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目的:系统评价血管紧张素Ⅱ受体拮抗药(ARBs)对肝纤维化患者血清学指标的影响。方法:计算机检索PubMed、中国期刊全文数据库及万方数据库中关于ARBs治疗肝纤维化的临床随机对照试验(RCT),对符合纳入标准的临床研究进行评估与资料提取后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入9项RCT,合计457例患者。Meta分析结果表明,ARBs可以显著降低肝纤维化患者血清玻璃酸(HA)[WMD=-66.31,95%CI(-102.80,-29.82),P=0.000]、层黏蛋白(LN)[WMD=-44.49,95%CI(-70.28,-18.69),P=0.000]、血清Ⅳ型胶原(CⅣ)[WMD=-36.40,95%CI(-61.84,-10.95),P=0.005]、血清Ⅲ型前胶原氨基端肽(pⅢp)[WMD=-41.29,95%CI(-74.57,-8.02),P=0.02]水平。结论:在常规治疗基础上,加服ARBs治疗肝纤维化,能够明显改善患者血清HA、LN、CⅣ及pⅢp等相关指标。由于纳入研究的质量不高,此结论有待更多高质量、大样本的RCT加以验证。
Objective: To systematically evaluate the effect of angiotensin Ⅱ receptor antagonist (ARBs) on serum markers in patients with liver fibrosis. METHODS: Randomized controlled trials (RCTs) of ARBs on hepatic fibrosis were performed in PubMed, China Journal Full-text Database and Wanfang Database. After comparisons of the clinical trials that met the inclusion criteria were carried out and the data were extracted, RevMan 5.2 statistical software Meta-analysis. Results: A total of 9 RCTs were enrolled, totaling 457 patients. Meta-analysis showed that ARBs could significantly reduce serum hyaluronic acid (HA) [WMD = -66.31,95% CI -102.80, -29.82, P = 0.000], laminin (WM) -44.49,95% CI (-70.28, -18.69), P = 0.000], serum type IV collagen (CIV) [WMD = -36.40,95% CI (-61.84, -10.95), P = 0.005] Type procollagen amino terminal peptide (pⅢp) [WMD = -41.29,95% CI (-74.57, -8.02), P = 0.02]. Conclusion: On the basis of conventional treatment, the addition of ARBs for liver fibrosis can significantly improve the serum HA, LN, CⅣ and pⅢp and other related indicators. Due to the poor quality of the included studies, this conclusion needs to be validated by more high-quality, large sample RCTs.