目的：系统评价门冬氨酸鸟氨酸联合纳洛酮治疗肝性脑病的临床疗效。方法计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普数据库、PubMed数据库建库至2015年1月有关门冬氨酸鸟氨酸联合纳洛酮治疗肝性脑病临床疗效的随机对照文献，提取纳入文献相关数据进行Meta分析，以门冬氨酸鸟氨酸联合纳洛酮治疗肝性脑病（试验组）与门冬氨酸鸟氨酸或纳洛酮治疗肝性脑病（对照组）的临床疗效的比值比（ OR）以及95％CI为效应指标，并对两组治疗前后血氨、丙氨酸转氨酶（ALT）、总胆红素（TBIL）、神志转清醒时间及不良反应进行分析。采用 Revman 5.2进行Meta分析总体有效率。结果共纳入10个随机对照试验，共535例受试者，其中试验组269例，对照组266例。 Meta分析结果显示：试验组临床疗效优于对照组（ OR ＝3.92，95％ CI 2.48～6.17， P＜0.00001）。治疗前试验组与对照组的血氨、ALT、TBIL 比较差异无统计学意义（ SMD ＝2.33，95％ CI －0.10～4.76，P＞0.05；SMD＝5.32，95％ CI －0.45～11.09，P＞0.05；SMD＝1.58，95％ CI－1.84～5.01，P＞0.05）；治疗后，试验组血氨、TBIL低于对照组，神志转清醒短于对照组，差异有统计学意义（SMD＝－18.58.34，95％ CI －32.24～－4.93，P＜0.05；SMD＝－20.73，95％ CI －28.51～－12.96，P＜0.05；SMD＝－16.34，95％CI －23.53～－9.14，P＜0.05）。治疗后两组ALT、不良反应发生率比较差异无统计学意义（SMD＝－30.34，95％ CI －63.61～－2.93，P＞0.05；OR＝0.58，95％CI 0.18～1.92，P＞0.05）。结论门冬氨酸鸟氨酸联合纳洛酮治疗肝性脑病疗效显著，值得临床推广。%Objective To evaluate the clinical effects of naloxone combining with ornithine aspartate on hepatic encephalopathy.Methods Computer retrieval of Chinese biomedical literature database, CNKI, Wanfang database and VIP database to January 2015 the aspartic acid ornithine combined with naloxone in treatment of hepatic encephalopathy clinical randomized controlled literature.The pooled odds ratios ( ORs) with 95% confidence intervals (95%CIs) of the association between ornithine aspartate combining with nal-oxone in treatment of hepatic encephalopathy ( experimental group ) and ornithine aspartate or naloxone in treatment of hepatic encephalopathy ( control group) were performed.And analyse the two groups of the blood ammonia concentration,ALT,TBIL,conscious transfer time and adverse reactions before and after the treat-ment.Data statistical analysis were performed by Revman 5.2 software.Results A total of 10 studies invol-ving 535 patients met inclusion criteria .The experimental group shows better effects on hepatic encephalopathy in clinical effects(OR=3.92,95% CI 2.48-6.17,P<0.000 01).The blood ammonia con-centration,ALT,TBIL before the treatment has no diffenrence(SMD =2.33,95% CI -0.10-4.76,P >0.05;SMD=5.32,95% CI -0.45-11.09,P>0.05;SMD=1.58,95% CI -1.84-5.01,P>0.05).The experimental group shows better effects on reducing the blood ammonia concentration,TBIL,conscious trans-fer time than control group.The blood ammonia concentration,TBIL,conscious transfer time has diffenrences after the treatment(SMD=-18.58.34,95% CI -32.24--4.93,P <0.05;SMD =-20.73,95% CI-28.51--12.96,P<0.05;SMD=-16.34,95% CI -23.53--9.14,P<0.05).But the adverse reac-tion and ALT after treatment has no diffenrence between the two groups after treatment(OR=0.58,95% CI 0.18-1.92,P>0.05;OR=-30.34,95% CI -63.61--2.93,P>0.05).Conclusion Naloxone combi-ning with ornithine aspartate shows better effects on hepatic encephalopathy .
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