【摘要】 目的探讨人工肝支持系统对肝功能衰竭的治疗效果。方法检索国内外1970年1月~2008年6月公开发表的人工肝治疗肝功能衰竭的相关论文,提取生存率或出院时临床好转率等可以反映远期预后的资料,以风险比(RR)为效应量进行异质性检验和统计量合计分析。结果共有12篇研究论文入选,共包含肝功能衰竭病例304例。治疗组给予机械型人工肝或生物型人工肝联合常规内科治疗。对照组均给予常规内科治疗。10篇文献讨论了人工肝对肝功能衰竭的疗效,另两篇探讨了生物肝的应用。总体而言,人工肝支持系统对肝功能衰竭的预后有一定程度的改善(RR值0.80,可信区间0.664~0.969,P值0.022),对急性肝功能衰竭的预后基本无改善(RR值0.899,可信区间0.72~1.12,P值0.361)对慢性肝功能衰竭急性加重患者的预后改善明显。(RR值0.57,可信区间为0.39~0.84,P值为0.004)。结论人工肝支持治疗对肝功能衰竭的生存率改善轻微,对慢性肝功能衰竭急性加重者明显降低死亡率。人工肝支持系统类型影响生存率。生物肝对急性肝衰竭或慢性肝功能衰竭急性加重患者都可以降低死亡率。开发生物肝支持系统应是该领域重点研发方向。更多还原

【Abstract】 Objective To evaluate the effect of artificial and bioartificial liver support systems for management of acute and acute-on-chronic liver failure. Methods Articles documenting randomized clinical trials concerning any liver support systems vs standard conservative therapy, published between January, 1970 and June, 2008, were retrieved by database searching. Of the 1134 articles retrieved, 12 randomized trials involving 479 patients were included. The data were extracted and the trial quality was assessed by 2 independent reviewers. The primary outcome measure was all-cause mortality, and the results were combined on the risk ratio (RR) scale. Results Of the 12 trials included, 10 assessed artificial liver support systems for acute or acute-on-chronic liver failure, and 2 assessed bioartificial systems for acute liver failure. Overall, the liver support systems had moderate effect on mortality compared with standard conservative therapy (RR=0.80; 95% CI 0.664-0.969, P=0.022). Meta-regression indicated that the effect of the support systems depended on the type of liver failure (P=0.00). In stratified meta-analyses, the support systems appeared to reduce the mortality by 43% in acute-on-chronic liver failure (RR=0.57; 95% CI 0.39-0.84, P=0.004), but not in acute liver failure (RR=0.899; 95% CI 0.72-1.12, P=0.361). Conclusion Artificial liver support systems reduce the mortality of acute-on-chronic liver failure as compared with standard conservative therapy, but have no significant effect on the mortality of acute liver failure. Bioartificial liver support systems lower the mortality rates in both acute and acute-on-chronic liver failure, and should be the future focus of development.更多还原