聚乙二醇与乳果糖治疗肝性脑病患者疗效和安全性的Meta分析

doi:10.3969/j.issn.1672-5069.2021.01.026

摘要/Abstract

摘要： 目的比较聚乙二醇(PEG)与乳果糖治疗肝性脑病(HE)患者的疗效和安全性。方法利用计算机在 PubMed、EMbase、Cochrane、万方数据库、中国知网中检索自建库至 2019年11月20日期间关于PEG与乳果糖治疗HE患者的随机对照试验,选取符合纳入条件的文献并对其进行质量评价。应用RevMan 5.3 软件进行Meta分析。结果纳入8项随机对照研究,包括PEG处理组249例和乳果糖处理组244例患者。Meta分析结果显示,PEG组不良反应发生率为12.9%,显著低于乳果糖组的27.4%(P＜0.0001);PEG组24 h HESA评分改善率为91.5%,显著高于乳果糖组的65.5%(P＜0.0001);PEG组和乳果糖组住院日分别为,治疗前后血氨分别下降了。结论 PEG较乳果糖治疗HE患者不良反应少,能更快地降低患者24 h HESA评分,缩短住院日,其临床应用值得进一步观察。

关键词: 肝性脑病, 聚乙二醇, 乳果糖, Meta 分析, 治疗

Abstract: Objective The aim of this study was to meta-analyzed the randomized controlled trials(RCTs) of polyethylene glycol (PEG) and lactulose in the treatment of patients with hepatic encephalopathy (HE). Methods The meta-analysis was conducted in PubMed, EMbase,Cochrane,WanFang Data and CNKI by computer search and retrieve untill November 20,2019. RCTs were selected and their quality was evaluated by RevMan 5.3 software. Results A total of 8 randomized controlled studies were obtained, including 249 patients in the PEG group and 244 patients in the lactulose group; the results of Meta analysis showed that the incidence of adverse reactions in PEG group was 12.9%, significantly lower than that in lactulose group(27.4%, P＜0.0001); the improvement rate of 24-hour HESA score in PEG group was 91.5%, significantil higher than 65.5% in lactulose group (P＜0.0001); the hospital stay in PEG group and lactulose group was ,and serum ammonia decreased after treatment were in the two groups. Conclution Compared with lactulose intervention, the administration of PEG has fewer adverse reactions in patients with HE, which might decrease 24-hour HESA score, shorten hospital stay, and needs further investigation.

Key words: Hepatic encephathy, Polyethylene glycol, Lactulose, Meta-analysis, Therapy

曾娇, 郭贵海. 聚乙二醇与乳果糖治疗肝性脑病患者疗效和安全性的Meta分析[J]. 实用肝脏病杂志, 2021, 24(1): 99-102.

Zeng Jiao, Guo Guihai. Efficacy and safety of polyethylene glycol and lactulose in the treatment of patients with hepatic encephalopathy:a Meta-analysis[J]. Journal of Practical Hepatology, 2021, 24(1): 99-102.

参考文献

[1] Vilstrup H,Amodio P,Bajaj J,et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American association for the study of liver diseases and the European association for the study of the liver. Hepatology,2014,60(2):715-735.
[2] Fleming KM,Aithal GP,Solaymani-Dodaran M,et al. Incidence and prevalence of cirrhosis in the United Kingdom, 1992-2001: A general population-based study. J Hepatol,2008,49(5):732-738.
[3] Bannister CA,Orr JG,Reynolds AV,et al. Natural history of patients taking rifaximin-alpha for recurrent hepatic encephalopathy and risk of future overt episodes and mortality: A post-hoc analysis of clinical trials data. Clin Ther,2016,38(5):1081-1089.e1084.
[4] Sawhney R,Jalan R. Liver: The gut is a key target of therapy in hepatic encephalopathy. Nat Rev Gastroenterol Hepatol,2015,12(1):7-8.
[5] 李明强,王砚砚,徐德魁. 乳果糖联合聚乙二醇辅助治疗肝性脑病的疗效观察. 中国实用医药,2015,10(33):168-169.
[6] 钟天胜. 聚乙二醇-电解质溶液在肝性脑病中的应用效果观察. 中外医学研究,2016,14(22):9-10.
[7] 严涛,江振,钟金妹,等. 复方聚乙二醇电解质散在治疗肝性脑病中的疗效观察. 医学理论与实践,2016,29(10):1268-1270.
[8] 汤泗玲. 聚乙二醇-电解质溶液在肝性脑病中的应用效果观察. 中国现代药物应用,2017,11(22):120-121.
[9] Naderian M,Akbari H,Saeedi M,et al. Polyethylene glycol and lactulose versus lactulose alone in the treatment of hepatic encephalopathy in patients with cirrhosis: A non-inferiority randomized controlled trial. Middle East J Dig Dis,2017,9(1):12-19.
[10] Bajwa KN,Aziz B,Nazar T. Comparison of the effectiveness and safety profile of polyethylene glycol-electrolyte solution with lactulose in patients of overt hepatic encephalopathy. Pakistan J Med Healt Sci,2019,13(2):411-414.
[11] Shehata H,Elfert AA,Abdin AA,et al. Randomized controlled trial of polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy. Eur J Gastroenterol Hepatol,2018,30(12):1476-1481.
[12] Rahimi RS,Singal AG,Cuthbert JA,et al. Lactulose vs polyethylene glycol 3350-electrolyte solution for treatment of overt hepatic encephalopathy: The help randomized clinical trial. JAMA Intern Med,2014,174(11):1727-1733.
[13] Romero-Gomez M,Montagnese S,Jalan R. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure. J Hepatol,2015,62(2):437-447.
[14] 彭思璐,刘冰,孙宏,等. HBV相关慢加急性肝衰竭患者预后及其影响因素分析. 实用肝脏病杂志,2019,22(4):545-548.
[15] 马雅琼,李芝兰,夏冰. 早期肠内营养联合微生态制剂治疗肝性脑病患者肠道菌群的改变. 实用肝脏病杂志,2019,22(6):892-895.
[16] Sidhu SS,Sharma BC,Goyal O,et al. L-ornithine l-aspartate in bouts of overt hepatic encephalopathy. Hepatology,2018,67(2):700-710.
[17] Nardelli S,Lattanzi B,Merli M,et al. Muscle alterations are associated with minimal and overt hepatic encephalopathy in patients with liver cirrhosis. Hepatology,2019,70(5):1704-1713.
[18] Vierling JM,Mokhtarani M,Brown RS, Jr.,et al. Fasting blood ammonia predicts risk and frequency of hepatic encephalopathy episodes in patients with cirrhosis. Clin Gastroenterol Hepatol,2016,14(6):903-906.
[19] Jarzebicka D,Sieczkowska-Golub J,Kierkus J,et al. Peg 3350 versus lactulose for treatment of functional constipation in children: Randomized study. J Pediatr Gastroenterol Nutr,2019,68(3):318-324.
[20] Wang Z,Chu P,Wang W. Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy. Drug Des Devel Ther,2019,13(17):1-11.