在急性肝衰竭中使用非生物人工人工肝支持系统:对随机对照试验的综合系统性审查和元分析
Ruizhi Shi1, Xu Hui2, Ting Tong3
1The First Clinical Medical College of Lanzhou University, 730000, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Science, Lanzhou University, 730000, Lanzhou, China.
Clinics and research in hepatology and gastroenterology
|January 12, 2025
概括
非生物人工人造肝脏支持系统 (NBALSS) 可能改善急性肝衰竭 (ALF) 患者的生存率并减少炎症标志物. 然而,证据质量低至中等,需要更大,高质量的试验才能得出最终结论.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 关键护理医学 关键护理医学
- 生物医学工程 生物医学工程
背景情况:
- 急性肝衰竭 (ALF) 是一种危及生命的疾病,死亡率高.
- 非生物人工人工肝支持系统 (NBALSS) 用作移植桥梁或非移植候选人的最后手段.
- 在ALF中NBALSS的临床疗效仍然不完全理解.
研究的目的:
- 系统地审查和对ALF的NBALSS进行随机对照试验 (RCT) 的元分析.
- 评估NBALSS对整体存活时间 (OS) 和炎症标志物的影响.
- 用GRADE方法评估证据的确定性.
主要方法:
- 在多个数据库中进行全面的文献搜索,直到2023年7月.
- 对12项涉及824名患者的RCT进行了系统审查和元分析.
- 进行了偏差风险评估,GRADE确定性评级和子组分析.
主要成果:
- NBALSS显著改善了整体存活率 (OS) [RR = 1.42,95% CI (1.26,1.61) ] .
- NBALSS降低了总 bilirubin (TBIL),ALT,TNF-α 和 IL-6 的水平.
- 由于证据确定性非常低,对IL-2,IL-8和SOFA评分的影响是不确定的.
结论:
- 目前的证据表明,NBALSS可能会改善ALF患者的生存系统和生化/细胞因子概况.
- 证据的确定性受到偏见,不一致性和不准确性的限制.
- 高质量,大规模的试验对于确认NBALSS对患者重要结果的疗效至关重要.
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