多烯磷脂酰胆碱联合还原型谷胱甘肽治疗非酒精性脂肪性肝炎疗效和安全性的Meta分析  

Therapeutic Efficacy and Safety of Polyene Phosphatidylcholine Combined with Reduced Glutathione in the Treatment of Nonalcoholic Steatohepatitis: a Meta-analysis

作　　者：石万红 邹浩[1] 周磊[1] 康强[1] 刘立鑫[1] 王连敏[1] 冯婧星 张小文[1] Shi Wanhong;Zou Hao;Zhou Lei(Department of Hepatpbiliary Surgery,The 2nd Affiliated Hospital of Kunming Medical University,Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院肝胆外科,650101

出　　处：《医学研究杂志》2018年第11期41-48,共8页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81260084);云南省科技厅-昆明医科大学联合专项基金资助项目(2015FB056)

摘　　要：目的系统评价多烯磷脂酰胆碱联合还原型谷胱甘肽治疗非酒精性脂肪性肝炎(NASH)的治疗效果及安全性。方法计算机检索Pub Med、EMbase、Cochrane Library、中国知网、万方、维普及中国生物医学文献数据库(CBM)从建库到2017年10月前发表的有关多烯磷脂酰胆碱联合还原型谷胱甘肽治疗非酒精性脂肪性肝炎的随机对照试验。两名研究者独立,严格按照纳入和排除标准进行文献筛选。评价纳入文献的方法学质量,提取符合纳入标准的数据,采用Rev Man 5. 1软件进行Meta分析。结果共有7项试验纳入研究,共计649例NASH患者。Meta分析结果显示:与单用多烯磷脂酰胆碱或还原型谷胱甘肽相比,多烯磷脂酰胆碱联合还原型谷胱甘肽可明显改善肝功能指标:AST(MD=-17. 04,95%CI:-26. 24～-7. 83,P=0. 000)、ALT(MD=-15. 47,95%CI:-23. 34～-7. 59,P=0. 000)、TG(MD=-0. 76,95%CI:-1. 03～-0. 49,P=0. 000)、TC(MD=-0. 68,95%CI:-1. 04～-0. 33,P=0. 000)、TBi L (MD=-6. 58,95%CI:-12. 95～-0. 21,P=0. 040);降低患者BMI(MD=-1. 67,95%CI:-2. 40～-0. 95,P=0. 000)和肝脏B超评分(MD=-0. 35,95%CI:-0. 47～-0. 23,P=0. 000);提高临床总有效率(RR=1. 27,95%CI:1. 17～1. 37,P=0. 000),但并不能降低LDL水平(MD=-0. 06,95%CI:-0. 32～0. 19,P=0. 620),且不良反应少,安全性好。结论多烯磷脂酰胆碱联合还原型谷胱甘肽能够明显改善NASH患者的肝脏生化指标,如AST、ALT、TG、TC、TBi L以及降低BMI和肝脏B超评分,提高临床总有效率。个别报道存在不良反应,但发生率相对较低。故多烯磷脂酰胆碱联合还原型谷胱甘肽治疗NASH疗效好,安全性高。Abstract Objective To evaluate the clinical effectiveness and safety treatment of non -alcoholic steatohepatitis (NASH)by polyene phosphatidylcholine combining with reduced glutathione.Methods With computer,we retrieval PubMed,EMbase,Coehrane Li- brary,China national Knowledge Internet,Wanfang,Vip and China Biology medicine disc (CBM)databases to find all of the randomized controlled trials about the effectiveness and safety of polyene phosphatidylcholine combining with reduced glutathione in the treatment of NASH.The retrieval time was from the establishment of database to October,2017.Literature screening by two independent researchers was based on strict inclusion criteria and exclusion criteria.Meta -analysis was carried out using RevMan 5.1software to evaluate the quality of the methodology of the study and extract the data that met the inclusion criteria.Results Seven articles were included in the study,a total of 649patients.The Meta analysis results showed that polyene phosphatidylcholine combining with reduced glutathione significantly improve the liver function index compared with single use polyene phosphatidylcholine or reduced glutathlone:AST(MD = -17.04,95%CI:-26.24^-7.83,P=0.000),ALT(MD =-15.47,95%CI:-23.34^-7.59,P=0.000),TG(MD = -0.76,95%CI:-1.03^-0.49,P=0.000),TC(MD=-0.68,95%CI:-1.04^-0.33,P=0.000),TBiL(MD=-6.58, 95%CI :-12.95^-0.21,P =0.040);Moreover,patients with combination therapy obviously decreased BMI (MD =-1.67,95% CI:-2.40^-0.95,P=0.000)and score of liver B-ultrasound (MD=-0.35,95%CI:-0.47^-0.23,P=0.000)and improved the clinical total effective rate (RR =1.27,95%CI:1.17-1.37,P =0.000);However,the LDL levels (MD =-0.06,95% CI:-0.32-0.19,P =0.620)was not found decrease.Conclusion Polyene phosphatidyleholine combining with reduced glutathione can significantly improve the clinical total effective rate,the liver fuction and reduce BMI and score of liver B -ultrasound in patients with NASH.Adverse reactions,the low incidence,appeared in individual patients with NASH.Hence,polyene phosphatidyl

关 键 词：非酒精性脂肪性肝炎 多烯磷脂酰胆碱 还原型谷胱甘肽 META分析 

分 类 号：R575.1[医药卫生—消化系统]