中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
Chinese Journal of Clinical Infectious Diseases
2015年
5期
436-443
,共8页
孙纷纷%郑嵘炅%孙丽华%鲁晓擘%张跃新
孫紛紛%鄭嶸炅%孫麗華%魯曉擘%張躍新
손분분%정영경%손려화%로효벽%장약신
肝,人工%肝功能衰竭%荟萃分析
肝,人工%肝功能衰竭%薈萃分析
간,인공%간공능쇠갈%회췌분석
Liver,artificial%Liver failure%Meta analysis
目的:系统评价人工肝支持系统联合常规内科治疗对肝衰竭病死率的影响。方法检索被万方数据、维普期刊、中国知网全文数据库、Medline、Cochrane Library和PubMed数据库收录的2004至2014年人工肝支持系统治疗肝衰竭的相关论文。根据Cochrane系统评价指导手册进行文献质量评价,采用RevMan5.3软件进行荟萃分析,根据异质性检验采用随机效应模型或固定效应模型;采用贝格漏斗图表示其偏倚程度。结果共筛选出20篇文献纳入研究,均为完全随机临床对照试验,共包括研究对象2356例,其中1247例给予人工肝支持系统联合内科治疗,1109例给予常规内科治疗。荟萃分析显示,人工肝联合内科治疗肝衰竭的病死率(316/1247,25.3%)低于单纯内科治疗(524/1109,47.2%)[OR=0.36,95%可信区间(CI):0.30~0.43,Z=11.19,P<0.01);联合治疗急性(亚急性)及慢加亚急性肝衰竭的病死率(54/203,26.6%)低于单纯内科治疗组(76/188,40.4%)(OR=0.53,95%CI:0.34~0.81,Z=2.91,P<0.01);联合治疗慢性肝衰竭患者的病死率为25.6%(89/347),亦低于单纯内科治疗组的病死率(171/340,50.3%)(OR=0.32,95%CI:0.23~0.45,Z=6.73,P<0.01)。对不同类型人工肝支持系统治疗肝衰竭的病死率分析发现,分子吸附再循环系统联合内科治疗肝衰竭患者的病死率(26/110,23.6%)低于单纯内科治疗组(42/108,38.9%)(OR=0.48,95%CI:0.26~0.88,Z=2.38,P<0.05);血浆置换联合内科治疗组的病死率(126/575,21.9%)低于单纯内科治疗组(257/492,52.2%)(OR=0.24,95%CI:0.18~0.31,Z=10.14,P<0.01);两种及两种以上人工肝支持系统联合内科治疗组的病死率为29.7%(80/269),低于单纯内科治疗组(103/227,45.4%)(OR=0.45,95%CI:0.31~0.67,Z=4.02,P<0.01)。结论人工肝支持系统联合内科治疗可明显降低各类肝衰竭患者的病死率。
目的:繫統評價人工肝支持繫統聯閤常規內科治療對肝衰竭病死率的影響。方法檢索被萬方數據、維普期刊、中國知網全文數據庫、Medline、Cochrane Library和PubMed數據庫收錄的2004至2014年人工肝支持繫統治療肝衰竭的相關論文。根據Cochrane繫統評價指導手冊進行文獻質量評價,採用RevMan5.3軟件進行薈萃分析,根據異質性檢驗採用隨機效應模型或固定效應模型;採用貝格漏鬥圖錶示其偏倚程度。結果共篩選齣20篇文獻納入研究,均為完全隨機臨床對照試驗,共包括研究對象2356例,其中1247例給予人工肝支持繫統聯閤內科治療,1109例給予常規內科治療。薈萃分析顯示,人工肝聯閤內科治療肝衰竭的病死率(316/1247,25.3%)低于單純內科治療(524/1109,47.2%)[OR=0.36,95%可信區間(CI):0.30~0.43,Z=11.19,P<0.01);聯閤治療急性(亞急性)及慢加亞急性肝衰竭的病死率(54/203,26.6%)低于單純內科治療組(76/188,40.4%)(OR=0.53,95%CI:0.34~0.81,Z=2.91,P<0.01);聯閤治療慢性肝衰竭患者的病死率為25.6%(89/347),亦低于單純內科治療組的病死率(171/340,50.3%)(OR=0.32,95%CI:0.23~0.45,Z=6.73,P<0.01)。對不同類型人工肝支持繫統治療肝衰竭的病死率分析髮現,分子吸附再循環繫統聯閤內科治療肝衰竭患者的病死率(26/110,23.6%)低于單純內科治療組(42/108,38.9%)(OR=0.48,95%CI:0.26~0.88,Z=2.38,P<0.05);血漿置換聯閤內科治療組的病死率(126/575,21.9%)低于單純內科治療組(257/492,52.2%)(OR=0.24,95%CI:0.18~0.31,Z=10.14,P<0.01);兩種及兩種以上人工肝支持繫統聯閤內科治療組的病死率為29.7%(80/269),低于單純內科治療組(103/227,45.4%)(OR=0.45,95%CI:0.31~0.67,Z=4.02,P<0.01)。結論人工肝支持繫統聯閤內科治療可明顯降低各類肝衰竭患者的病死率。
목적:계통평개인공간지지계통연합상규내과치료대간쇠갈병사솔적영향。방법검색피만방수거、유보기간、중국지망전문수거고、Medline、Cochrane Library화PubMed수거고수록적2004지2014년인공간지지계통치료간쇠갈적상관논문。근거Cochrane계통평개지도수책진행문헌질량평개,채용RevMan5.3연건진행회췌분석,근거이질성검험채용수궤효응모형혹고정효응모형;채용패격루두도표시기편의정도。결과공사선출20편문헌납입연구,균위완전수궤림상대조시험,공포괄연구대상2356례,기중1247례급여인공간지지계통연합내과치료,1109례급여상규내과치료。회췌분석현시,인공간연합내과치료간쇠갈적병사솔(316/1247,25.3%)저우단순내과치료(524/1109,47.2%)[OR=0.36,95%가신구간(CI):0.30~0.43,Z=11.19,P<0.01);연합치료급성(아급성)급만가아급성간쇠갈적병사솔(54/203,26.6%)저우단순내과치료조(76/188,40.4%)(OR=0.53,95%CI:0.34~0.81,Z=2.91,P<0.01);연합치료만성간쇠갈환자적병사솔위25.6%(89/347),역저우단순내과치료조적병사솔(171/340,50.3%)(OR=0.32,95%CI:0.23~0.45,Z=6.73,P<0.01)。