护肝片预防性治疗抗结核药物性肝损伤的Meta分析  

Prophylactic treatment with Hugan tablets for antituberculosis drug-induced liver injury:A systematic review and meta-analysis of randomized controlled trials

作　　者：王岗[1,2] 张丹 陈新[1] WANG Gang;ZHANG Dan;CHEN Xin(Zigong First People's Hospital,Zigong,Sichuan,643000,China)

机构地区：[1]自贡市第一人民医院,四川自贡643000 [2]成都中医药大学附属医院

出　　处：《中西医结合肝病杂志》2024年第1期42-48,共7页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:评价预防性使用护肝片对anti-TB DILI的有效性和安全性,明确护肝片对anti-TB DILI的预防作用。方法:对6个主要的中文和英文数据库进行了检索,从数据库建立之日起至2021年12月,不限制语言和发表偏倚。两名作者根据纳入和排除标准独立选择合格的研究,然后提取数据并进行Meta分析。结果:本研究共纳入18项研究的4270例患者,Meta分析结果显示预防性使用护肝片与anti-TB DILI发生率降低相关[RR=0.29,95%CI(0.24,0.36),P<0.05],敏感性分析提示结果稳健。预防性服用护肝片在4周内[RR=0.27,95%CI(0.16,0.48),P<0.001]和4周后[RR=0.34,95%CI(0.17,0.66),P=0.001]均可显著降低anti-TB DILI的发生率,且异质性较低。在乙型肝炎表面抗原阳性(HBsAg+)患者中的anti-TB DILI发生率也显著降低[R=0.25,95%CI(0.15,0.39),P<0.001]。结论:在抗结核治疗的患者中预防性使用护肝片可降低anti-TB DILI发生,尤其在HBsAg+的患者中有更多获益。由于纳入研究的方法学质量不高,尚需要更多高质量的研究来进一步验证其有效性和安全性。Objective:Antituberculosis drug-induced liver injury(anti-TB DILI)is a common adverse effect in patients undergoing anti-TB treatment.Hugan tablets(HGT),a traditional Chinese patent medicine,are widely used to treat and prevent DILI in China.However,their prophylactic effects on anti-TB DILI remain largely unknown.The aim of the present study was to evaluate the efficacy and safety of prophylactic therapy with HGT for anti-TB DILI.Methods:Six major Chinese and English databases were searched from the date of their inception to December 2021 without restrictions on language and publication bias.Qualifying studies were selected independently by two authors based on the inclusion and exclusion criteria,after which the data were extracted and a meta-analysis was conducted.Results:A total of 4270 patients from 18 studies were included in the present systematic review and meta-analysis.The results revealed that HGT was associated with a significant reduction in the occurrence of anti-TB DILI[RR=0.29,95%CI(0.24,0.36),P<0.05].Sensitivity analysis indicated that the results were stable.HGT administration was associated with a significant reduction in the occurrence of anti-TB DILI within-[RR=0.27,95%CI(0.16,0.48),P<0.001]and after four weeks[RR=0.34,95%CI(0.17,0.66),P=0.001],with low heterogeneity.The incidence of anti-TB DILI in patients with Hepatitis B surface antigen positive(HBsAg+)was also significantly reduced[R=0.25,95%CI(0.15,0.39),P<0.001].Conclusion:We found that prophylactic treatment with HGT apparently positively affects anti-TB DILI,especially in HBsAg+patients.More high-quality studies are needed to further investigate its efficacy and safety.

关 键 词：护肝片 抗结核药物性肝损伤 预防性治疗 META分析 

分 类 号：R575[医药卫生—消化系统]