不限钠与限钠治疗对肝硬化腹水合并低钠血症患者疗效的Meta分析  

Meta-Analysis of the therapeutic efficacy of unrestricted and sodium restricted for patient with liver cirrhosis ascites combined with hyponatremia

作　　者：吴杰 李京涛 刘永刚 王国泰 魏海梁 闫曙光[1] 常占杰 WU Jie;LI Jing-tao;LIU Yong-gang(The Shaanxi University of Chinese Medicine,Shanxi,Xianyang,712046,China;The Hospital Affiliated To Shaanxi University Of Chinese Medicine,Shanxi,Xianyang,712046,China)

机构地区：[1]陕西中医药大学第一临床医学院,陕西咸阳712046 [2]陕西中医药大学附属医院

出　　处：《中西医结合肝病杂志》2021年第11期1017-1021,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家自然科学基金(No.81603612);陕西省重点研发计划(No.2020ZDLSF05-15);陕西省科技厅科研基金(No.2018KJXX-093);陕西省“特支计划”区域发展人才项目(2017);宁夏回族自治区自然科学基金(No.NZ17278);陕西中医药大学学科创新团队建设项目(No.2019-YL05)。

摘　　要：目的:对比分析不限钠治疗与限钠治疗在肝硬化腹水合并低钠血症患者临床治疗中的效果。方法:计算机检索Cochrane Library、PubMed、Embase、知网、万方、维普、中国生物医学文献数据库、中华医学会数字化期刊库等中英文数据库,检索截止日期2019年10月。找出对比不限钠与限钠治疗肝硬化腹水合并低钠血症患者临床治疗效果的文献,由2名研究人员进行筛查和数据提取,并应用Revman 5.3软件对纳入文献指标进行Meta分析。结果:共纳入10篇随机对照试验,共952例患者,其中不限钠组455例,限钠组497例。Meta分析结果显示,与限钠组相比,不限钠组可提高患者临床有效率、腹水好转率[RR=1.29,95%CI(1.16,1.43),P<0.00001;RR=2.37,95%CI(1.61,3.48),P<0.0001],显著降低患者肝性脑病、肝肾综合征、消化道出血、住院病死率,差异均有统计学意义[RR=0.33,95%CI:(0.17,0.62),P=0.0007;RR=0.39,95%CI:(0.26,0.59)P<0.00001;RR=0.52,95%CI:(0.37,0.73),P=0.0001;RR=0.38,95%CI:(0.28,0.53),P<0.00001]。结论:对于肝硬化腹水合并低钠血症患者,不限钠治疗较限钠治疗有明显优势。在临床治疗中应在控制原发病的基础上,积极应用钠盐治疗,纠正低钠血症,促进患者疾病康复。Objective:Comparative analysis of the effects of unrestricted sodium therapy and sodium limited therapy in the clinical treatment of patient with liver cirrhosis ascites combined with hyponatremia.Methods:Computer searches Chinese and English databases such as Cochrane Library,PubMed,Embase,HowNet,Wanfang,Weipu,Chinese Biomedical Literature Database,Chinese Medical Association Digital Periodical Database,The search deadline is October 2019。Find out the literature that compares the effect of unrestricted sodium and sodium restriction in the clinical treatment of patients with cirrhosis and ascites combined with hyponatremia.screening and data extraction by two researchers,meta-analysis of included literature indicators using Revman5.3 software.Results:A total of 10 randomized controlled trials were included,with a total of 952 patients,including 455 in the sodium-limited group and 497 in the sodium-limited group。Meta analysis results show that compared with the sodium-limited group,the sodium-free group can improve clinical effectiveness and ascites improvement rate[RR=1.29,95%CI(1.16,1.43),P<0.00001;RR=2.37,95%CI(1.61,3.48),P<0.0001],significantly reduced the hepatic encephalopathy,hepatorenal syndrome,gastrointestinal bleeding,and hospital mortality.The differences were statistically significant[RR=0.33,95%CI:(0.17,0.62),P=0.0007;RR=0.39,95%CI:(0.26,0.59)P<0.00001;RR=0.52,95%CI:(0.37,0.73),P=0.0001;RR=0.38,95%CI:(0.28,0.53),P<0.00001].Conclusion:For patients with cirrhosis and ascites combined with hyponatremia,unrestricted sodium therapy has obvious advantages over sodium limited therapy,In clinical treatment should be based on controlling the primary disease,actively apply sodium salt treatment to correct hyponatremia and promote patient rehabilitation.

关 键 词：肝硬化腹水 低钠血症 META分析 

分 类 号：R575.2[医药卫生—消化系统]