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乳果糖联合益生菌治疗轻微型肝性脑病的Meta分析 认领

Lactulose combined with probiotics in the treatment of minimal hepatic encephalopathy:a systematic review and Meta-analysis
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摘要 目的系统评价乳果糖联合益生菌治疗轻微型肝性脑病(minimal hepatic encephalopathy,MHE)的疗效和安全性。方法系统检索PubMed、Embase、Web of Science、Cochrane Library等英文数据库,以及CBM、CNKI、万方、维普等中文数据库,检索2020年1月31日前发表的乳果糖联合益生菌治疗在肝硬化或慢性肝病基础上发生MHE的随机对照试验;2名研究者单独按照纳入及排除标准进行文献筛选、质量评价、数据提取;最后采用RevMan 5.3软件进行Meta分析。结果最终纳入8篇文献,受试者共计545例。Meta分析结果显示:乳果糖联合益生菌和单用乳果糖相比,显性肝性脑病(overt hepatic encephalopathy,OHE)进展率(RR=0.15,95%CI:0.05~0.51,P=0.002)、血氨(MD=-14.37,95%CI:-17.35~-11.38,P<0.0001)、数字连接试验(MD=-18.56,95%CI:-28.29~-8.82,P=0.0002)差异有统计学意义,肝功能ALT(MD=-0.74,95%CI:-8.74~7.26,P=0.86)、AST(MD=-4.20,95%CI:-13.29~4.88,P=0.36)、不良反应发生率(RR=0.47,95%CI:0.13~1.64,P=0.23)差异无统计学意义(P>0.05)。结论现有证据表明,与单用乳果糖相比,联合使用益生菌可有效降低MHE患者血氨水平,减少MHE向OHE进展,临床效果值得推广。 Objective To systematically evaluate the efficacy and safety of lactulose combined with probiotics in the treatment of minimal hepatic encephalopathy(MHE).Methods English databases such as PubMed,Embase,Web of Science and Cochrane Library were systematically searched by computer,as well as Chinese databases such as CBM,CNKI,Wanfang and VIP.Randomized controlled trials of lactulose combined with probiotics in the treatment of MHE on the basis of cirrhosis or chronic liver disease,published before Jan.31,2020,were searched.Two researchers independently screened the literature,evaluated the quality and extracted the data according to the inclusion and exclusion criteria.Finally,the RevMan 5.3 software was used for Meta-analysis.Results Eight literatures including 545 patients were included.The results of Meta-analysis showed that there were statistically significant differences in the rate of progression of overt hepatic encephalopathy(OHE)(RR=0.15,95%CI:0.05-0.51,P=0.002),blood ammonia(MD=-14.37,95%CI:-17.35--11.38,P<0.0001),and number connection test A(MD=-18.56,95%CI:-28.29--8.82,P=0.0002)between lactulose combined with probiotics group and lactulose alone group;while there were no significant differences in ALT(MD=-0.74,95%CI:-8.74-7.26,P=0.86),AST(MD=-4.20,95%CI:-13.29-4.88,P=0.36)and incidence of adverse reactions(RR=0.47,95%CI:0.13-1.64,P=0.23).Conclusion The existing evidence shows that,compared with lactulose alone,the combination of probiotics can effectively reduce blood ammonia and reduce the progress from MHE to OHE,which is worthy of clinical promotion.
作者 张哲 魏延 韩伟 赵曙光 赵丽 ZHANG Zhe;WEI Yan;HAN Wei;ZHAO Shuguang;ZHAO Li(Department of Gastroenterology,Tangdu Hospital,Air Force Military Medical University,Xi’an 710038,China)
出处 《胃肠病学和肝病学杂志》 CAS 2021年第1期95-101,共7页 Chinese Journal of Gastroenterology and Hepatology
基金 国家自然科学基金资助项目(81270485)。
关键词 肝性脑病 乳果糖 益生菌 META分析 Hepatic encephalopathy Lactulose Probiotics Meta-analysis
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