摘要
目的评价特立加压素治疗肝。肾综合征（HRS）的疗效、不良反应和安全性。方法在Medline、Embase、CochraneLibrary、VIP和CNKI中国期刊全文数据库中检索2008年11月1日之前已发表的关于特立加压素治疗HRS的随机对照临床试验。利用Stata9．0软件进行荟萃分析。结果按入选标准，共纳入7篇随机对照临床试验，共305例HRS患者纳入荟萃分析。荟萃分析表明：与安慰剂相比，特立加压素治疗HRS缓解率高，比值比（OR）值6．76[95％可信区间（c，）为：3．37-13．56，P=0．000]；心肌梗死，心律失常，肠缺血及外周组织缺血发生率差异均无统计学意义[1．37（95％CI：0．26-7．31，P=0．715），3．25（95％CI：0．49-21．31，P=0．222），2．14（95％CI：0．46-10．02，P=0．336），1．72（95％CI：0．34-8．76，P=0．516）]；病死率略低，OR值0．55（95％CI：0．31-0．98，P=0．044）。与去甲肾上腺素相比，特立加压素治疗HRS缓解率、心肌梗死、心律失常、肠缺血、外周组织缺血发生率及病死率差异均无统计学意义[0．92（95％CI：0．32-2．67，P=0．877），0．92（95％CI：0．06-15．34，P：0．952），0．32（95％CI：0．03-3．73，P=0．364），0．92（95％CI：0．06-15．34，P：0．952），0．92（95％CI：0．06-15．34，P=0．952），0．80（95％CI：0．29-2．24，P=0．673）]。结论特立加压素和去甲肾上腺素均能有效地治疗HRS，特立加压素并不增加心肌梗死、心律失常、肠缺血和外周组织缺血发生率；特立加压素能否降低HRS患者病死率尚需大样本多中心的随机对照临床试验进行研究。
Objective To evaluate the efficacy, adverse effect and safety of terlipressin in the treatment of hepatorenal syndrome （ HRS ） . Methods Correlated randomized controlled clinical trials （RCTs） comparing terlipressin with other therapies in the treatment of HRS were searched in Medline, Embase, Cochrane Library, VIP and National Knowledge Infrastructure （CNKI）. Stata 9. 0 was used for meta-analysis. Results 7 RCTs including 305 cases were selected for analysis in accordance with the enrollment criteria. HRS reversal rate of terlipressin was superior to that of placebo （ total OR = 6. 76, 95% CI = 3.37 - 13.56, P = 0. 000） ; Myocardial infarction rate （ total OR = 1.37, 95 % CI = 0. 26 - 7.31, P = 0. 715）, arrhythmic rate （ total OR = 3.25, 95% CI = 0. 49 - 21.31, P = 0. 222 ）, suspected intestinal ischemic rate （total OR = 2. 14, 95% CI = 0. 46 - 10. 02, P = 0. 336） and peripheral ischemic rate （ total OR = 1.72, 95% CI = 0. 34 - 8. 76, P = 0. 516） of terlipressin were similar with those of placebo ; Mortality rate of terlipressin was a little lower than that of placebo （ total OR = 0. 55, 95% CI = 0. 31 - 0. 98, P = 0. 044）. HRS reversal rate （ total OR = 0. 92, 95% CI = 0. 32 - 2. 67, P = 0. 877 ）, myocardial infarction rate （ total OR = 0. 92, 95 % CI = 0. 06 - 15.34, P = 0. 952）, arrhythmic rate （ total OR = 0. 32, 95 % CI = 0. 03 - 3.73, P = 0. 364）, suspected intestinal ischemic rate （ total OR = 0. 92, 95% CI = 0. 06 - 15.34, P =0. 952）, peripheral ischemic rate （total OR =0. 92, 95% CI=O. 06 - 15.34, P =0. 952） and mortality rate （ total OR = 0. 80, 95% CI = 0. 29 - 2. 24, P = 0. 673 ） of terlipressin were similar to those of noradrenalin. Conclusion Terlipressin and noradrenalin are effective and safe in the treatment of HRS, the relationship between terlipressin and HRS mortality rate should be elucidated with further studies.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第28期1970-1974,共5页
National Medical Journal of China
