胰岛素增敏剂治疗非酒精性脂肪性肝炎的Meta分析

肝脏 ›› 2022, Vol. 27 ›› Issue (1): 98-102.

胰岛素增敏剂治疗非酒精性脂肪性肝炎的Meta分析

王德鹤, 王怡群, 周盼, 叶敏超, 张玮, 李莹

200032 上海中医药大学附属龙华医院肝科

收稿日期:2021-08-25 出版日期:2022-01-31 发布日期:2022-02-11
通讯作者: 李莹,Email:13817270542@163.com
基金资助:
上海市卫生健康委员会中医药管理局临床项目(2020LP018)

Insulin sensitizers for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials

WAND De-he, WANG Yi-qun, ZHOU Pan, YE Min-chao, ZHANG Wei, LI Ying

Department of Hepatology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China

Received:2021-08-25 Online:2022-01-31 Published:2022-02-11
Contact: LI Ying,Email:13817270542@163.com

摘要/Abstract

摘要： 目的评估胰岛素增敏剂治疗非酒精性脂肪型肝炎(Nonalcoholic steatohepatitis,NASH)的组织学及血清学临床疗效。方法计算机检索中文数据库、英文数据库中关于胰岛素增敏剂治疗NASH的随机临床安慰剂试验。以RevMan5.3软件进行meta分析。结果共纳入8篇文献,共750例研究对象。结果显示,与安慰剂相比,胰岛素增敏剂可以改善肝纤维化(RR=1.53,95%CI:1.09~2.14,P<0.05)、脂肪变性(RR= 2.29,95%CI:1.76~2.98,P<0.05)、肝细胞气球样变(RR=1.77,95%CI:1.30~2.42,P<0.05),以及血清学指标ALT(改变值MD=-18.42,95%CI:-29.79~-7.05,终点值SMD=-1.01,95%CI:-1.46~-0.56,均P<0.05)、AST(改变值MD=-8.26,95%CI:-15.12~-1.39,终点值MD=-15.09,95%CI:-21.12~-9.07,均P<0.05)、TG(SMD=-0.46,95%CI:-0.65~-0.27,P<0.05)、FPG(改变值SMD=-0.62,95%CI:-0.98~-0.26,终点值SMD=-0.50,95%CI:-0.93~-0.07,均P<0.05)、FINS(SMD=-0.77,95%CI:-1.11~-0.44,P<0.05)等,但不能改善肝脏小叶炎症(RR=1.53,95%CI:0.92~2.54,P>0.05)、TC(SMD=-0.21,95%CI:-0.63~0.21,P>0.05)和BMI(改变值MD=0.06,95%CI:-1.53~1.64,终点值MD=-0.33,95%CI:-1.44~0.78,均P>0.05)等指标。结论胰岛素增敏剂治疗NASH具有一定作用,在改善肝组织学和血清学指标方面具有较好的作用。

关键词: 双胍类, 噻唑烷二酮, 非酒精性脂肪性肝炎, Meta分析

Abstract: Objective To explore and evaluate the histological and serological efficacy of existing?medicine of insulin sensitizers in the clinical treatment and effect of nonalcoholic steatohepatitis (NASH).Methods Chinese and English database were electronically searched for the goal of collecting randomized clinical placebo trials (RCTs) on existing insulin sensitizers in the clinical treatment of NASH. Two different researchers independently screened these studies, collected data from them using the same forms and gave judgment independently of the risk of bias on these chosen clinical studies above. After then, Meta-analysis was performed precisely by RevMan5.3 software on computer.Results A total of 8 articles including 750 qualified researched subjects with NASH were finally chosen. And the results of analysis revealed that insulin sensitizers were able to alleviate liver fibrosis (RR=1.53, 95%CI [1.09, 2.14], P<0.05), steatosis (RR=2.29, 95%CI [1.76, 2.98], P<0.05), hepatocellular ballooning (RR=1.77, 95%CI [1.30, 2.42], P<0.05) and serological ALT (change value MD=-18.42, 95%CI [-29.79, -7.05], terminal value SMD=-1.01, 95%CI [-1.46, -0.56], P<0.05), AST (change value MD=-8.26, 95%CI [-15.12, -1.39], terminal value MD=-15.09, 95%CI [-21.12, -9.07], P<0.05), TG (SMD=-0.46, 95%CI [-0.65, -0.27], P<0.05), FPG (change value SMD=-0.62, 95%CI [-0.98, -0.26], Terminal value SMD=-0.50, 95%CI [-0.93, -0.07], P<0.05), FINS (SMD=-0.77, 95%CI [-1.11, -0.44], P<0.05) indicators, compared with the placebo group, but they could not give a substantial improvement in lobular inflammation (RR=1.53, 95%CI[0.92, 2.54],P>0.05), TC (SMD =-0.21, 95%CI[-0.63, 0.21], P>0.05) and BMI (change value MD=0.06, 95%CI [-1.53, 1.64], terminal value MD=-0.33, 95%CI [-1.44, 0.78], P>0.05) indicators.Conclusion Insulin sensitizer has a certain efficacy in the treatment of NASH, and has a good effect in improving liver histology and serological indicators.

Key words: Biguanide, Thiazolidinedione, Non-alcoholic steatohepatitis, Meta-analysis

王德鹤, 王怡群, 周盼, 叶敏超, 张玮, 李莹. 胰岛素增敏剂治疗非酒精性脂肪性肝炎的Meta分析[J]. 肝脏, 2022, 27(1): 98-102.

WAND De-he, WANG Yi-qun, ZHOU Pan, YE Min-chao, ZHANG Wei, LI Ying. Insulin sensitizers for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials[J]. Chinese Hepatolgy, 2022, 27(1): 98-102.

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