系统性审查:在患有肝硬化或酒精相关性肝炎的患者中治疗酒精使用障碍的干预措施
Christopher Oldroyd1,2, Olivia Greenham2, Graham Martin3
1Cambridge NIHR Biomedical Research Centre, Cambridge, UK.
Alimentary pharmacology & therapeutics
|August 21, 2023
概括
巴克洛芬在治疗肝硬化患者的酒精使用障碍方面表现有前途,随机试验显示了显著的益处. 非药物干预也可以改善该群体的临床结果.
科学领域:
- 肝病学和胃肠病学 肝病学和胃肠学
- 成 药物 药物 药物 药物
- 临床药理学 临床药理学
背景情况:
- 酒精使用是与酒精有关的肝硬化和酒精相关的肝炎患者的预后的一个关键决定因素.
- 在这个弱势群体中,针对酒精使用障碍 (AUD) 的有效干预对于改善结果至关重要.
研究的目的:
- 系统地审查针对AUD的干预措施,特别是在被诊断为肝硬化或酒精相关肝炎的患者中.
- 评估各种干预措施在关键结局 (如禁欲,肝脏衰竭和死亡率) 上的疗效.
主要方法:
- 从创立到2022年11月,对五个数据库进行了系统搜索.
- 包括的研究是随机和非随机试验,评估在肝病患者中对AUD的干预措施.
- 主要结局包括戒断率,肝衰竭事件和死亡率;在可行的情况下进行了元分析.
主要成果:
- 包括23项研究 (6项随机,17项非随机) 涉及104,298名患者.
- 在一项随机试验中,巴克洛芬是唯一一项在统计学上显著改善戒断的干预措施 (OR:6.3).
- 非随机化研究表明,心理治疗和药物治疗在减少肝脏衰竭方面具有潜在的益处.
结论:
- 巴克洛芬是唯一一个具有强有力的随机试验证据的干预措施,支持其在肝硬化患者的AUD疗效.
- 包括心理治疗在内的非药物干预措施,基于非随机数据,显示出改善该患者群体临床结果的潜力.
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