Bjelakovic Goran, Gluud Lise Lotte, Nikolova Dimitrinka, Bjelakovic Marija, Nagorni Aleksandar, Gluud Christian
Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University Hospital, and Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000.
Cochrane Database Syst Rev. 2011 Mar 16(3):CD007749. doi: 10.1002/14651858.CD007749.pub2.
Several liver diseases have been associated with oxidative stress. Accordingly, antioxidants have been suggested as potential therapeutics for various liver diseases. The evidence supporting these suggestions is equivocal.
To assess the benefits and harms of antioxidant supplements for patients with liver diseases.
We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science to January 2011. We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials.
We considered for inclusion randomised trials that compared antioxidant supplements (beta-carotene, vitamin A, C, E, and selenium) versus placebo or no intervention for autoimmune liver diseases, viral hepatitis, alcoholic liver disease, and cirrhosis (any aetiology).
Four authors independently selected trials for inclusion and extracted data. Outcome measures were all-cause mortality, liver-related mortality, liver-related morbidity, biochemical indices at maximum follow-up in the individual trials as well as adverse events, quality-of-life measures, and cost-effectiveness. For patients with hepatitis B or C we also considered end of treatment and sustained virological response. We conducted random-effects and fixed-effect meta-analyses. Results were presented as relative risks (RR) or mean differences (MD), both with 95% confidence intervals (CI).
Twenty randomised trials with 1225 participants were included. The trials assessed beta-carotene (3 trials), vitamin A (2 trials), vitamin C (9 trials), vitamin E (15 trials), and selenium (8 trials). The majority of the trials had high risk of bias and showed heterogeneity. Overall, the assessed antioxidant supplements had no significant effect on all-cause mortality (relative risk [RR] 0.84, 95% confidence interval [CI] 0.60 to 1.19, I(2) = 0%), or liver-related mortality (RR 0.89, 95% CI 0.39 to 2.05, I(2) = 37%). Stratification according to the type of liver disease did not affect noticeably the results. Antioxidant supplements significantly increased activity of gamma glutamyl transpeptidase (MD 24.21 IU/l, 95% CI 6.67 to 41.75, I(2) = 0%).
AUTHORS' CONCLUSIONS: We found no evidence to support or refute antioxidant supplements in patients with liver disease. Antioxidant supplements may increase liver enzyme activity.
多种肝脏疾病与氧化应激相关。因此，抗氧化剂被认为是治疗各种肝脏疾病的潜在药物。支持这些观点的证据并不明确。
评估抗氧化剂补充剂对肝脏疾病患者的益处和危害。
我们检索了截至2011年1月的考克兰图书馆、医学索引数据库、荷兰医学文摘数据库、拉丁美洲和加勒比地区卫生科学数据库、科学引文索引扩展版以及会议论文引文索引 - 科学版。我们查阅了相关出版物的参考文献，并向专家和制药公司询问其他试验。
我们纳入了比较抗氧化剂补充剂（β - 胡萝卜素、维生素A、C、E和硒）与安慰剂或无干预措施治疗自身免疫性肝病、病毒性肝炎、酒精性肝病和肝硬化（任何病因）的随机试验。
四位作者独立选择纳入试验并提取数据。结局指标包括全因死亡率、肝脏相关死亡率、肝脏相关发病率、各试验最大随访时的生化指标以及不良事件、生活质量指标和成本效益。对于乙型或丙型肝炎患者，我们还考虑了治疗结束时和持续病毒学应答情况。我们进行了随机效应和固定效应荟萃分析。结果以相对风险（RR）或平均差（MD）表示，并带有95%置信区间（CI）。
纳入了20项随机试验，共1225名参与者。这些试验评估了β - 胡萝卜素（3项试验）、维生素A（2项试验）、维生素C（9项试验）、维生素E（15项试验）和硒（8项试验）。大多数试验存在高偏倚风险且显示出异质性。总体而言，所评估的抗氧化剂补充剂对全因死亡率（相对风险[RR] 0.84，95%置信区间[CI] 0.60至1.19，I² = 0%）或肝脏相关死亡率（RR 0.89，95% CI 0.39至2.05，I² = 37%）无显著影响。根据肝病类型进行分层对结果影响不明显。抗氧化剂补充剂显著增加了γ - 谷氨酰转肽酶的活性（平均差[MD] 24.21 IU/L，95% CI 6.67至41.75, I² = 0%）。
我们没有发现支持或反驳在肝病患者中使用抗氧化剂补充剂的证据。抗氧化剂补充剂可能会增加肝酶活性。
