特利加压素联合白蛋白治疗Ⅰ型肝肾综合征的疗效和安全性的评价  

Meta-analysis about the efficacy and safety of terlipressin combined with albumin in patients with type I hepato-renal syndrome

作　　者：唐东[1] 吴建新[1] 朱长红[1] 范建高[1] 

机构地区：[1]上海交通大学医学院附属新华医院消化内科,上海200092

出　　处：《胃肠病学和肝病学杂志》2010年第10期875-879,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的评价特利加压素联合白蛋白治疗肝肾综合征(hepato-renal syndrome,HRS)Ⅰ型的疗效与安全性。方法选定HRS和特利加压素和(或)白蛋白作为主题词,应用计算机检索MEDLINE、EMBASE和中国生物医学文献光盘数据库以及中国期刊全文数据库等有关临床随机对照研究(RCTs),以Cochrane协作网提供RevMan 5.0软件分析缓解率、死亡率和不良反应发生率等评价指标。结果在4 412篇文献中,筛选出6篇符合标准的研究用作分析;治疗14天统计,特利加压素联合白蛋白组治疗Ⅰ型HRS,缓解率显著高于单独应用白蛋白组(48.1%vs 13.3%;RR=3.51;95%CI=2.10～5.86;P<0.000 01);联合治疗组总死亡率较单独用药组显著降低(55.2%vs 73.6%;RR=0.75;95%CI=0.60～0.94;P=0.01);但联合用药组心律失常、痉挛性腹痛或肠缺血、胸痛、支气管痉挛和外周局部缺血等不良反应的发生率显著高于单独应用白蛋白治疗组(36.8%vs 0;RR=15;95%CI=2.08～108.06;P=0.007)。结论特利加压素联合白蛋白治疗可以显著提高Ⅰ型肝肾综合征的缓解率、减低死亡率,优于单独使用白蛋白,但良性心律失常等不良反应可能增多。Objective To evaluate the efficacy and safety of terlipressin combined with albumin in patients with type Ⅰ hepato-renal syndrome（HRS）.Methods HRS,terlipressin and（or） albumin were determined as subjects and searched in the electronic databases of MEDLINE,EMBASE,Chinese Biomedical Literature Database on Disc and China Academic Journal Fulltext Database for randomized controlled trials（RCTs）.Review manager 5.0 was used to perform the statistical analysis on the remission rate,mortality and the incidence of adverse events.Results From a total of 4 412 articles,6 RCTs which met the inclusion criteria were used for the meta-analysis.After 14 days of treatment,the remission rate was significantly higher in the group of terlipressin combined with albumin than that in albumin group（48.1% vs 13.3%;RR =3.51;95% CI =2.10 ～5.86;P 0.000 01）.Total mortality in the former group significantly decreased compared with the later group（55.2% vs 73.6%;RR = 0.75;95% CI = 0.60 ～ 0.94;P = 0.01）.However,the adverse events such as cardiac arrhythmia,abdominal cramp,chest pain,bronchus spasm and peripheral ischemia were found more common in the combined therapy group（36.8% vs 0;RR = 15;95% CI = 2.08 ～ 108.06;P = 0.007）.Conclusion Significantly higher remission rate and decreased mortality were demonstrated in type Ⅰ HRS patients treated by the combination of terlipressin and albumin,when compared with those treated by albumin alone,but more adverse events might occur in the former group.

关 键 词：肝肾综合征Ⅰ型 特利加压素 白蛋白 META分析 

分 类 号：R575.3[医药卫生—消化系统]