特利加压素治疗肝肾综合征患者临床有效性及安全性的Meta分析

摘要

目的：从循证医学的角度对特利加压素治疗肝肾综合征的有效性和安全性进行分析，以期为临床应用提供医学依据。方法以“特利加压素”、“肝肾综合征”为关键词检索，检索时间截至2016年1月，检索数据库为CNKI、万方、PubMed、CBM、Embase、CCTR及Medline；采用Cochrane系统评价方法，对符合筛选标准的文献进行评价，采用Review Manger6.0软件进行Meta分析。结果在检索出的51篇文献中符合纳入标准的共4篇英文文献，包括234例HRS患者，均为随机对照临床试验。按照Cochrane质量评价标准，纳入的文献均为B级。Meta分析结果显示：特利加压素治疗HRS患者的有效率与对照组相比差异有统计学意义（OR =6.85，95%CI：3.47～13.55，P＜0.00001）。各项研究的Meta分析不存在显著的发表偏倚，结果较为稳定。采用特利加压素治疗的部分HRS患者出现不良反应，但耐受性均较好，一般可自行缓解，稍严重的经对症干预后均得到有效缓解。结论特利加压素可显著提高HRS患者的生存率，降低肌酐水平，增加尿量，改善肾脏功能，有效性及安全性良好。%Objective To analyze the clinical efifcacy and safety of Terlipressin in treatment of hepatorenal syndrome (HRS) from the aspect of evidence-based medicine in order to provide medical evidence for clinical application.Methods Terlipressin and hepatorenal syndrome were retrieved in CNKI, Wanfang Data, PubMed, CBM, Embase, CCTR and Medline, the retrieval time was up to January 2016. Cochrane system evaluation method was used to evaluate the papers which were conformed to the selection criteria. Meta-analysis was carried out by Review Manger 6.0 software. Results Total of 4 English randomized comparison clinical trial (RCT) articles out of 51 retrieved papers were conformed to the selection criteria, which included 234 patients with HRS. According to the Cochrane quality evaluation criteria, the 4 RCT articles were all class B. Meta-analysis showed that the efifcacy of terlipressin in patients with HRS was statistically different from that of the control group (OR = 6.85, 95%CI: 3.47~13.55,P< 0.00001). There was no signiifcant publication bias in Meta-analysis and the results were stable.Part of the HRS patients treated with terlipressin showed adverse reactions, but they were well tolerated and usually relieved by themselves, and some serious adverse reactions were effectively relieved after symptomatic intervention.Conclusions Terlipressin can signiifcantly increase the survival rate of patients with HRS. It can also decrease the creatinine levels, increase the urine output, improve the renal function and has good efifcacy and safety.