【作者】 田玲；

【导师】 王一平；

【作者基本信息】 四川大学 ， 内科学， 2004， 硕士

【副题名】A Cochrane Systematic Review

【摘要】 背景:双糖与抗生素治疗肝性脑病在国内外已使用多年,其主要依据是临床经验的积累。近年来已发表了一些双糖或抗生素治疗肝性脑病临床随机对照试验的文章,但还没有对其治疗肝性脑病的有效性和安全性进行系统评价的研究。 目的:本研究采用Cochrane系统评价的方法,对全世界所有关于双糖与安慰剂或空白对照,及抗生素治疗肝性脑病的随机对照试验进行评价,以了解目前是否已有充分的随机对照试验证据证实双糖或抗生素治疗肝性脑病有效和安全。 方法:制定明确的纳入和排除标准。全面检索Cochrane临床对照试验数据库(2004年1期)、Medline(1980-2004年2月)、Embase(1980-2004年2月)、中国生物医学文献数据库(CBM-disc)(1981-2004年3月)。手工检索相关会议论文集及所有检索到试验的参考文献。由两位研究者独立地对符合纳入标准的试验进行质量评价和资料提取,并进行交叉核对。如有分歧,通过讨论或由第三位研究人员协助解决。最后对所纳入的研究进行资料合成。采用治疗或随访期末病死率、不良反应发生率、更多还原

【Abstract】 Background: Experimental data indicates that Nonabsorbable disaccharides and antibiotics can interfere with the process of hepatic encephalopathy in multiple aspects. Many trials have been published and those have been assessed.Objective: he aim of systematic review is to assess the effectiveness and safety of nonabsorbable disaccharides and antibiotics in the treatment of hepatic encephalopathy.Methods: A Cochrane systematic review of randomized controlled trials of nonabsorbable disaccharides and antibiotics for hepatic encephalopathy was performed. Trials were identified by searching for Cochrane Controlled Trials Register (CENTRAL/CCTR) 2004 Issue 1, Medline( 1980-2004,2), Embase( 1980-2004,2) and the Chinese Biological Medicine Database (CBM-disc). We handsearched the data from the proceedings of correlated conferences and the references of all included trials. Two reviewers assessed quality of studies, extracted data independently. Disagreement were resolved by discussion or the third party if needed. The following primary outcomes were assessed: 1) Clinical effective rate. 2)Adverse events. 3)Death at the end of treatment. Secondary outcome measures were: 1) Blood ammonia concentration. 2) Total days of treatment. 3) Mental state. 4)Asterixis. 5)The number connection test. 6) Digit symbol test. 7) Electroencephalography. 8)Mean stool pH.Results: Nineteen trials involving 979 patients were included. Most trials were of poor quality. There was significant difference in the clinical effective rate, Blood ammonia concentration,the number connection test and Digit symbol test at the end of the treatment between nonabsorbable disaccharides and normal control group(p<0.05 ). And there wasn’t a significant difference betweent nonabsorbable disaccharides and antibiotics in the clinical effective rate for hepatic encephalopathy (Peto OR 1.17? 95%CI 0.74 to 1.86, P = 0.5 ) . The reported adverse events of nonabsorbable antibiotics was lesser than those of nonabsorbable disaccharides (Peto OR 0.30, 95% CI 0.18 to 0.50, P<0.00001). There was significant difference in the treatment between nonabsorbable antibiotics and nonabsorbable disaccharides (SMD ^j-0.32, 95% CI -0.54 to-0.09, P=0.005) orplaceboCSMD ^-0.71, 95% CI ^J-1.22 to-0.21, p=0.006) .Conclusions: Nonabsorbable disaccharides and antibiotics appear to be modality of safe and effective treatment with a favourable trend, but there is not enough evidence to support this conclusion at present as trails published is not good quality. More trials with enough sample size and scientifically sound methodology are required.更多还原