服用类固醇的酒精相关肝炎患者的预防性抗生素:系统性审查和元分析
Joo Wei E Quek1, Jing Hong Loo2, Aunchalee Jaroenlapnopparat3
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
概括
预防性抗生素可以降低服用类固醇的酒精相关肝炎患者的感染和肝脏脑病变风险. 然而,它们并不能改善存活率或预防急性损伤.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 酒精相关性肝炎 (AH) 是一种严重的肝病,通常用类固醇治疗.
- 在接受类固醇治疗的AH患者中,预防性抗生素的作用尚不清楚.
研究的目的:
- 评估预防性抗生素对正在接受类固醇治疗的酒精相关性肝炎 (AH) 患者的临床影响.
主要方法:
- 在2023年11月之前对四个电子数据库进行系统审查.
- 包括6项研究 (4项RCT,2项匹配队列研究) 涉及510名患者.
- 分析使用随机效应模型和对90天死亡率的试验顺序分析.
主要成果:
- 预防性抗生素显著降低了30天和90天感染的风险,并减少了肝脏脑病变 (HE).
- 在90天生存率,败血症相关死亡率,肝综合征 (HRS) 或急性损伤 (AKI) 中没有明显改善.
- 与药物相关的不良事件和真菌感染的风险在各组之间是可比的.
结论:
- 在接受类固醇治疗的住院AH患者中,预防性抗生素有效降低了感染和HE风险.
- 与标准医疗治疗相比,预防性抗生素不能提高生存率或防止AKI在这种患者群体中.
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