特利加压素对1型肝肾综合征的治疗疗效:一项系统评价及meta分析

肝脏 ›› 2020, Vol. 25 ›› Issue (3): 254-259.

特利加压素对1型肝肾综合征的治疗疗效:一项系统评价及meta分析

董欣欣, 王海清, 王兴纯

610100 成都航天医院心血管肾内科(董欣欣,王兴纯);电子科技大学医学院附属四川省肿瘤医院肝胆胰外科(王海清)

收稿日期:2019-06-30 出版日期:2020-03-31 发布日期:2020-04-16
通讯作者: 董欣欣,Email:541026814@qq.com
基金资助:
四川省科技计划项目(18YYJC0671)

Terlipressin in the treatment of type one hepatorenal syndrome: a systematic review and meta-analysis

DONG Xin-xin¹, WANG Hai-qing², WANG Xing-chun¹.

1. Department of Cardiovascular and kidney Internal Medicine, Chengdu Aerospace hospital, Chengdu 610100, China;
2. Department of Hepato-Biliary-Pancreatic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China

Received:2019-06-30 Online:2020-03-31 Published:2020-04-16
Contact: DONG Xin-xin, Email: 541026814@qq.com

摘要/Abstract

摘要： 目的评价特利加压素治疗1型肝肾综合征的安全性和有效性。方法检索PubMed、Embase等数据库特利加压素治疗1型肝肾综合征有关的随机对照试验;2名研究者独立地对文献进行筛选、质量评价和数据提取,并用RevMan 5.3软件进行安全性和有效性分析。结果研究共纳入13项随机对照试验,共746例患者,试验组均为特利加压素治疗组;对照组包括5项安慰剂、6项去甲肾上腺素、1项多巴胺和1项奥曲肽治疗。总的肝肾综合征缓解为33.7%,死亡率60.1%,meta分析显示特利加压素治疗比对照组更能提高肝肾综合征缓解率(RR=2.13, 95%CI: 1.26~3.61, P=0.005, I²=51%);但同时伴有更多的不良反应(RR=2.05, 95%CI: 1.36~3.09, P=0.0006, I²=0%)。亚组分析显示特利加压素比安慰剂对治疗肝肾综合征具有优势;但其疗效和安全性与去甲肾上腺素比较差异无统计学意义。结论特利加压素是治疗1型肝肾综合征患者有效的药物之一。

关键词: 肝肾综合征, 特利加压素, 肝肾综合征缓解, 副作用

Abstract: Objective Hepatorenal syndrome is a fatal complication of the decompensated stage of cirrhosis. Terlipressin is the most widely used treatment method, however, the therapy effects remains inconsonant. We aim to systematically assess the safety and efficacy of terlipressin in the treatment type 1 hepatorenal syndrome.Methods We conducted a systematic review and meta-analysis. Randomized controlled trials form databases such as PubMed and Embase involving terlipressin for hepatorenal syndrome were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate the safety and efficacy of terlipressin for hepatorenal syndrome. Results A total of 13 randomized controlled trials including 746 patients were included. These studies included 5 studies comparing with placebo, 6 studies comparing with noradrenaline, one comparing with dopamine and one comparing with octreotide. The total hepatorenal syndrome reverse rate was 33.7% and the total mortality was 60.1%. Terlipressin had greater hepatorenal syndrome reverse (RR=2.13, 95%CI: 1.26-3.61, P=0.005, I² =51%) and more adverse events (RR=2.05, 95%CI: 1.36-3.09, P=0.0006, I² =0%) than the control group in the management of type 1 hepatorenal syndrome. The subgroup analysis showed that terlipressin had superiority comparing to placebo, but the safety and efficacy was similar when comparing with norepinephrine.Conclusion Terlipressin was one of the most effective drugs for management of type 1 hepatorenal syndrome.

Key words: Adverse event, Hepatorenal syndrome, Hepatorenal syndrome reverse, Terlipressin

董欣欣, 王海清, 王兴纯. 特利加压素对1型肝肾综合征的治疗疗效:一项系统评价及meta分析[J]. 肝脏, 2020, 25(3): 254-259.

DONG Xin-xin, WANG Hai-qing, WANG Xing-chun.. Terlipressin in the treatment of type one hepatorenal syndrome: a systematic review and meta-analysis[J]. Chinese Hepatolgy, 2020, 25(3): 254-259.

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