人工肝支持系统治疗慢加急性肝衰竭效果的网状Meta分析  

Efficacy of artificial liver support system in treatment of acute-on-chronic liver failure:A network Meta-analysis

作　　者：甘亮亮 张金周 王贤东[1] 傅彩虹[1] 苏佳 汤雪梅 GAN Liangliang;ZHANG Jinzhou;WANG Xiandong;FU Caihong;SU Jia;TANG Xuemei(Department of Critical Care Medicine,Gansu Provincial Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院重症医学科,兰州730000

出　　处：《临床肝胆病杂志》2022年第1期135-140,共6页Journal of Clinical Hepatology

基　　金：甘肃省人民医院院内基金(18GSSY6-5)。

摘　　要：目的采用网状Meta分析系统评价不同人工肝支持系统治疗慢加急性肝衰竭(ACLF)的疗效。方法计算机检索PubMed、EMBASE、Cochrane library、Clinical Trial、CNKI、SinoMed和万方数据库中关于不同形式人工肝治疗ACLF患者的随机对照试验。根据纳入排除标准进行文献筛选、资料提取及方法学质量评价,采用Stata15.1及R4.1.0软件进行网状Meta分析。结果共纳入14篇文献,共计1141例患者。网状Meta分析结果显示:不同干预方式交叉对比降低病死率差异均无统计学意义(P值均>0.05),排序概率图显示降低30 d病死率血浆置换(PE)最优,其他依次为体外细胞疗法(ELAD)、分级血浆分离吸附(Prometheus)、分子吸附再循环系统(MARS)、Biologic-DT肝脏透析设备、PE+MARS。降低90 d病死率PE最优,其他依次为Prometheus、ELAD、MARS。改善肝性脑病方面,Biologic-DT最优,其他依次为MARS、PE+MARS、ELAD。出血风险最低者为ELAD,与标准医学治疗(SMT)相比Biologic-DT可能增加出血风险(RR=1.9×10^(8),95%CI:4.6~6.2×10^(27))。结论PE可能是降低ACLF患者30 d及90 d病死率的最优选择。Biologic-DT可能在改善肝性脑病方面效果较好,但有可能增加出血风险。Objective To systematically review the efficacy of different artificial liver support systems in the treatment of acute-on-chronic liver failure(ACLF)using a network Meta-analysis.Methods PubMed,Embase,the Cochrane library,Clinical Trial,CNKI,SinoMed,and Wanfang Data were searched for randomized controlled trials(RCTs)on different artificial liver support systems in the treatment of ACLF.Literature screening,data extraction,and methodological quality assessment were performed according to inclusion and exclusion criteria,and Stata15.1 software and R4.1.0 software were used to perform a network Meta-analysis.Results A total of 14 RCTs were included,with 1141 patients in total.The network meta-analysis showed different intervention methods had no significant difference in reducing mortality rate based on cross comparison(all P>0.05).The probability ranking diagram showed that plasma exchange(PE)showed the best effect in reducing 30-day mortality rate,followed by extracorporeal liver assist device(ELAD),fractionated plasma separation and adsorption with Prometheus system,molecular adsorbent recirculating system(MARS),Biologic-DT liver dialysis device,and PE+MARS.PE showed the best effect in reducing 90-day mortality rate,followed by Prometheus,ELAD,and MARS.Biologic-DT showed the best effect in improving hepatic encephalopathy,followed by MARS,PE+MARS,and ELAD.Patients undergoing ELAD had the lowest risk of bleeding,and compared with standard medical treatment,Biologic-DT might increase the risk of bleeding[risk ratio=1.9×10^(8),95%confidence interval:(4.6-6.2)×10^(27)].Conclusion PE might be the best option for reducing 30-and 90-day mortality rates in ACLF patients.Biologic-DT has a better effect in improving hepatic encephalopathy,but it may increase the risk of bleeding.

关 键 词：慢加急性肝功能衰竭 肝 人工 Meta分析(主题) 

分 类 号：R575.3[医药卫生—消化系统]