摘要
目的系统评价熊去氧胆酸(Ursodeoxycholic acid,UDCA)联合免疫抑制剂治疗原发性胆汁性胆管炎-自身免疫性肝炎(primary biliary cholangitis-autoimmune hepatitis,PBC-AIH)重叠综合征的疗效和安全性。方法计算机检索PubMed、EmBase、Cochrane Library、Web of Science、中国知网、万方、中国生物医学文献、维普等数据库收录的有关UDCA联合免疫抑制剂治疗PBC-AIH重叠综合征的文献,检索时限为建库至2022年3月1日。根据纳入及排除标准筛选文献并提取数据,对纳入文献进行质量评价,运用RevMan 5.3软件进行Meta分析。结果最终共纳入24篇文献,其中中文文献9篇,英文文献15篇,包括联合治疗组(UDCA联合免疫抑制剂治疗)484例,UDCA单药治疗组(UDCA单药治疗)358例。Meta分析结果显示,与UDCA单药治疗相比,联合治疗可提高PBC-AIH重叠综合征患者多种生化、免疫指标的应答率(ALT:RR=1.33,95%CI:1.13~1.56,P=0.0006;ALP:RR=1.20,95%CI:1.06~1.36,P=0.004;IgG:RR=1.24,95%CI:1.05~1.47,P=0.01),并可延缓或减少肝纤维化进展(RR=0.41,95%CI:0.20~0.83,P=0.01),降低肝移植或肝相关死亡率(RR=0.33,95%CI:0.14~0.77,P=0.01)。单药治疗与联合治疗比较肝脏相关不良事件发生率(RR=0.60,95%CI:0.34~1.06,P=0.08)以及药物不良反应发生率(RR=1.38,95%CI:0.93~2.05,P=0.11),差异均无统计学意义。结论与UDCA单药治疗相比,联合治疗可显著提高生化、免疫指标的应答率,延缓或减少肝纤维化进展,降低肝移植或肝相关死亡率,并且不增加肝脏不良事件发生率及药物不良反应发生率。
Objective To systematically evaluate the efficacy and safety of Ursodeoxycholic acid(UDCA)combined with immunosuppressive agents in the treatment of primary biliary cholangitis-autoimmune hepatitis(PBC-AIH)overlap syndrome.Methods The literature on UDCA combined with immunosuppressive agents in the treatment of PBC-AIH overlap syndrome(included in PubMed,EmBase,Cochrane Library,Web of Science,CNKI,WanFang,CBM,VIP)and other databases were retrieved.The retrieval time limit was from the establishment of the database to Mar.1st,2022.According to the inclusion and exclusion criteria,the articles was screened and the data were extracted.The quality of the included articles was evaluated,and the RevMan 5.3 software was used for Meta-analysis.Results Finally,a total of 24 articles were included,including 9 Chinese articles and 15 English articles,including 484 cases in the combination therapy group(UDCA combined with immunosuppressive agents treatment)and 358 cases in the UDCA monotherapy group(UDCA monotherapy).The results of Meta-analysis showed that compared with UDCA monotherapy,combined therapy could improve the response rate of multiple biochemical and immune indicators in patients with PBC-AIH overlap syndrome(ALT:RR=1.33,95%CI:1.13-1.56,P=0.0006;ALP:RR=1.20,95%CI:1.06-1.36,P=0.004;IgG:RR=1.24,95%CI:1.05-1.47,P=0.01),delay or reduce the progress of liver fibrosis(RR=0.41,95%CI:0.20-0.83,P=0.01),and reduce liver transplantation or liver related mortality(RR=0.33,95%CI:0.14-0.77,P=0.01).There was no significant difference in the incidence of liver related adverse events(RR=0.60,95%CI:0.34-1.06,P=0.08)and adverse drug reactions(RR=1.38,95%CI:0.93-2.05,P=0.11)between monotherapy and combination therapy.Conclusion Compared with UDCA monotherapy,combined therapy can significantly improve the response rate of biochemical and immune indicators,delay or reduce the progress of liver fibrosis,reduce liver transplantation or liver related mortality,and do not increase the incidence of adverse liver events and adverse drug reactions.
作者
游琪琪
霍丽娟
YOU Qiqi;HUO Lijuan(The First Clinical Medical College of Shanxi Medical University,Taiyuan 030024;Department of Gastroenterology,the First Hospital of Shanxi Medical University,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第7期785-792,共8页
Chinese Journal of Gastroenterology and Hepatology
