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目的系统评价L-鸟氨酸-L-门冬氨酸(L-ornithine-L-aspartate,LOLA)治疗肝性脑病(hepaticencephalopathy,HE)的疗效和不良反应。方法计算机检索PubMed、EMbase、Web of Science、e CochraneCentral Register of Controlled Trials(CENTRAL)、CNKI、VIP、WanFang Data(检索时间截至2011年11月30日),纳入LOLA治疗肝性脑病的随机对照试验(RCT),由两位评价员独立评价纳入研究的质量、进行资料提取和交叉核对后,采用RevMan 5.0软件进行Meta分析。结果纳入6个RCT,C型HE患者432例,A型HE患者185例。Meta分析结果显示:与安慰剂相比,LOLA能明显降低C型HE患者的血氨水平[WMD=16.60,95%CI(8.34,24.85,P<0.000 1],改善数字连接试验(NCT-A)反应时间[WMD=9.6,95%CI(5.26,13.93),P<0.000 1],有效提高HE临床缓解率[RR=1.36,95%CI(1.06,1.73),P=0.01];但LOLA对于A型HE的疗效与安慰剂相比,差异无统计学意义(P>0.05)。结论 LOLA对C型HE患者疗效肯定,在临床上可作为一种治疗选择;但对A型HE的疗效有待更多高质量RCT进一步评价。
Objective To evaluate the efficacy and adverse reactions of L-ornithine-L-aspartate (LOLA) in the treatment of hepatic encephalopathy (HE). Methods A randomized controlled trial of LOLA for the treatment of hepatic encephalopathy was enrolled in Pubmed, EMbase, Web of Science, e Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, VIP and WanFang Data (retrieved on November 30, 2011) RCT). Two reviewers independently evaluated the quality of the included studies. After data extraction and cross-checking, RevMan 5.0 software was used for meta-analysis. Results Six RCTs were enrolled in this study, including 432 cases of type C HE and 185 cases of type A HE. Meta-analysis showed that LOLA significantly reduced blood ammonia levels in patients with type C HE than in placebo [WMD = 16.60, 95% CI (8.34, 24.85, P <0.0001], improved digital connectivity test (RR = 1.36, 95% CI (1.06, 1.73), P = 0.01]; however, LOLA was significantly higher than that of control group (WMD = 9.6,95% CI 5.26,13.93, P 0.0001) There was no significant difference in efficacy between type A HE and placebo (P> 0.05) .Conclusion LOLA is effective in patients with type C HE and may be used clinically as a treatment option. However, the efficacy of type A HE More high-quality RCT to be further evaluated.