水飞蓟素治疗丙型肝炎肝功能损害疗效的meta分析

发布时间：2018-05-24 00:18

本文选题：水飞蓟素 + 丙型肝炎　；参考：《广西医科大学》2013年硕士论文

【摘要】：目的：评价水飞蓟素对丙型病毒性肝炎肝功能损害和临床症状改善的作用。方法：电子和手工检索数据库PubMed (1975.12-2012.12)、 EMBASE(1990.12-2012.12)、Cochrane(1998.12-2012.12)、中国生物医学文献数据库(1992.12-2012.12)。收集水飞蓟素与安慰剂相比较治疗丙型肝炎随机对照实验(Randomized controlled trial,RCT)的文献,文献质量的评估考虑四个部分：随机分配方法、分配方案的隐藏、盲法、脱落和失访人数及原因的描述。两名评价者独立进行方法质量评估并提取资料。对提取的资料进行Meta分析,必要时进行敏感性分析和亚组分析。敏感性分析将按照以下标准进行：去掉低质量的RCT、去掉短期治疗的RCT和去掉小样本的RCT。疗效评价的主要指标是转氨酶治疗前后改变,有效率。采用Cochrane协作网提供的专用软件包(Revman5.0)进行数据统计分析。结果：初检共检索出80篇相关文献,通过阅读题目、摘要,排除综述类、非临床类、排除诊断标准不同、干预措施不同、最终得到10篇文献共包含688个患者符合本研究的纳入标准,其中研究水飞蓟素治疗总有效率的有4篇,研究水飞蓟素治疗后谷丙转氨酶(ALT)改变情况的有6篇。其文献质量采用Cocharane Reviewer's Handbook5.0RCT的六条质量评估标准量表进行评分：所有入选研究的分配序列生产、分配隐藏、盲法设定均恰当,结局数据完整并选择性报告,但没有提供其他偏倚来源。总共4篇文献报道了水飞蓟素治疗242名丙型肝炎患者的总有效率。Meta分析显示,水飞蓟素对丙型肝炎的治疗是有效果的,主要表现在提高生存时间,胆红素指标及病毒载量降低。(相对危险度为2.66,95%可信区间1.88-3.75,PO.00001)。总共有6篇RCT文献报道了关于水飞蓟素对于446例丙型肝炎患者治疗后ALT改变的报道,各研究之间无统计学异质性(P=0.06,I2=52%),故采用固定效应模型,结果显示：水飞蓟素组治疗疗效优于安慰剂组,差距有统计学意义(MD值为-33.44,95%可信区间：-41.28,-25.61,P0.00001)。所有试验没有报告与水飞蓟素有关的严重副作用事件。结论：水飞蓟素治疗丙型肝炎可以提高肝脏疾病患者治疗的有效率,改善患者的临床症状和体征,提高患者的生活质量。水飞蓟素能降低丙型肝炎对肝脏的进一步损害,可以改善和恢复肝功能。
[Abstract]:Objective: To evaluate the effect of silymarin on liver function and clinical symptoms in patients with viral hepatitis C. Methods: Electronic and manual retrieval database PubMed (1975.12-2012.12), EMBASE (1990.12-2012.12), Cochrane (1998.12-2012.12), Chinese Biomedical Literature Database (1992.12-2012.12). The literature on silymarin compared with placebo in the treatment of hepatitis C was collected. The literature quality was evaluated in four parts: random distribution method, concealment of distribution scheme, blind method. Description of the number and causes of shedding and missing visits. Two reviewers independently evaluate the quality of the method and extract the data. The extracted data were analyzed by Meta, sensitivity analysis and subgroup analysis when necessary. Sensitivity analysis will be conducted according to the following criteria: remove low-quality RCTs, remove short-term RCT and remove small sample RCTs. The main index of curative effect evaluation is the change of transaminase before and after treatment and the effective rate. A special software package provided by Cochrane Cooperative Network (Cochrane) was used to carry out statistical analysis. Results: A total of 80 related articles were retrieved at the initial examination. By reading topics, abstracts, excluding summary, non-clinical, excluding diagnostic criteria and intervention measures, 10 articles including 688 patients met the inclusion criteria of this study. The total effective rate of silymarin and alanine aminotransferase after silymarin treatment were 4 and 6, respectively. The quality of the literature was evaluated by Cocharane Reviewer's Handbook5.0RCT 's six quality assessment scales: all the selected subjects were assigned sequence production, distribution hiding, blind setting, complete outcome data and selective report. No other sources of bias were provided. The total effective rate of silymarin in the treatment of 242 patients with hepatitis C was reported. Meta-analysis showed that silymarin was effective in the treatment of hepatitis C. it mainly showed that silymarin was effective in improving survival time, decreasing bilirubin index and viral load. (the relative risk was 2.66% 95% confidence interval 1.88-3.75% PO.001). A total of 6 RCT papers reported the changes of silymarin in 446 patients with hepatitis C after treatment. There was no statistical heterogeneity among the studies, so the fixed effect model was used. The results showed that silymarin group was more effective than placebo group, and the difference of MD was -33.44% 95% CI: -41.28% -25.61% P 0.00001. No serious side effects associated with silymarin were reported in all trials. Conclusion: Silymarin treatment of hepatitis C can improve the effective rate of liver disease patients, improve the clinical symptoms and signs of patients, improve the quality of life of patients. Silymarin can reduce the further damage to liver caused by hepatitis C, and can improve and restore liver function.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.63

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