대불동류형인공간지지계통치료간쇠갈적병사솔분석발현,분자흡부재순배계통연합내과치료간쇠갈환자적병사솔(26/110,23.6%)저우단순내과치료조(42/108,38.9%)(OR=0.48,95%CI:0.26~0.88,Z=2.38,P<0.05);혈장치환연합내과치료조적병사솔(126/575,21.9%)저우단순내과치료조(257/492,52.2%)(OR=0.24,95%CI:0.18~0.31,Z=10.14,P<0.01);량충급량충이상인공간지지계통연합내과치료조적병사솔위29.7%(80/269),저우단순내과치료조(103/227,45.4%)(OR=0.45,95%CI:0.31~0.67,Z=4.02,P<0.01)。결론인공간지지계통연합내과치료가명현강저각류간쇠갈환자적병사솔。
Objective To evaluate the efficacy of artificial liver support system ( ALSS) combined with conventional medical treatment for liver failure .Methods Literature retrieval of Wanfang Data , CQVIP, CNKI, Medline, Cochrane Library and PubMed from 2004 to 2014 was conducted to identify all studies on ALSS in treatment of liver failure .The quality of the literature was assessed according to Cochrane systematic guide manual , and meta-analysis was performed using RevMan 5.3.Random-effects or fixed-effects model was performed based on the heterogeneity , and publication bias was evaluated with Begg ’ s funnel pot .Results A total of 20 randomized controlled clinical trials involving 2 356 patients were included for systematic review , among which 1 247 patients were treated with ALSS combined with medical therapy, and 1 109 patients were treated with medical therapy only .Meta-analysis showed that the mortality of patients with liver failure treated with combined therapy was 25.3%(316/1247), which was lower than that with medical treatment alone (524/1 109, 47.2%) ( OR=0.36, 95%CI:0.30-0.43, Z=11.19, P<0.01).The mortality of patients with acute (subacute) and subacute-on-chronic liver failure treated with combined therapy (54/203, 26.6%) was lower than that with medical treatment group (76/188, 40.4%) (OR=0.53, 95%CI:0.34-0.81, Z=2.91, P<0.01).The mortality of patients with chronic liver failure treated with combined therapy was 25.6% (89/347), which was also lower than that with medical treatment group (171/340, 50.3%) (OR=0.32, 95%CI:0.23-0.45, Z=6.73, P<0.01). Mortality in patients received medical treatment plus molecular adsorption recirculation system , plasma exchange or multiple ALSS were 23.6% (26/110), 21.9% (126/575) and 29.7% (80/269), which were significantly lower than those in patients received only medical treatment [38.9%(42/108), 52.2%(257/492) and 45.4%(103/227)] (OR=0.48, 0.24 and 0.45, 95%CI:0.26-0.88, 0.18-0.31 and 0.31-0.67, Z=2.38, 10.14 and 4.02, all P<0.05 or <0.01).Conclusion ALSS combined with medical therapy can reduce the mortality of patients with various types of liver failures .