双重血浆分子吸附系统治疗肝衰竭疗效及安全性的Meta分析  

Efficacy and safety of dual plasma molecular adsorption system in the treatment of liver failure:a Meta-analysis

作　　者：贺新春[1] 陈亮[1] 唐世刚[1] 朱柏宁[1] 杨彩霞[1] He Xinchun;Chen Liang;Tang Shigang;Zhu Baining;Yang Caixia(Department of Infectious Disease, Hunan Provincial People's Hospital, Hunan Province,Changsha 410005, China)

机构地区：[1]湖南省人民医院/湖南师范大学附属第一医院感染科,长沙410005

出　　处：《疑难病杂志》2021年第6期613-618,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：湖南省卫生健康委科研计划课题项目(B2019054);长沙市科技计划项目(kq1801087)。

摘　　要：目的系统评价双重血浆分子吸附系统(DPMAS)与血浆置换(PE)治疗肝衰竭的疗效及安全性。方法计算机检索PubMed、Cochrane Library、Embase、Web of science、万方数据库、维普数据库、中国学术期刊全文数据库(CNKI)和中国生物医学文献服务系统(CMB),检索时限均为建库至2020年6月30日,查找所有关于DPMAS和PE治疗肝衰竭的文献,由2位研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险,使用RevMan5.3软件进行Meta分析。结果共纳入14项研究833例患者,其中422例患者采用PE治疗(对照组),411例患者采用DPMAS治疗(观察组)。Meta分析结果显示,2组血总胆红素、直接胆红素、谷氨酸氨基转移酶、白蛋白、凝血酶原活动度、C反应蛋白、白细胞、血小板及不良反应方面比较,差异均无统计学意义(P均>0.05);观察组治疗后的总有效率高于对照组,差异有统计学意义(OR=1.60,95%CI 1.11~2.32,P=0.01);TNF-α、IL-6水平低于对照组(TNF-α:SMD=-1.16,95%CI-1.74~-0.57,P=0.00;IL-6:SMD=-1.85,95%CI-3.19~-0.51,P=0.01)。结论DPMAS治疗肝衰竭患者总有效率优于PE治疗,能更好地抑制炎性反应,促进肝功能恢复,其不良反应与PE治疗相当。Objective To systematically evaluate the efficacy and safety of dual plasma molecular adsorption system(DPMAS)and plasma exchange(PE)in the treatment of liver failure.Methods Computer search of PubMed,Cochrane Library,Embase,Web of science,Wanfang Database,Weipu Database,Chinese Academic Journal Full-text Database(CNKI)and China Biomedical Document Service System(CMB),the search time limit is to build the database until June 2020 On the 30th,we searched all the literature on the treatment of liver failure with DPMAS and PE.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies.Meta-analysis was performed using RevMan5.3 software.Results A total of 833 patients were included in 14 studies,of which 422 patients were treated with PE(control group)and 411 patients were treated with DPMAS(observation group).Meta analysis results showed that there was no difference in total bilirubin,direct bilirubin,glutamate aminotransferase,albumin,prothrombin activity,C-reactive protein,white blood cells,platelets and adverse reactions between the two groups.Statistically significant(all P>0.05).The total effective rate of the observation group after treatment was higher than that of the control group,and the difference was statistically significant(OR=1.60,95%CI 1.11~2.32,P=0.01);the levels of TNF-αand IL-6 were lower than those of the control group(TNF-α:SMD=-1.16),95%CI-1.74~-0.57,P=0.00;IL6:SMD=-1.85,95%CI-3.19~-0.51,P=0.01).Conclusion The overall effective rate of DPMAS in the treatment of patients with liver failure is better than that of PE treatment.It can better inhibit inflammatory reactions and promote the recovery of liver function.Its adverse reactions are equivalent to those of PE treatment.

关 键 词：肝衰竭 双重血浆分子吸附系统 血浆置换 META分析 

分 类 号：R542.2[医药卫生—心血管疾病]