摘要目的 通过荟萃分析评价糖皮质激素治疗重型肝炎的疗效.方法 检索PubMed (1966-2011年)、EMCC(西文生物医学期刊文献服务系统1995-2011年)、Springe全文数据库、CNKI全文数据库、万方数据库、中国生物医学文献数据库中公开发表的中、英文文献,并对相关的参考文献严格按照文献纳入和排除标准进行筛选.采用RvMan5.0软什进行荟萃分析,病死率采用相对危险度(RR)进行评估,总胆红素(TBil)、ALT和凝血酶原活动度(PTA)采用加权均数差值(WMD)和95％可信区间(CI)进行评估,并应用森林图、漏斗图对判定指标进行发表偏倚检验和敏感性分析结果 共纳入23篇文献,1457例病例.与对照组比,应用糖皮质激素治疗组患者的病死率明显降低(RR=0.39,95％ CI:0.32 ～0.47.Z=9.75,P＜0.01),TBil(WMD=-88.03,95％ CI:-1122.80～-63.26,Z=6.97,P＜0.01),ALT(WMD=-25.04,95％ CI:-42.23 ～-7.84,Z-2.85,P＜0.01)和PTA(WMD =21.56,95％ CI:6.52 ～36.60,Z=2.81,P＜0.01)明显改善.结论 应用糖皮质激素治疗重型肝炎能够明显改善患者的ALT、TBil 和 PTA水平,降低患者的病死率.

abstractsObjective To evaluate the clinical efficiency of glucocorticoids in treatment of severe hepatitis.Methods A systematic review on the efficacy of glucocorticoids in treatment of severe hepatitis was conducted.Relevant literatures were searched in PubMed (1966-2011),EMCC (1995-2011),Springer,CNKI,Wanfang Database and CBM.The retrieved literatures were screened according to the predefined inclusion and exclusion criteria.RevMan 5.0 statistical software was used for Meta-analysis.The mortality was evaluated by relative risk (RR),while the total bilirubin (TBil),ALT and prothrombin activity (PTA) were evaluated by weighted mean difference (WMD) and 95％ confidential interval (CI).The publication bias and sensitivity about the data were measured by forest plot and funnel plot.Results Twenty-three papers involving a total of 1457 patients were included in the study.Compared to control group,the mortality in glucocorticoids-treated group was lower (RR =0.39,95％ CI:0.32-0.47,Z =9.75,P＜0.01); and the TBil (WMD=-88.03,95％CI:-112.80-63.26,Z=6.97,P＜0.01),ALT (WMD=-25.04,95％CI:-42.23-7.84,Z=2.85,P＜0.01) and PTA levels (WMD=21.56,95％ CI:6.52-36.60,Z=2.81,P ＜0.01) in glucocorticoids-treated group were improved.Conclusion Glucocorticoids can effectively improve TBil,ALT and PTA levels,and reduce the mortality of patients with severe hepatitis.