖皮质激素与己酮可可碱治疗重症酒精性肝病效果的Meta分析

杨君; 胡中杰; 朱跃科; 于红卫; 李娟; 侯维; 宁琪琪

doi:10.3969/j.issn.1001-5256.2019.07.025

糖皮质激素与己酮可可碱治疗重症酒精性肝病效果的Meta分析

DOI: 10.3969/j.issn.1001-5256.2019.07.025

首都医科大学附属北京佑安医院肝病重症医学科

基金项目:

中国初级保健基金会佑安肝病艾滋病基金(2017003)；

详细信息

中图分类号: R575
计量
- 文章访问数: 547
- HTML全文浏览量: 69
- PDF下载量: 188
- 被引次数: 0
出版历程
- 收稿日期: 2019-02-11
- 出版日期: 2019-07-20

Clinical effect of glucocorticoids versus pentoxifylline in patients with severe alcoholic liver disease: A Meta-analysis

Department of Severe Liver Disease, Beijing YouAn Hospital, Capital Medical University

Research funding:

摘要

摘要:
目的评估重症酒精性肝病患者单独以及联合应用糖皮质激素与己酮可可碱的临床疗效。方法计算机检索Pub Med、Embase、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、中华医学会数字化期刊库自建库至2018年11月中英文文献,同时手检相关期刊和会议论文集,对糖皮质激素与对照、糖皮质激素与己酮可可碱、糖皮质激素联合己酮可可碱与糖皮质激素进行分析。评估二者单独或联用对重症酒精性肝病患者28 d生存率和肝肾综合征的影响。应用比值比(OR)和95%可信区间(CI)评价结局指标。数据采用Rev Man 5. 3软件进行分析。结果共纳入22项研究的1956例患者,单用糖皮质激素的28 d病死率为25. 12%,低于对照组的30. 67%,差异有统计学意义(OR=0. 71,95%CI:0. 55～0. 93,P=0. 01)。亚组分析显示,糖皮质激素与己酮可可碱28 d病死率比较差异有统计学意义(OR=0. 68,95%CI:0. 48～0. 97,P=0. 03);糖皮质激素联合己酮可可碱与糖皮质激素28 d病死率比较,差异无统计学意义(OR=0. 92,95%CI:0. 66～...
- 糖皮质激素类 /
- 己酮可可碱 /
- 肝疾病,酒精性 /
- 肝肾综合征 /
- Meta分析
Abstract:
Objective To systematically review the clinical effect of glucocorticoids used alone or in combination with pentoxifylline in patients with severe alcoholic liver disease. Methods PubMed, Embase, Chinese Scientific Journal Full-Text Database, CBM, China Scientific Journal Database, and Chinese Medical Association Digital Journal Database were searched for related articles published up to November 2018, and related journals and collected papers from conferences were searched manually. The clinical effect of glucocorticoids versus placebo, glucocorticoids versus pentoxifylline, and glucocorticoids combined with glucocorticoids versus glucocorticoids alone was analyzed.The effect of glucocorticoids and pentoxifylline used alone or in combination on 28-day survival rate and hepatorenal syndrome in patients with severe alcoholic liver disease was assessed. Odds ratio ( OR) and 95% confidence interval ( CI) were used to evaluate outcome indicators. RevMan 5. 3 software was used for data analysis. Results A total of 22 studies were included, with 1956 patients in total. The glucocorticoid group had a significantly lower 28-day mortality rate than the control group ( 25. 12% vs 30. 67%, OR = 0. 71, 95% CI: 0. 55-0. 93, P = 0. 01) . Subgroup analysis showed that there was a significant difference in 28-day mortality rate between the glucocorticoid group and the pentoxifylline group ( OR = 0. 68, 95% CI: 0. 48-0. 97, P = 0. 03) , while there was no significant difference between the glucocorticoid + pentoxifylline group and the glucocorticoid group ( OR = 0. 92, 95% CI: 0. 66-1. 29, P = 0. 64) . Compared with the glucocorticoid group, the glucocorticoid + pentoxifylline group had a significantly lower incidence rate of hepatorenal syndrome ( 3. 94% vs8. 03%, OR = 0. 45, 95% CI: 0. 24-0. 83, P = 0. 01) . Funnel plots showed no publication bias. Conclusion Glucocorticoids combined with pentoxifylline can reduce the incidence rate of hepatorenal syndrome in patients with severe alcoholic liver disease.
- glucocorticoids /
- pentoxifylline /
- liver diseases, alcoholic /
- hepatorenal syndrome /
- Meta-analysis

