代償性肝硬化患者的白蛋白管理：一項薈萃分析更新

StephenW

Albumin administration in patients with decompensated liver cirrhosis: a meta-analytic update

Ashour, Anas A.a,,b; Atta, Mohamed A.a,,b; Sadek, Khaled W.a,,b; Obaid, Koutaibah R.a,,b; Ashour, Mohammed Awadb; Ashour, Amrb; Danjuma, Mohammed I.a,,b; Doi, Suhail A.a; ElZouki, Abdel-Nasera,,b,,cAuthor Information

aCollege of Medicine, QU Health, Qatar University

bHamad General Hospital

cWeill Cornell Medicine-Qatar, Doha, Qatar

Received 23 June 2020 Accepted 17 August 2020

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Correspondence to Dr. Mohammed I. Danjuma, MBBS, MSc, Hamad General Hospital, 3050, Doha, Qatar, Tel: +974 5589 6229; e-mail: [email protected]
European Journal of Gastroenterology & Hepatology: April 2021 - Volume 33 - Issue 4 - p 479-486
doi: 10.1097/MEG.0000000000001932

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Abstract

End-stage liver disease and its related complications exert a huge disease burden and reduce the survival rates of many patients. Albumin administration for patients with decompensated liver cirrhosis has been a controversial topic of discussion. The aim of this study is to investigate whether albumin reduces the mortality and complications of liver cirrhosis compared to standard medical therapy (SMT) alone. Clinical trials in which albumin administration was compared to SMT in patients with liver cirrhosis were included in this meta-analysis. The primary outcome of this study was to evaluate the effect on reducing all-cause mortality. Ascites control, renal failure and hepatic encephalopathy were evaluated as secondary outcomes. Nine clinical trials with 1231 patients were recruited and analyzed using the quality effect model. Mortality rate was significantly reduced in the albumin group [relative risk (RR) 0.73, 95% confidence interval (CI) 0.56–0.96]. Heterogeneity was mild across all studies (I2 23.3%). Studies reporting long-term albumin (LTA) administration were found to have a significant decrease in mortality (RR 0.57, 95% CI 0.44–0.73). However, studies reporting short-term albumin administration were found to have no effect on mortality (RR 0.90, 95% CI 0.56–1.45). Furthermore, there was a significant decrease in the incidence of all secondary outcomes. This meta-analysis provides evidence that LTA administration is significantly effective in reducing the mortality of liver cirrhosis compared to SMT. Albumin administration was also shown to reduce the occurrence of ascites, renal failure and hepatic encephalopathy as complications of liver cirrhosis.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

StephenW

代償性肝硬化患者的白蛋白管理：一項薈萃分析更新

Ashour，Anas A.a，b；穆罕默德（Mohamed A.a，b）的阿塔（Atta） Sadek，Khaled W.a，b； Outad，庫塔伊巴R.a ,, b;穆罕默德·阿瓦德（Asham），阿瑟（Ashour）；阿瑟（Ashour），阿姆（Amrb）；丹朱瑪（Mohammed I.a，b）；杜伊（Suhail A.a）； ElZouki，Abdel-Nasera，b，c作者信息

卡塔爾大學QU Health醫學院

哈馬德總醫院

cWeill Cornell Medicine-卡塔爾，卡塔爾多哈

2020年6月23日收到2020年8月17日接受

補充數字內容可用於本文。直接URL引用出現在印刷文本中，並在期刊網站www.eurojgh.com上以本文的HTML和PDF版本提供。

通訊作者：Mohammed I. Danjuma博士，MBBS，理學碩士，哈馬德綜合醫院，3050，卡塔爾，多哈，電話：+974 5589 6229；電子郵件：[email protected]
《歐洲胃腸病學和肝病學雜誌》：2021年4月-第33卷-第4期-第479-486頁
doi：10.1097 / MEG.0000000000001932

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抽象的

終末期肝病及其相關並發症給疾病造成了巨大負擔，並降低了許多患者的生存率。對於失代償性肝硬化患者使用白蛋白一直是有爭議的話題。這項研究的目的是調查與單獨的標準藥物治療（SMT）相比，白蛋白是否可降低肝硬化的死亡率和並發症。這項薈萃分析包括對肝硬化患者使用白蛋白與SMT進行比較的臨床試驗。這項研究的主要結果是評估降低全因死亡率的效果。腹水控制，腎功能衰竭和肝性腦病被評估為次要結果。招募了9項針對1231例患者的臨床試驗，並使用質量效應模型進行了分析。白蛋白組的死亡率顯著降低[相對風險（RR）0.73，95％置信區間（CI）0.56-0.96]。在所有研究中，異質性均較輕（I2 23.3％）。報告長期服用白蛋白（LTA）的研究發現死亡率顯著降低（RR 0.57，95％CI 0.44–0.73）。但是，發現短期服用白蛋白的研究對死亡率沒有影響（RR 0.90，95％CI 0.56-1.45）。此外，所有次要結局的發生率顯著降低。這項薈萃分析提供了證據，與SMT相比，LTA給藥在降低肝硬化死亡率方面顯著有效。還顯示白蛋白的施用減少了作為肝硬化並發症的腹水，腎衰竭和肝性腦病的發生。
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