标题：己酮可可碱对非酒精性脂肪肝治疗疗效与安全性的Meta分析

      作者：牟翊瑄，刘强，周晓琳    (三峡大学第一临床医学院宜昌市中心人民医院感染性疾病科，湖北 宜昌 443003)

      卷次： 2018年29卷20期

      【摘要】 目的 系统评价己酮可可碱对非酒精性脂肪性肝治疗的临床疗效和安全性。方法 检索PubMed、Embase、The Cochrane library、中国知网(CNKI)、万方(VIP)、维普中收录的2017年12月前发表的关于己酮可可碱治疗非酒精性脂肪性肝病的随机对照试验。评价所纳入的文献质量并使用Revman 5.3对其疗效和安全性进行Meta分析。结果 最终纳入7篇随机对照实验，共222例非酒精性脂肪肝患者，在使用己酮可可碱3~12个月后，其组织学特征得到显著改善，并且降低患者血清中的谷丙转氨酶、谷草转氨酶 [加权均差数 (WMD)=-19.60，95%CI：-32.78~-5.34，P=0.006；WMD=-9.73，95%CI：-17.02~-2.44，P=0.009]，降低空腹血糖水平[WMD=-10.30，95%CI：-15.22~-5.39，P<0.0001]，改善肝组织学炎症指数、纤维化程度[WMD=-1.18，95%CI：-1.47~-0.89，P<0.00001；WMD=-0.44，95%CI：-0.78~-0.11，P=0.009]，但并不能降低患者的血清中甘油三酯和总胆固醇水平[WMD=5.16，95%CI：-10.82~21.14，P=0.53；WMD=0.49，95%CI：-0.37~1.35，P=0.26]、体质指数[WMD=-0.48，95%CI：-0.97~0.00，P=0.05]、肿瘤坏死因子-α和白细胞介素-6 [WMD=-0.98，95%CI：-1.66~-0.29，P=0.005，WMD=7.48，95%CI：-9.13~24.09，P=0.38]，以及不能改善胰岛素抵抗[WMD=-3.15，95%CI：-10.52~4.21，P=0.40]。结论 己酮可可碱可对非酒精性脂肪肝患者有一定的治疗效果，且不良反应较少。
      【关键词】 己酮可可碱；非酒精性脂肪性肝病；Meta分析
      【中图分类号】 R575.5 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2921—08

Effects and safety of pentoxifylline on nonalcoholic fatty liver disease: a meta-analysis.
MOU Yi-xuan, LIU Qiang,ZHOU Xiao-lin. Department of Infectious Diseases, People's Hospital of Yichang Center, Yichang 443003, Hubei, CHINA
【Abstract】 Objective To evaluate the efficacy and safety of pentoxifylline in the treatment of non-alcoholicfatty liver disease (NAFLD). Methods Randomized controlled trials (RCTs) that evaluated the efficacy of pentoxifyl-line for NAFLD treatment were searched in multiple databases, including Pubmed, Embase, the Cochrane library, CNKI,Wanfang database and VIP, from inception to December 2017. Literature identification and data extraction were basedon the inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis. Results A total of 7 RCTswith 222 patients of NAFLD were included. Improved liver histology improved level of alanine aminotransferase and as-partate aminotransferase (WMD=-19.60, 95%CI: -32.78 to -5.34, P=0.006; WMD=-9.73, 95%CI: -17.02 to -2.44, P=0.009), reduced glucose levels (WMD=-10.30, 95%CI:-15.22 to -5.39, P<0.0001), and improved the activity score andfibrosis score (WMD=-1.18, 95%CI:-1.47 to -0.89, P<0.00001; WMD=-0.44, 95%CI: -0.78 to -0.11, P=0.009) wereseen after 3 to 12 months pentoxifylline treatment. However, pentoxifylline could not decrease the level of serum choles-terol and triglyceride (WMD=5.16, 95%CI: -10.82 to 21.14, P=0.53; WMD=0.49, 95%CI: -0.37 to 1.35, P=0.26), bodymass index (WMD=-0.48, 95%CI: -0.97 to 0.00, P=0.05), tumor necrosis factor-α and interleukin 6 (WMD=-0.98, 95%CI:-1.66 to -0.29, P=0.005; WMD=7.48, 95%CI: -9.13 to 24.09, P=0.38), and homeostasis model assessment-insulin re-sistance (WMD=-3.15, 95%CI: -10.52 to 4.21, P=0.40). Conclusion Pentoxifylline has confirmed therapeutic effecton NAFLD with less adverse reactions.
      【Key words】 Pentoxifylline; Nonalcoholic fatty liver disease (NAFLD); Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2018.20.034基金项目：湖北省宜昌市医疗卫生计划项目(编号：A16-301-06)