HTML全文

参考文献(29)

[1]National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association;Fatty Liver Expert Committee, Chinese Medical Doctor Association.Guidelines of prevention and treatment for alcoholic liver disease:A 2018 update[J].J Clin Hepatol, 2018, 34 (5) :939-946. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会.酒精性肝病防治指南 (2018年更新版) [J].临床肝胆病杂志, 2018, 34 (5) :939-946.

[2]YANG S, XING HC, CHENG J.Comparison and interpretation of Chinese, American, and European guidelines on alcoholic liver diseases[J].J Clin Hepatol, 2018, 34 (7) :1420-1422. (in Chinese) 杨松, 邢卉春, 成军.中美欧酒精性肝病相关指南的对比与解读[J].临床肝胆病杂志, 2018, 34 (7) :1420-1422.

[3]PARKER R, ARMSTRONG MJ, CORBETT C, et al.Systematic review:Pentoxifylline for the treatment of severe alcoholic hepatitis[J].Aliment Pharmacol Ther, 2013, 37 (9) :845-854.

[4]THURSZ MR, RICHARDSON P, ALLISON M, et al.Prednisoloneor pentoxifylline for alcoholic hepatitis[J].N Engl J Med, 2015, 372 (17) :1619-1628.

[5]BLITZER BL, MUTCHNICK MG, JOSHI PH, et al.Adrenocorticosteroid therapy in alcoholic hepatitis.A prospective, double-blind randomized study[J].Am J Dig Dis, 1977, 22 (6) :477-484.

[6]BORIES P, GUEDJ JY, MIROZE D, et al.Treatment of acute alcoholic hepatitis with prednisolone 45 patients[J].Presse Med, 1987, 16 (16) :769-772.

[7]CAMPRA JL, HAMLIN EM Jr, KIRSHBAUM RJ, et al.Prednisone therapy of acute alcoholic hepatitis.Report of a controlled trial[J].Ann Intern Med, 1973, 79 (5) :625-631.

[8]CARITHERS RL Jr, HERLONG HF, DIEHL AM, et al.Methylprednisolone therapy in patients with severe alcoholic hepatitis.A randomized multicenter trial[J].Ann Intern Med, 1989, 110 (9) :685-690.

[9]DEPEW W, BOYER T, OMATA M, et al.Double-blind controlled trial of prednisolone therapy in patients with severe acute alcoholic hepatitis and spontaneous encephalopathy[J].Gastroenterology, 1980, 78 (3) :524-529.

[10]CABRE E, RODRIGUEZ-IGLESIAS P, CABALLERIA J, et al.Short-and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition:A multicenter randomized trial[J].Hepatology, 2000, 32 (1) :36-42.

[11]HELMAN RA, TEMKO MH, NYE SW, et al.Alcoholic hepatitis.Natural history and evaluation of prednisolone therapy[J].Ann Intern Med, 1971, 74 (3) :311-321.

[12]LESESNE HR, BOZYMSKI EM, FALLON HJ.Treatment of alcoholic hepatitis with encephalopathy.Comparison of prednisolone with caloric supplements[J].Gastroenterology, 1978, 74 (2 Pt 1) :169-173.

[13]MADDREY WC, BOITNOTT JK, BEDINE MS, et al.Corticosteroid therapy of alcoholic hepatitis[J].Gastroenterology, 1978, 75 (2) :193-199.

