【摘要】 目的系统评价人工肝支持系统治疗药物性肝衰竭的疗效。方法计算机检索Pub Med、Embase、The Cochrane Library、CMB、CNKI和VIP数据库,时间截至2019年10月。纳入人工肝支持系统治疗药物性肝衰竭的相关随机对照试验或临床对照试验,并进行统计分析。计数资料用比值比(OR)为效应量,计量资料的组间差值为效应量,效应量的合并采用加权均数差(WMD)法,各效应量均计算95%可信区间(95%CI)。I~2统计量和P值用来评估纳入文献的异质性,若I~2<50%,P> 0. 1采用固定效应模型;否则采用随机效应模型进行Meta分析。结果共纳入16篇文献945例患者,其中人工肝联合常规内科治疗组520例,常规内科治疗组425例。结果显示与常规内科治疗相比,人工肝治疗组能明显降低药物性肝衰竭的病死率(OR=0. 27,95%CI:0. 20～0. 36,P <0. 001);人工肝支持系统可以明显改善Alb(MD=1. 21,95%CI:0. 18～2. 25,P=0. 02)及PTA(MD=11. 84,95%CI:6. 34～17. 35,P <0. 001),降低TBil(MD=-104. 97,95%CI:-163. 63～-46. 30,P <0. 001)。进一步分析停止使用人工肝治疗后4～5 d的Alb、TBil及PTA水平,人工肝支持系统亦可以明显改善Alb(MD=1. 74,95%CI:1. 20～2. 27,P <0. 001)及PTA(MD=4. 45,95%CI:2. 80～6. 10,P <0. 001),降低TBil(MD=-128. 41,95%CI:-217. 22～-39. 59,P=0. 005)。结论与常规内科治疗相比,联合人工肝治疗可以显著改善药物性肝衰竭患者的主要生化学指标,降低其病死率。更多还原

【Abstract】 Objective To systematically review the clinical of artificial liver support system( ALSS) in the treatment of drug-induced liver failure. Methods PubMed,Embase,The Cochrane Library,CMB,CNKI,and VIP databases were searched for related randomized controlled trials or randomized controlled trials on ALSS in the treatment of drug-induced liver failure published up to October 2019,and a statistical analysis was performed. Odds ratio( OR) was the effect size for categorical data,and the difference between groups was the effect size for continuous data. The weighted mean difference( WMD) method was used for the pooled analysis of effect size,and 95% confidence interval( CI) was calculated for each effect size. I~2 and P values were used to evaluate the heterogeneity of the articles included in the analysis; a fixed effect model was used when I~2< 50% and P > 0. 1,otherwise a random effects model was used. Results A total of 16 articles with 945 patients were included,with 520 patients in the ALSS + routine medical treatment( RMT) group and 425 in the RMT group. The meta-analysis showed that compared with the RMT group,the ALSS + RMT group had a significantly lower mortality rate of drug-induced liver failure( OR = 0. 27,95% CI: 0. 20-0. 36,P < 0. 001),significant improvements in albumin( Alb)( MD = 1. 21,95% CI: 0. 18-2. 25,P = 0. 02) and prothrombin activity( PTA)( MD = 11. 84,95% CI: 6. 34-17. 35,P < 0. 001),and a significant reduction in total bilirubin( TBil)( MD =-104. 97,95% CI:-163. 63 to-46. 30,P < 0. 001). Further analysis of Alb,TBil,and PTA after the withdrawal of ALSS showed that ALSS significantly improved Alb( MD = 1. 74,95% CI: 1. 20-2. 27,P < 0. 001) and PTA( MD = 4. 45,95% CI:2. 80-6. 10,P < 0. 001) and significantly reduced TBil( MD =-128. 41,95% CI:-217. 22 to-39. 59,P = 0. 005). Conclusion Compared with RMT alone,RMT combined with ALSS can significantly improve the main biochemical indicators of patients with drug-induced liver failure and reduce their mortality rate.更多还原