吡格列酮治疗非酒精性脂肪肝的系统评价  

Systematic Evaluation of Pioglitazone in the Treatment of Non-alcoholic Fatty Liver

作　　者：张蕊[1] 于磊[1] 徐珽[1] Zhang Rui;Yu Lei;Xu Ting(Department of Clinical Pharmacy,West China Hospital,Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]四川大学华西医院临床药学部,四川成都610041

出　　处：《四川医学》2018年第6期658-662,共5页Sichuan Medical Journal

摘　　要：目的对吡格列酮治疗非酒精性脂肪肝的疗效和安全性进行系统评价。借此筛选出治疗非酒精性脂肪肝较为合适的药物。方法根据Cochrane协作网推荐方法、遵循临床流行病学和循证医学原则,计算机检索Pubmed、EMBase、Cochrane图书馆、中国生物医学数据库、中国期刊全文数据库等数据库,纳入采用吡格列酮治疗非酒精性脂肪肝的随机对照试验。对纳入的相关研究进行方法学质量评价,使用Rev Man5.3软件进行Meta分析。结果共纳入7篇研究。其中4篇为吡格列酮与安慰剂对照,4篇为吡格列酮与维生素E(1篇为吡格列酮、维生素E、安慰剂三组对照)。Meta分析结果显示:(1)吡格列酮与安慰剂对比,在对改善肝脏纤维化上,差异有统计学意义(RR=1.40,95%CI(1.01,1.95));(2)吡格列酮与安慰剂对比,在对改善肝细胞气球样变性上,差异有统计学意义(RR=1.80,95%CI(1.26,2.58));(3)吡格列酮与安慰剂对比,在减少肝脏脂肪变性上,差异有统计学意义(RR=1.86,95%CI(1.39.2.49));(4)吡格列酮与安慰剂对比,在降低丙氨酸氨基转移酶方面,差异具有统计学意义(SMD=-0.82,95%CI(-1.17,-0.47));(5)吡格列酮与维生素E对比,在对丙氨酸氨基转移酶的影响上,差异具有统计学意义(SMD=-3.39,95%CI(-5.23,-1.55)),吡格列酮联用维生素E与维生素E对比,在对丙氨酸氨基转移酶的影响上,差异无统计学意义(SMD=0.39,95%CI(-0.49,1.28))。安全性指标:试验组共67例退出试验,对照组48例退出试验。共有6篇研究报道了吡格列酮的药物38例不良反应/事件,吡格列酮组发生2例,对照组共发生17例严重不良反应/事件,但未做详细描述。报道最常见为皮肤组织、体质量增加的不良反应/事件。结论吡格列酮在非酒精性脂肪肝患者使用中,吡格列酮与安慰剂、维生素E比较,在改善肝功能、肝组织学、降低血糖等方面有较为明显优势。基于目前现有证据,在非酒精性脂肪肝�Objective To systematically evaluate the efficacy and safety of pioglitazone in the treatment of non-alcoholic fatty liver and to screen out drugs that are more suitable for the treatment of non-alcoholic fatty liver.Methods Based on the recommended methods of Cochrane Collaboration,following the principles of clinical epidemiology and evidence-based medicine,searching Pubmed,EMBase,Cochrane Library,China Biomedical Database,Chinese Journal Full-text Database and other databases,including the randomized controlled trials which use pioglitazone in the treatment of non-alcoholic fatty liver.The studies included had a quality evaluation methodologically and a meta-analysis using RevMan 5.3 software.Results A total of 7 studies were included.Among them,4 were pioglitazone and placebo control,4 were pioglitazone and vitamin E(1 was pioglitazone,vitamin E,placebo).Meta-analysis showed that:①Compared with placebo,pioglitazone had statistically significant differences in improving hepatic fibrosis(RR=1.40,95%CI(1.01,1.95));②Compared with placebo,pioglitazone had statistically significant differences in improving hepatocyte balloon-like degeneration(RR=1.80,95%CI(1.26,2.58))③Compared with placebo,pioglitazone had statistically significant differences in reducing hepatic steatosis(RR=1.86,95%CI(1.39.2.49));④Compared with placebo,pioglitazone had statistically significant differences in reducing alanine aminotransferase(SMD=-0.82,95%CI(-1.17,-0.47))⑤Compared with vitamin E,pioglitazone had statistically significant differences in the effect on alanine aminotransferase.(SMD=-3.39,95%CI(-5.23,-1.55)).When comparing pioglitazone combined with vitamin E and vitamin E,there was no statistically significant difference in the effect on alanine aminotransferase(SMD=0.39,95%CI(-0.49,1.28)).Safety indicators:A total of 67 people in the experimental group withdrew from the trial,while 48 patients in the control group withdrew from the trial.A total of 6 studies reported 38 adverse reactions/events of pioglitazone,2 in the pi

关 键 词：吡格列酮 非酒精性脂肪肝 系统评价 

分 类 号：R575.5[医药卫生—消化系统]