重型乙型肝炎预后荟萃分析  

Meta analysis on prognostic factors of patients with severe hepatitis B

作　　者：彭新国[1] 姚津剑[2] 于伟玲[2] 刘丽凤[2] 常莹[2] 林园园[2] 林菊生[2] 

机构地区：[1]滨州医学院附属医院,滨州市256603 [2]华中科技大学同济医学院附属同济医院肝病研究所

出　　处：《中华实验和临床感染病杂志（电子版）》2011年第1期10-13,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(30600277);国家重点基础研究发展计划(973计划)(2007CB512900)

摘　　要：目的荟萃分析重型乙型肝炎预后的影响因素。方法检索截至2009年11月公开发表的重型乙型肝炎相关的论文,提取其中反映预后相关的临床资料,包括总胆红素(TBil)、凝血酶原活动度(PTA)、甲胎蛋白(AFP)、肌酐水平、临床生化指标及肝性脑病情况。用随机模型分析以标准化均数差(SMD)和相对危险度(RR)为效应量进行异质性检验和统计量合并。结果 13项研究共包含重型乙型肝炎患者2429例。生存组和死亡组中,TBil、PTA、AFP、肌酐水平在荟萃分析中均存在明显差异(P<0.001)。研究中除肌酐和肝性脑病异质性差异无统计学意义,其他预后变量存在较大异质性,且异质性不能通过荟萃回归和分层降低。结论在荟萃分析中TBil、PTA、AFP、肝性脑病及肌酐在重型乙型肝炎病程中具有良好的预后判断价值。肝性脑病和肌酐水平在各研究中对预后判断的结果一致。然而TBil、PTA、AFP对预后的判断仍然存在较大的异质性。异质性可能来源于研究样本排除标准的差异,对于重型乙型肝炎的诊断需要一个纳入标准(PTA≤40%,TBil>10倍正常值上限),同时也需要相关的排除标准。这将对预后判断的准确性和诊断模型的效能有重要价值。Objective To analyze the risk factors determining the prognosis of severe hepatitis B after HBV infection.Methods Articles about severe hepatitis B published before November 2009 were retrieved and risk factors affecting prognosis of severe hepatitis B such as total bilirubin（TBil）,prothrombin activity（PTA）,alpha-fetoprotein（AFP）,creatinine and hepatic encephalopathy（HE）were summarized.Heterogeneity tests and variables merging were used to count standared mean difference and relative risk in stochastic model.Results Thirteen studies including 2429 patients with severe hepatitis B patients were summarized.In meta analysis,the levels of AFP,PTA,TBil and the incidence of HE in survival group were different from those in death group（P0.001）.In meta analysis,heterogeneity were tested in AFP,PTA,TBil and the heterogeneity were not decreased by subgrouping and meta-regression analysis.Conclusions There were homogenously significantly differences in occurrence of HE and increased creatinine between survival group and death group.The levels of PTA,TBil and AFP show significantly heterogeneity which might originated from other excluding criterion such as cirrhosis,coinfection with other virus and habitual alcoholic intake.Diagnostic criteria for severe hepatitis B to HBV infection should include a set of prognostic factors（PTA≤ 40%,TBil10 times of normal level）and also exclude some potential factors influencing prognosis of severe hepatitis B.

关 键 词：肝炎 乙型 重型 预后因素 荟萃分析 

分 类 号：R512.62[医药卫生—内科学]