[14]MENDENHALL CL, ANDERSON S, GARCIA-PONT P, et al.Short-term and long-term survival in patients with alcoholic hepatitis treated with oxandrolone and prednisolone[J].N Engl J Med, 1984, 311 (23) :1464-1470.

[15]GOLDBERG SJ, MENDENHALL CL, CONNELL AM, et al.“Nonalcoholic”chronic hepatitis in the alcoholic[J].Gastroenterology, 1977, 72 (4 Pt 1) :598-604.

[16]PORTER HP, SIMON FR, POPE CE 2nd, et al.Corticosteroid therapy in severe alcoholic hepatitis.A double-blind drug trial[J].N Engl J Med, 1971, 284 (24) :1350-1355.

[17]RAMOND MJ, POYNARD T, RUEFF B, et al.A randomized trial of prednisolone in patients with severe alcoholic hepatitis[J].N Engl J Med, 1992, 326 (8) :507-512.

[18]SHUMAKER JB, RESNICK RH, GALAMBOS JT, et al.A controlled trial of 6-methylprednisolone in acute alcoholic hepatitis.With a note on published results in encephalopathic patients[J].Am J Gastroenterol, 1978, 69 (4) :443-449.

[19]THEODOSSI A, EDDLESTON AL, WILLIAMS R.Controlled trial of methylprednisolone therapy in severe acute alcoholic hepatitis[J].Gut, 1982, 23 (1) :75-79.

[20]SIDHU SS, GOYAL O, SINGLA M, et al.Pentoxifylline in severe alcoholic hepatitis:A prospective, randomised trial[J].JAssoc Physicians India, 2012, 60:20-22.

[21]DE BK, GANGOPADHYAY S, DUTTA D, et al.Pentoxifylline versus prednisolone for severe alcoholic hepatitis:A randomized controlled trial[J].World J Gastroenterol, 2009, 15 (13) :1613-1619.

[22]PARK SH, KIM DJ, KIM YS, et al.Pentoxifylline vs.corticosteroid to treat severe alcoholic hepatitis:A randomised, non-inferiority, open trial[J].J Hepatol, 2014, 61 (4) :792-798.

[23]MATHURIN P, LOUVET A, DUHAMEL A, et al.Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis:A randomized clinical trial[J].JAMA, 2013, 310 (10) :1033-1041.

[24]LIN SF.Prospective clinical research of efficacy of pentoxifylline in the treatment of severe alcoholic hepatitis[J].Pract Pharm Clin Remedies, 2014, 17 (7) :924-926. (in Chinese) 林素芳.己酮可可碱治疗重症酒精性肝炎的前瞻性临床研究[J].实用药物与临床, 2014, 17 (7) :924-926.

[25]LIN Y.Effect of pentoxifylline on severe alcoholic hepatitis[J].Strait Pharm J, 2011, 23 (11) :102-103.林雅.己酮可可碱治疗重症酒精性肝炎的疗效观察[J].海峡药学, 2011, 23 (11) :102-103.

[26]KIM EJ, LEE JG, KIM JY, et al.Enhanced immune-modulatory effects of thalidomide and dexamethasone co-treatment on T cell subsets[J].Immunology, 2017, 152 (4) :628-637.

[27]WANG XF, FENG GH.Research advances in glucocorticoids for the treatment of liver failure[J].J Clin Hepatol, 2018, 34 (7) :1565-1568. (in Chinese) 王秀芳, 冯国和.糖皮质激素治疗肝衰竭研究现状[J].临床肝胆病杂志, 2018, 34 (7) :1565-1568.

[28]SUK KT, KIM MY, BAIK SK.Alcoholic liver disease:Treatment[J].World J Gastroenterol, 2014, 20 (36) :12934-12944.

[29]LOUVET A, LABREUCHE J, ARTRU F, et al.Main drivers of outcome differ between short and long-term in severe alcoholic hepatitis:A prospective study[J].Hepatology, 2017, 66 (5) :1464-1473.

施引文献

资源附件(0)

访问统计