营养治疗对酒精性肝病的疗效与安全性分析

发布时间：2018-04-25 22:08

本文选题：酒精性肝病 + 营养治疗　；参考：《暨南大学》2014年硕士论文

【摘要】：目的：评价营养治疗对酒精性肝病（ALD）的疗效与安全性。方法：检索Pubmed、Embase、Web of Science、The Cochrane Central Register of ControlledTrials、相关期刊论文、中国科技期刊数据库（维普）、万方数字化期刊全文数据库等有关营养治疗酒精性肝病的临床随机对照试验，采用RevMan5.1.0软件对入选试验进行Meta分析。结果：共13项随机对照试验（RCT）包含590名ALD患者符合入选标准。Meta分析结果显示：①与对照组相比，营养治疗可以更有效地降低ALD患者血清总胆红素（P=0.04）、碱性磷酸酶（ALP）（P=0.04）以及升高血清转铁蛋白（P＜0.00001），但在其他肝功能及ALD并发症等其他指标方面两种治疗方法无显著统计学差异；②营养治疗组的短期及长期死亡率与对照组相比无显著统计学差异，RR值分别为1.09（95%CI：0.80~1.47，P=0.59）及0.75（95%CI：0.55~1.01，P=0.06）；③营养治疗与对照组相比，总不良反应发生率及感染发生率均无显著统计学差异（RR1.64，P=0.11；RR0.99，P=0.97）；④根据营养方式不同，将13个RCT分为肠内营养亚组（9个RCT）和肠外营养亚组（4个RCT），，Meta分析结果显示：与对照组相比，肠外营养能更加明显降低ALD患者血清总胆红素（P＜0.00001），而肠内营养与对照组相比在降低血清总胆红素的疗效方面无显著统计学差异（P=0.84）；其它疗效指标如ALP、短期及长期死亡率等亚组分析结果与上述未分组时的结果一致。结论：营养治疗可以明显改善ALD患者的血清胆红素、碱性磷酸酶、转铁蛋白等部分肝功能指标，但不能改善其短期或长期生存率、其他肝功能及ALD并发症等指标，不良反应较少，可以作为ALD患者的常规治疗方法。
[Abstract]:Objective: to evaluate the efficacy and safety of nutritional therapy in patients with alcoholic liver disease (ALD). Methods: a randomized controlled clinical trial on nutritional therapy of alcoholic liver disease was conducted in Pubmedus Embase of Science and Technology (Cochrane Central Register of ControlledTrials,), Chinese Journal of Science and Technology (WYPU), Chinese Science and Technology Journals (WYPX), and the Chinese Journal of Science and Technology (Cochrane Central Register of ControlledTrials,). RevMan5.1.0 software was used to analyze the selected test by Meta. Results: a total of 13 randomized controlled trials (RCTs) included 590 ALD patients who met the inclusion criteria. Meta-analysis showed that: 1 was compared with the control group. Nutritional therapy could effectively reduce serum total bilirubin, alkaline phosphatase (ALP) and elevated serum transferrin (P < 0.00001) in patients with ALD, but there was no significant difference in other indexes such as liver function and ALD complications. 2There was no significant difference in the short-term and long-term mortality rates between the nutrition treatment group and the control group. The RR values were 1.09 / 95, respectively (CI: 0.80 / 1.47) (0.59) and 0.75 ~ 95% (CI: 0.551.01) and 0.06% (P < 0.05), respectively, compared with those in the control group, and there was no significant difference between the nutrition treatment group and the control group. There was no significant difference in the incidence of total adverse reactions and the incidence of infection. According to the different nutrition patterns, 13 RCT were divided into enteral nutrition subgroup (9 RCT) and parenteral nutrition subgroup (4 RCTs). The results of meta-analysis showed that: compared with the control group, 13 RCT were divided into two groups: compared with the control group, 13 RCT were divided into enteral nutrition subgroup (9 RCTs) and parenteral nutrition subgroup (4 RCTs). Parenteral nutrition significantly decreased serum total bilirubin in patients with ALD (P < 0.00001), but there was no significant difference in the efficacy of enteral nutrition in reducing serum total bilirubin compared with control group. The results of subgroup analysis were consistent with those of the ungrouped group. Conclusion: nutritional therapy can obviously improve some liver function indexes such as serum bilirubin, alkaline phosphatase and transferrin in ALD patients, but can not improve short-term or long-term survival rate, other liver function and ALD complications. There are few adverse reactions and can be used as a routine therapy for ALD patients.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.5

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