【作者】 李慧；

【导师】 金建军；

【作者基本信息】 河南科技大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:评价特利加压素联合白蛋白对I型肝肾综合征(HRS)的疗效及安全性,为临床肝肾综合征的治疗选择提供证据。方法:采用Cochrane系统评价方法,检索Pub Med,The Cochrane Library,Web of Science,LILACS,Medline,Embase,中国生物医学文献数据库,维普中文科技期刊数据库,中国CNKI学术总库,万方数据资源系统等数据库,收集使用特利加压素联合白蛋白治疗I型肝肾综合征(HRS)的所有文献,由两位研究者分别根据纳入标准与排除标准独立进行文献筛选,然后提取相关资料,采用Cochrane协作网提供的Rev Man 5.3软件进行荟萃分析。计算机检索截止2016年6月以前的所有公开发表的文献。结果:1.文献检索结果:所有数据库中,初检出相关文献共693篇,经过逐层筛选,最终共6篇文献纳入本荟萃分析,6篇文献,共542例患者,均为随机对照试验。其中,2项研究为特利加压素联合白蛋白与安慰剂对照,1项研究为特利加压素联合白蛋白与蒸馏水进行对照,3项为特利加压素联合白蛋白与单独应用白蛋白进行对照。纳入文献研究总体质量较高。2.荟萃分析结果:6篇前瞻性随机对照试验,共542例患者,纳入了本荟萃分析,特利加压素联合白蛋白在肝肾综合征的治疗可明显提高I型肝肾综合征(HRS)的缓解率(OR:4.25,95%CI:2.77-6.52,P<0.00001);提高生存率(OR:2.33,95%CI:1.11-4.88,P=0.03);同时可降低血肌酐水平(SWD=-1.26,95%CI:-2.36--0.15,P=0.03);升高平均动脉压(SWD=0.92,95%CI:0.01-0.76,P=0.0005);但对尿量的影响无明显统计学意义(SWD=8.30,95%CI:-3.93-20.54,P=0.18)。治疗过程中出现的不良反应包括由于体循环充血及外周循环收缩所导致的症状,包括:非致命性心肌梗死、非持续性室上性心动过速、呼吸困难、呼吸性酸中毒、心律失常、房颤、胸痛、腹痛、外周血管痉挛等,但所纳入文献中无致死性不良反应报道。结论:特利加压素联合白蛋白对改善I型肝肾综合征(HRS)有较好的疗效,不良反应少,安全性好,是一种较为理想的治疗方法。更多还原

【Abstract】 Objective: to assess the efficacy and safety of terlipressin plus albumin on the treatment of Type 1 hepatorenal syndrome(HRS),To provide evidence for clinical treatment of hepatorenal syndrome.Method: Cochrane strategy was used to identify the previously published randomized controlled trials,before July 2016,by searching PubMed,The Cochrane Library,Web of Science and LILACS,Medline,Embase,Chinese Biomedical Literature Database(CBM),Chongqing VIP Information Co,Ltd,China National Knowledge Internet Database,Wanfang Data.Collect all the literature that use of terlipressin combined with albumin in patients with type 1 hepatorenal syndrome(HRS),two researchers independently screened literature and extracted data according to the inclusion and exclusion criteria.Use RevMan 5.3 provided by the Cochrane collaboration to meta-analysis.Results:1.Search Results In all the databases,we initially identified 693 articles of which 6 articles were included in the meta-analysis after screening,All of them were randomized controlled trials.There were 2 studies comparing terlipressin plus albumin with placebo,and 1 study comparing terlipressin plus albumin with distilled water,3 studies for terlipressin plus albumin with albumin alone.The general quality of the studies are of high standard.2.The results of Meta analysis 6 randomized controlled trials,542 cases were selected for this Meta analysis,which showed that the Type 1 HRS remission rate and the survival rate were increased by the terlipressin plus albumin,with(OR:4.25,95% CI:2.77-6.52,p?0.0001);and(OR: 2.33,95% CI: 1.11-4.88,P=0.03),respectively,Blood creatinine was decreased by terlipressin,with(OR:2.33,95% CI: 1.11-4.88,P=0.03)and mean arterial pressure was increased significantly,with(SWD=0.92,95% CI:0.01-0.76,P=0.0005),while there was no difference in urine output(SWD=8.30,95% CI:-3.93-20.54,P=0.18).Side effects due to the systemic circulation congestion and peripheral vasoconstriction were reported,such as non fatal myocardial infarction,non persistent aventricular tachycardia,dyspnea,spiratory acidosis,arrhythmia,atrial fibrillation,chest pain,abdominal pain,peripheral vascular spasm,etc.Nofatal side effect was reported.Conclusion: Terlipressin plus albumin to improve type I hepatorenal syndrome(HRS)is an ideal treatment method because of its good curative effect,less adverse reaction and good security.更多还原