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摘要：
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摘要：目的 评估糖皮质激素联合核苷（酸）类似物治疗对乙型肝炎病毒相关（hepatitis B virus，
HBV）肝衰竭的临床疗效。方法 通过计算机检索PubMed、中国期刊全文数据库、中国生物医学文献
数据库、中文科技期刊数据库和中华医学会数字化期刊库中采用糖皮质激素联合核苷（酸）类似物
治疗HBV相关肝衰竭的随机对照研究，检索范围为自建库至2019年3月，同时手动检索相关期刊和会
议论文集。中文数据库主要检索词包括：糖皮质激素、肝衰竭、乙型肝炎、HBV、氢化可的松、地
塞米松、泼尼松及甲泼尼龙；英文数据库主要检索词包括liver failure、hepatitis B、glucocorticoids、
dexamethasone及methylprednisolone。采用RevMan 5.3件进行Meta分析，评估糖皮质激素联合核苷
（酸）类似物治疗对HBV相关肝衰竭患者病死率、肝性脑病发生率及消化道出血的影响。结果 本研
究共纳入12篇文献，总计1069例患者，使用的糖皮质激素药物包括地塞米松和甲泼尼龙。地塞米松
组4周病死率为12.44%（24/193），对照组为35.05%（68/194），差异有统计学意义（OR = 0.26，
95%CI：0.16～0.44，P ＜ 0.001）。甲泼尼龙组4周病死率为20.34%（24/118），对照组为33.91%
（39/115），差异有统计学意义（OR = 0.38，95%CI：0.19～0.75，P = 0.006）。地塞米松组肝
性脑病发生率为5.56%（9/162），对照组为15.88%（27/170），差异无统计学意义（OR = 0.53，
95%CI：0.03～9.44，P = 0.66）。甲泼尼龙组4周肝性脑病发生率为6.82%（6/88），对照组为19.10%
（17/89），差异有统计学意义（OR = 0.31，95%CI：0.11～0.84，P = 0.02）。地塞米松组消化道
出血发生率为2.47%（4/162），对照组为4.70%（8/170），甲泼尼龙组消化道出血发生率为11.67%
（14/120），对照组为10.26%（12/117），差异均无统计学意义（OR = 0.55，95%CI：0.16～1.88，
P = 0.34；OR = 1.02，95%CI：0.43～2.40，P = 0.96）。结论 地塞米松或甲泼尼龙联合核苷（酸）类
似物治疗均可降低HBV相关肝衰竭患者4周病死率，对消化道出血均无显著影响。
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Abstract: Objective To estimate the clinical effects of glucocorticoids combined with nucleos(t)ide analogues on
hepatitis B virus (HBV) related liver failure. Methods Randomized controlled trials about glucocorticoids combined
with nucleos(t)ide analogues in treatment of HBV related liver failure were searched in database including PubMed,
China Academic Journals Full-text Database (CJFD), Chinese Biomedical Literature Database, Chinese Science
and Technology Periodicals Database, Wanfang Data and Digital Library of Chinese Medical Association from
the establishment time to March 2019. Related journals and conference proceedings were manually searched. The
key words were liver failure, hepatitis B, glucocorticoids, dexamethasone and methylprednisolone in Chinese and
English. Meta analysis was conducted by RevMan 5.3 to assess the effects of glucocorticoids on mortality, incidence
of hepatic encephalopathy and gastrointestinal bleeding. Results A total of 1069 patients from 12 studies were
included, and the glucocorticoids drugs included dexamethasone and methylprednisolone. The 4-week mortality
of patients in dexamethasone group and control group were 12.44% (24/193) and 35.05% (68/194), respectively, the
difference was statistically significant (OR = 0.26, 95%CI: 0.16～0.44, P ＜ 0.001). The 4-week mortality of patients in
methylprednisolone group and control group were 20.34% (24/118) and 33.91% (39/115), respectively, the difference
was statistically significant (OR = 0.38, 95%CI: 0.19～0.75, P = 0.006). The incidence of hepatic encephalopathy
of patients in dexamethasone group and control group were 5.56% (9/162) and 15.88% (27/170), respectively, the
difference was not statistically significant (OR = 0.53, 95%CI: 0.03～9.44, P = 0.66). The incidence of hepatic
encephalopathy of patients in methylprednisolone group and control group were 6.82% (6/88) and 19.10% (17/89),
respectively, the difference was statistically significant (OR = 0.31, 95%CI: 0.11～0.84, P = 0.02). The incidence of
gastrointestinal bleeding of patients in dexamethasone group and control group were 2.47% (4/162) and 4.70% (8/170),
respectively, the difference was not statistically significant (OR = 0.55, 95%CI: 0.16～1.88, P = 0.34). The incidence
of gastrointestinal bleeding of patients in methylprednisolone group were 11.67% (14/120) and 10.26% (12/117),
respectively, the difference was not statistically significant (OR = 1.02, 95%CI: 0.43～2.40, P = 0.96). Conclusions
Dexamethasone or methylprednisolone combined with nucleos(t)ide analogues antiviral treatment can reduce the 4-week
mortality rate for patients with HBV-related liver failure, and have no effects on gastrointestinal bleeding.
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