CAJ | 학술논문

目的系统评价胆道闭锁患儿Kasai术后应用激素治疗的疗效和安全性.方法系统检索PubMed数据库、中国期刊全文数据库(CNKI)、中国生物医学数据库、中国维普数据库(VIP)、Cochrane图书馆循证医学评价数据库,收集2014年8月以前胆道闭锁Kasai术后应用激素与未用激素治疗的随机或非随机对照研究,并应用RevMan软件进行统计学分析.结果共纳入7项研究(n=414),2项随机对照研究(n=211),5项病例对照研究(n=203).Meta分析结果显示:激素组与未应用激素组相比,6个月黄疸清除率差异无统计学意义[OR值1.73,95％CI(0.95,3.17),P=0.07];且RCT组、高剂量激素组分析结果示差异均无统计学意义,分别为OR值1.28,95％CI(0.74,2.19),P=0.38、OR值1.48,95％CI(0.87,2.52),P=0.15;小于70日龄组亚组分析结果提示差异也无统计学意义(P＞0.05).1年肝移植率、6个月总体生存率、6个月自体肝生存率和2年自体肝生存率差异均无统计学意义,分别为OR值0.59,95％ CI(0.21,1.72),P=0.34、OR值0.63,95 ％CI(0.16,2.46),P=0.51、OR值0.98,95％CI(0.51,1.88),P=0.96、OR值0.96,95％CI(0.53,1.74),P=0.90.激素相关副作用少见,且胆管炎发生率于激素组和对照组间差异无统计学意义[OR值0.71,95％CI(0.38,1.32),P=0.28],同时高剂量激素组亚组分析提示差异也无统计学意义[OR值0.49,95 ％CI(0.20,1.24),P=0.13];但激素组术后并发症发生更早,差异有统计学意义(P=0.008).结论胆道闭锁Kasai术后应用激素不能改善胆汁引流和减少胆管炎的发生,且不能推迟肝移植发生的时间以及延长生存年限.激素相关副作用少见,但可能致术后并发症发生提前.
목적 계통평개담도폐쇄환인Kasai술후응용격소치료적료효화안전성.방법 계통검색PubMed수거고、중국기간전문수거고(CNKI)、중국생물의학수거고、중국유보수거고(VIP)、Cochrane도서관순증의학평개수거고,수집2014년8월이전담도폐쇄Kasai술후응용격소여미용격소치료적수궤혹비수궤대조연구,병응용RevMan연건진행통계학분석.결과 공납입7항연구(n=414),2항수궤대조연구(n=211),5항병례대조연구(n=203).Meta분석결과현시:격소조여미응용격소조상비,6개월황달청제솔차이무통계학의의[OR치1.73,95％CI(0.95,3.17),P=0.07];차RCT조、고제량격소조분석결과시차이균무통계학의의,분별위OR치1.28,95％CI(0.74,2.19),P=0.38、OR치1.48,95％CI(0.87,2.52),P=0.15;소우70일령조아조분석결과제시차이야무통계학의의(P＞0.05).1년간이식솔、6개월총체생존솔、6개월자체간생존솔화2년자체간생존솔차이균무통계학의의,분별위OR치0.59,95％ CI(0.21,1.72),P=0.34、OR치0.63,95 ％CI(0.16,2.46),P=0.51、OR치0.98,95％CI(0.51,1.88),P=0.96、OR치0.96,95％CI(0.53,1.74),P=0.90.격소상관부작용소견,차담관염발생솔우격소조화대조조간차이무통계학의의[OR치0.71,95％CI(0.38,1.32),P=0.28],동시고제량격소조아조분석제시차이야무통계학의의[OR치0.49,95 ％CI(0.20,1.24),P=0.13];단격소조술후병발증발생경조,차이유통계학의의(P=0.008).결론 담도폐쇄Kasai술후응용격소불능개선담즙인류화감소담관염적발생,차불능추지간이식발생적시간이급연장생존년한.격소상관부작용소견,단가능치술후병발증발생제전.
Objective To evaluate the efficacy and safety of steroids in postoperative treatment of biliary atresis (BA) through a systematic review.Methods PubMed,China National Knowledge Infrastructure (CNKI),Chinese BioMedical (CBM),VIP Database and Cochrane library were searched for randomized controlled trials on steroids in postoperative treatment of BA.Meta-analysis was performed with RevMan 5.2 software for the results of homogeneous studies.Results In 7 eligible studies,there were 2 randomized control trials (RCTs,n =211) and 5 case control studies (n =203).Meta-analysis showed no significant inter-group difference in rate of jaundice clearing at 6 months postoperation OR 1.73,95％CI (0.95,3.17),P=0.07.And no statistical difference existed in subgroup analysis of RCT,high-dose steroids OR 1.28,95％CI (0.74,2.19),P =0.38,OR 1.48,95 ％CI (0.87,2.52),P =0.15,there was also no difference in subgroup analysis of the children aged under 70 days (P＞ 0.05).No significant difference existed in postoperative rate of liver transplantation within 1 year,6-month overall postoperative survival rate or postoperative survival rates of native liver at 6 months and 2 years OR 0.59,95 ％CI(0.21,1.72),P =0.34;OR 0.63,95 ％ CI(0.16,2.46),P =0.51;OR 0.98,,95％CI(0.51,1.88),P =0.96;OR 0.96,95％CI(0.53,1.74),P=0.90.The adverse events of steroids were few.The occurrence of cholangitis had no differences among groups OR 0.71,95％CI(0.38,1.32),P =0.28 as well as subgroup analysis of high-dose steroid group [OR 0.49,95％ CI (0.20,1.24),P =0.13].But steroid treatment was associated with an earlier onset of serious adverse events postsurgery in BA children (P =0.008).Conclusions Steroids have no significant efficacies in the treatment of BA.