不同糖皮质激素治疗措施治疗重型肝炎肝衰竭生存率及有效率对比:网状荟萃分析  

Survival rate and effective rate of different kinds of glucocorticoids-related interventions in the treatment of severe hepatitis-related liver failure: a network Meta-analysis

作　　者：汪萌[1] 聂青和[1] 

机构地区：[1]第四军医大学唐都医院全军感染病诊疗中心/传染病科,西安710038

出　　处：《胃肠病学和肝病学杂志》2016年第5期499-507,共9页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的采用网状荟萃分析和荟萃分析法评价不同糖皮质激素治疗措施治疗重型肝炎肝衰竭的长期生存率、短期生存率及有效率。方法计算机检索2000年-2016年网络数据库中有关激素治疗重型肝炎肝衰竭的临床随机对照试验。采用Rev Man 5.3软件和ADDIS 1.16.5对入选试验进行分析。结果共纳入8个病例对照研究,共692例重型肝炎肝衰竭患者。Meta分析:地塞米松(10 mg)、氢化可的松联用胸腺肽在改善短期生存率方面效果优于综合支持疗法,差异有统计学意义(P<0.05)。甲强龙联用腺苷蛋氨酸在改善长期生存率方面效果优于单用腺苷蛋氨酸,差异有统计学意义(P<0.05)。在提高治疗有效率方面,地塞米松(5 mg)、地塞米松(10 mg)的效果均优于综合支持疗法,甲强龙联用腺苷蛋氨酸优于综合支持疗法,甲泼尼龙联用腺苷蛋氨酸优于单用腺苷蛋氨酸,差异有统计学意义(P<0.05)。网状Meta分析:小剂量地塞米松(5 mg)在改善短期生存率和提高治疗有效率上的效果优于综合支持疗法,差异有统计学意义(P<0.05),其余治疗措施与综合支持疗法之间及各治疗措施之间差异均无统计学意义(P>0.05)。等级概率图联合SUCRA计算结果显示:改善短期生存率效果,地塞米松(5 mg)>氢化可的松联用胸腺肽>地塞米松(10 mg)>地塞米松联用肝素钠>氢化可的松>综合支持治疗;改善长期生存率效果,泼尼松龙联用腺苷蛋氨酸>甲强龙联用腺苷蛋氨酸>综合支持疗法>单用腺苷蛋氨酸;提高有效率效果,地塞米松(5 mg)>泼尼松龙联用腺苷蛋氨酸>甲强龙联用腺苷蛋氨酸>地塞米松(10 mg)>单用腺苷蛋氨酸>综合支持疗法。结论在治疗重型肝炎肝衰竭患者中,小剂量地塞米松(5 mg)或许在提高短期生存率、治疗有效率方面有较为出色的效果,而泼尼松龙联用腺苷蛋氨酸在提高患者长期生存率方面效果较为突出,值得临床专家在未来的临床和科研�Objective To perform a Meta-analysis and a network Meta-analysis of the survival rate and effective rate of glucocorticoids-related interventions in the treatment of severe hepatitis-related liver failure. Methods The databases of Medline, Embase, Cochrane Library, Web of Science, CBM, CNKI, VIP database, WanFang database were re- trieved with computer from 2000 to 2016 for collecting randomized controlled trials （RCTs）. Meta-analysis was carried out by RevMan 5.3 software and network Meta-analysis was carried out by ADDIS 1.16.5. The main outcome measures were short-term survival rate, long-term survival rate and effective rate. Results Eight RCTs composed of 692 severe hepatitis cases were included in the analysis. The direct Meta-analysis showed that Dexamethasone （10 mg） , the combination of Hydrocortisone and Thymosin could improve short-term survival rate, which was better than the comprehensive support therapy （P 〈 0.05）. The effect of Methyl prednisolone combined with Adenosine methionine in improving longterm survival rate was better than that of Adenosine methionine alone （P 〈 0. 05 ）. In improving treatment efficiency, both the Dexamethasone （5 mg） and Dexamethasone （10 mg） were better than comprehensive support therapy, Methyl- prednisolone combined with Adenosine methionine was superior to the comprehensive support therapy, Methylprednisolone combined with Adenosine methionine was better than Adenosine methionine alone （P 〈 0.05）. The network Meta-a- nalysis showed that low-dose Dexamethasone （5 rag） had benefit in improving short-term survival rate and treatment ef- fective rate, it was better than support therapy （P 〈 0.05 ）. The rest of the contrasts among the other treatment measures and the supporting therapy as well as the comparison among various treatment measures had no statistical difference （P 〉 0.05）. The rank probability plot and the SUCRA calculation results suggested that when concerning the effect of im- proving short-term survival rat

关 键 词：糖皮质激素类 重型肝炎肝衰竭 网状Meta分析 

分 类 号：R575.3[医药卫生—消化系统]