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首页> 外文期刊>Journal of clinical gastroenterology >Corticosteroids Versus Pentoxifylline for Severe Alcoholic Hepatitis: A Sequential Analysis of Randomized Controlled Trials
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Corticosteroids Versus Pentoxifylline for Severe Alcoholic Hepatitis: A Sequential Analysis of Randomized Controlled Trials

机译：皮质类固醇与己酮可可碱治疗严重酒精性肝炎：随机对照试验的顺序分析。

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Introduction:Despite the significant morbidity and mortality associated with alcoholic hepatitis, a consensus or generally accepted therapeutic strategy has not yet been reached. The purpose of this analysis was to evaluate the effects of corticosteroids and pentoxifylline on short-term mortality, incidence of hepatorenal syndrome, and sepsis in patients with severe alcoholic hepatitis.Materials and Methods:We conducted a comprehensive search of the Cochrane library, PUBMED, Scopus, EMBASE, and published proceedings from major hepatology and gastrointestinal meetings from January 1970 to June 2015. All relevant articles irrespective of language, year of publication, type of publication, or publication status were included. Two independent reviewers extracted data and scored publications; a third investigator adjudicated discrepancies. The scores were measured to assess the agreement between the 2 initial reviewers. The review and meta-analyses were performed following the recommendations of The Cochrane Collaboration. Conventional meta-analysis and Trial sequential analysis were performed. GRADEpro version 3.6 was used to appraise the quality of epidemiologic evidence.Results:A total of 14 studies satisfied inclusion criteria comparing corticosteroids, pentoxifylline, or placebo. Compared with placebo, corticosteroids reduced 28-day mortality (RR=0.53; 95% CI, 0.33-0.84; P=0.006). There was no statistically significant difference in short-term mortality between pentoxifylline and placebo (RR=0.74; 95% CI, 0.46-1.18; P=0.21). Neither corticosteroids nor pentoxifylline impacted the incidence of hepatorenal syndrome or sepsis. Trial sequential analysis confirmed the results of our conventional meta-analysis.Conclusions and Relevance:Corticosteroids demonstrated a decrease in 28-day mortality in patients with severe alcoholic hepatitis. The evidence from this study is insufficient to support any recommendations regarding the mortality benefit of pentoxifylline in severe alcoholic hepatitis.
机译：简介：尽管与酒精性肝炎相关的发病率和死亡率很高，但尚未达成共识或普遍接受的治疗策略。这项分析的目的是评估皮质类固醇和己酮可可碱对严重酒精性肝炎患者的短期死亡率，肝肾综合征的发生率和败血症的影响。 Scopus，EMBASE以及从1970年1月至2015年6月的主要肝病学和胃肠道会议上发表的论文。其中包括所有相关文章，而不论其语言，出版年份，出版类型或出版状态。两名独立的审稿人提取数据并给出版物打分;第三位调查员裁定差异。测量分数以评估2位初始审核者之间的一致性。根据Cochrane协作组织的建议进行了审查和荟萃分析。进行常规荟萃分析和试验顺序分析。结果：GRADEpro 3.6版用于评估流行病学证据的质量。结果：共有14项研究符合纳入标准，比较了皮质类固醇，己酮可可碱或安慰剂。与安慰剂相比，皮质类固醇降低了28天的死亡率（RR = 0.53; 95％CI，0.33-0.84; P = 0.006）。己酮可可碱与安慰剂之间的短期死亡率无统计学差异（RR = 0.74; 95％CI，0.46-1.18; P = 0.21）。皮质类固醇和己酮可可碱均不会影响肝肾综合征或败血症的发生。试验顺序分析证实了我们常规荟萃分析的结果。结论和相关性：糖皮质激素显示重度酒精性肝炎患者28天死亡率降低。这项研究的证据不足以支持有关己酮可可碱对重度酒精性肝炎的死亡率益处的任何建议。

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