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S-腺苷蛋氨酸治疗酒精性肝病的系统评价

作者：白冰何清唐尉唐奇远黄珊

单位：深圳市第三人民医院肝病科深圳 518112

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出版年,卷(期):页码：2012,4(2):1-9

摘要：

摘要：目的系统评价S-腺苷蛋氨酸治疗酒精性肝病的效果和安全性。方法采用Cochrane系统评价方法，检索Cochrane图书馆临床对照试验数据库、PubMed、EMbase、CBM、CNKI、中文科技期刊数据库VIP、万方数据库等电子资料库。由2名评价者共同评价纳入研究的质量，对同质研究进行Meta分析。结果共纳入10个研究，745例酒精性肝病患者。其中1篇文献采用随机数字法分组并实施盲法，其余9篇文献未描述具体随机方法，未实施盲法。所有文献均未描述分配隐藏方法。按测量指标和干预措施进行亚组分析：①在降低ALT方面：疗程为20天时，S-腺苷蛋氨酸＋一般治疗组与还原型谷胱甘肽＋一般治疗组差异无统计学意义[WMD = －18.00，95%CI（－38.36，－2.36）]；疗程为4周时，S-腺苷蛋氨酸＋多烯磷脂酰胆碱组与门冬氨酸钾镁＋多烯磷脂酰胆碱组差异无统计学意义[WMD = －8.39，95%CI（－19.81，3.02）]；疗程为2年时，S-腺苷蛋氨酸组与安慰剂组差异无统计学意义[WMD = －7.30，95%CI（－15.49，0.89）]，其余各研究组均优于对照组，差异有统计学意义；②在降低AST方面：疗程为4周时，S-腺苷蛋氨酸＋多烯磷脂酰胆碱组与门冬氨酸钾镁＋多烯磷脂酰胆碱组差异无统计学意义[WMD = －8.39，95%CI（－19.81，3.02）]；疗程为2年时，S-腺苷蛋氨酸组与安慰剂组差异无统计学意义[WMD = －7.40，95%CI（－17.96，3.16）]，其余各研究组均优于对照组，差异有统计学意义；③在降低GGT方面：疗程为4周时，S-腺苷蛋氨酸＋还原型谷胱甘肽组与门冬氨酸钾镁＋维生素C组差异无统计学意义[WMD = －20.10，95%CI（－40.77，0.57）]；疗程为2年时，S-腺苷蛋氨酸组与安慰剂组差异无统计学意义[WMD = －8.70，95%CI（－36.42，19.02）]，其余各研究组均优于对照组，差异有统计学意义；④在降低TG方面：研究组均优于对照组，差异有统计学意义[WMD = －1.04，95%CI（－1.23，－0.85）]；⑤在降低肝纤维化指标（PC Ⅲ、HA）方面：各研究组均优于对照组，差异有统计学意义[分别为WMD = －127.00，95%CI（－161.81，－92.19）；WMD = －162.00，95%CI（－226.10，－97.90）]；⑥在生存率方面：Child-Pugh A级、Child-Pugh B级（Child-Pugh分级）酒精性肝硬化患者生存率研究组优于对照组，差异有统计学意义[RR = 0.45，95%CI（0.20，1.00）]。结论现有研究显示，S-腺苷蛋氨酸对酒精性肝病患者的ALT、AST、GGT、肝纤维化和TG的改善可能有效，对Child-Pugh A级、Child-Pugh B级酒精性肝硬化患者生存率改善可能有效，且无严重不良反应。但本系统评价所纳入的文献多为较低质量的小样本研究，且用药时间不同，因此无法进行总体的效应合并分析，尚需更大量的文献支持。

Abstract: Objective To evaluate the effectiveness and safety of S-adenosyl methionine treatment for alcoholic liver disease. Methods We searched the Cochrane Database of Controlled Trials Register (CCTR), PubMed, EMBASE, the Chinese Biomedical Database (CBM), CNKI, Chinese Scientific and Technological Journal Database (VIP database) and Wanfang Database. Quality assessment and data extraction were conducted by two reviewers independently, and disagreement, if any, was resolved by discussion. Meta-analyses were performed for homogeneous studies. Results Total of ten studies were involved, and 745 patients met the inclusion criteria. Only one study were centralized randomly by a number table, and performed blindly. Other studies did not report randomized methods. Ten sutdies did not enforce allocation concealment and none of the trials performed blinding. Subgroup analyses were conducted based on the indexes measured and interventions. ①In terms of reducing ALT, no significant differences were noted between the S-adenosyl methionine ＋ conventional therapy group and the reduced glutathione ＋ conventional therapy group when the treatment course was 20 days [WMD = －18.0, 95%CI (－38.36, －2.36)], the S-adenosyl methionine ＋ essentiale N group and potassium magnesium asparaginate ＋ essentiale N group when the treatment course was 4 weeks [WMD = －8.39, 95%CI (－19.81, 3.02)], also for the S-adenosyl methionine therapy group and the placebo therapy group when the treatment course was 2 years [WMD = －7.3, 95%CI (－15.49, 0.89)]. Other studies showed that the study group was more effective than the control group. ②In terms of reducing AST, no significant differences were noted between the S-adenosyl methionine ＋ essentiale N group and potassium magnesium asparaginate ＋ essentiale N group when the treatment course was 4 weeks [WMD = －8.39, 95%CI (－19.81, 3.02)], also for the S-adenosyl methionine therapy group and the placebo therapy group when the treatment course was 2 years [WMD = －7.4, 95%CI (－17.96, 3.16)]. Other studies showed that the study group was more effective than the control group. ③In terms of reducing GGT, no significant differences were noted between the S-adenosyl methionine ＋ reduced glutathione group and potassium magnesium asparaginate ＋ Vitamin C group when the treatment course was 4 weeks [WMD = －20.10, 95%CI (－40.77, 0.57)]. No significant differences were noted between the S-adenosyl methionine therapy group and the placebo therapy group when the treatment course was 2 years [WMD = －8.7, 95%CI (－36.42, 19.02)]. Other studies showed that the study group was more effective than the control group. ④In terms of reducing TG, the treatment group was more effective than the control group [WMD = －1.04, 95%CI (－1.23, －0.85)]. ⑤In terms of reducing the index of hepatic fibrosis (PCⅢ, HA), the treatment group was more effective than the control group [WMD = －127, 95%CI (－161.81, －92.19), WMD = －162, 95%CI (－226.10, －97.90), respectively]. ⑥In terms of raising survival rate, the treatment group was more effective than the control group in patients with Child-Pugh A and B classification when the treatment course was 2 years. Conclusions S-adenosyl methionine might be effective in normalizing transaminase levels, and improving hepatic fibrosis, blood fat. S-adenosyl methionine might be a promising drug in the treatment of alcoholic liver cirrhosis of patients with Child-Pugh A and B classification with no serious adverse effects. However, the overall effects cannot be pooled for analysis, more evidence is needed to support this finding.

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