乙型重型肝炎并发症对重型肝炎预后影响的荟萃分析  

Meta analysis of the effect of complications in the prognosis of patients with severe hepatitis B

作　　者：姚津剑[1] 于伟玲[2] 常莹[1] 林圆圆[1] 林菊生[1] 

机构地区：[1]华中科技大学医学院附属同济医院肝病研究所,湖北武汉430030 [2]中南大学湘雅医学院附属海口医院肿瘤科

出　　处：《胃肠病学和肝病学杂志》2010年第11期1050-1053,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家重点基础研究发展计划(973项目)资助项目(2007CB512900)

摘　　要：目的荟萃分析乙型重型肝炎并发症对病人预后的影响,并探讨并发症成为乙型重型肝炎诊断标准的可能。方法检索截止到2009年11月国内公开发表的乙型重型肝炎相关的论文,提取文献中含有预后和并发症数据,包括肝性脑病、肝肾综合征、感染、上消化道出血和腹水,将上述效应量进行异质性检验,荟萃分析其合并后的效应量。结果共检索到2229篇文献通过遴选,最终有8项研究纳入荟萃分析,共包含1771例乙型重型肝炎病例。荟萃分析生存组(好转组)和死亡组中肝性脑病、肝肾综合征、感染、上消化道出血和腹水,均存在明显差异(P<0.05)。相对危险度依次肝性脑病、肝肾综合征、上消化道出血、感染和腹水。在荟萃分析中肝性脑病、感染和腹水在8项研究中具有同质性。上消化道出血和肝肾综合征有一定异质性。结论荟萃分析发现肝性脑病、肝肾综合征、感染、上消化道出血和腹水在死亡组和生存组之间有明显差异,肝性脑病、感染和腹水同质增加病人死亡率,考虑作为临床乙型重型肝炎预后判断指标。但由于各并发症发病率未超过半数,故各并发症不能作为乙型重型肝炎诊断标准。Objective To analyze the effect of complications in the prognosis of HBV-related acute liver failure through a meta-analysis of all the existing literature. Methods A comprehensive search for studies published up to 2009 was performed in Medline,CNKI and Wangfangdata databases. Variables in enrolled studies were collected by a pre-established strategy. Articles were independently reviewed by two authors. Discrepancies or disagreements,if any, on the inclusion or exclusion of studies were resolved by consulting the third author. Results Eight studies included 1 771 patients finally were enrolled in meta analysis,the total death rate was 67. 7% . In meta analysis,the incidence of complications including ascites,infection,upper gastrointestinal bleeding,hepatorenal syndrome （ HR） and hepatic encephalopathy （ HE） in survival group were significantly lower than those in the death group. The ascites,infection and HE in HBV-related acute liver failure were homogeneity in predicting the outcome,but the heterogeneity in determining the outcome existed in HR and upper gastrointestinal bleeding in our meta analysis. Conclusion The HE,ascites and infection homogenously present significantly different between survival group and death group in acute liver failure patients,while upper gastrointestinal bleeding and HR show significantly different with heterogeneity which might originate from the proportion of cirrhotic patients in the study. Proposed criteria included a complication is not reasonable due to overall incidence of acute liver failure complications,if it does,the future research might lose half information about HBV-related acute liver failure.

关 键 词：乙型重型肝炎 并发症 预后 荟萃分析 

分 类 号：R512.62[医药卫生—内科学]