熊去氧胆酸治疗非酒精性脂肪性肝病的系统评价  

Efficacy of ursodesoxycholic acid in treatment of nonalcoholic fatty liver disease:A meta-analysis

作　　者：李韦[1] 王枫[2] 吕宗舜[1] 张爱青[1] 

机构地区：[1]天津医科大学总医院消化科,天津市300052 [2]天津市人民医院消化科,天津市300121

出　　处：《世界华人消化杂志》2013年第23期2335-2343,共9页World Chinese Journal of Digestology

摘　　要：目的:对熊去氧胆酸治疗非酒精性脂肪性肝病(non alcoholic fatty liver disease,NAFLD)的有效性及安全性进行评价.方法:在Pubmed、Embase、OVID、Cochrane Library和中国期刊全文数据库,万方数据库系统中检索已发表的关于单独应用熊去氧胆酸及联合其他药物治疗NAFLD的随机对照临床试验.根据纳入标准筛选后对纳入的研究利用Review Manager 5.0软件进行系统评价.结果:与熊去氧胆酸单用组相比,联合用药组可明显提高治疗总有效率(RR=1.23,95%CI:1.07-1.41,P=0.004),可明显降低血清总胆固醇(serum total cholesterol,TC)(WMD=-1.69,95%CI:-2.77--0.62,P=0.002)、甘油三酯(triglyceride,TG)(WMD=-1.01,95%CI:-1.59--0.43,P=0.0006)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)(WMD=-22.65,95%CI:-35.27--10.04,P=0.0004)和天冬氨酸转氨酶(aspartate aminotransferase,AST)(WMD=-21.93,95%CI:-23.74--20.12,P<0.00001).单用组及联合用药组均可明显降低血清谷酰转肽酶(gamma-glutamyl transpeptidase,GGT),WMD值分别为(WMD=-21.96,95%CI:-35.73--8.18,P=0.002);(WMD=-28.80,95%CI:-51.85--5.76,P=0.01).两组不良反应发生率的差异无统计学意义(RR=2.26,95%CI:0.88-5.83,P=0.09).结论:熊去氧胆酸治疗NAFLD安全有效,但需联合其他药物才能更好地发挥作用.AIM： To evaluate the efficacy and safety of ur- sodesoxycholic acid in the treatment of nonalco- holic fatty liver disease （NAFLD）. METHODS： Randomized controlled clinical tri- als comparing the efficacy of ursodesoxycholic acid alone or in combination with other drugs versus other drugs or placebo alone in the treat- ment of NAFLD were retrieved by searching PubMed, Embase, OVID, Cochrane Library, CNKI, and Wanfang database. Review Manager 5.0 was used for meta-analysis. RESULTS： Compared to the ursodesoxycholic acid monotherapy group, the drug combination group had significantly improved total effective rate （RR = 1.23, 95%CI： 1.07-1.41, P = 0.004） and decreased serum levels of TC （WMD = -1.69,95%CI： -2.77--0.62, P = 0.002）, TG （WMD = -1.01, 95%CI： -1.59-0.43, P = 0.0006）, ALT （WMD = -22.65, 95%CI： -35.27--10.04, P = 0.0004）, and AST （WMD =- 21.93, 95%CI： -23.74--20.12, P 〈 0.00001）. The decrease in GGT was significant in both the ursodesoxycholic acid monotherapy group and drug combination group （WMD = -21.96, 95%CI： -35.73--8.18, P = 0.002; WMD = -28.80, 95%CI： -51.85--5.76, P -- 0.01）. There was no statistically significant difference in the in- cidence of adverse reactions （RR = 2.26, 95%CI： 0.88-5.83, P = 0.09）. CONCLUSION： Ursodesoxycholic acid is effec- tive and safe in the management of NAFLD, and better efficacy can be achieved when it is com- bined with other positive agents.

关 键 词：熊去氧胆酸 非酒精性脂肪性肝病 系统评价 

分 类 号：R575.5[医药卫生—消化系统]