Graduate School, Tianjin Medical University, Tianjin Infection Disease Hospital, Tianjin, China.
Eur J Gastroenterol Hepatol. 2011 Nov;23(12):1250-7. doi: 10.1097/MEG.0b013e32834d1938.
To evaluate the clinical efficacy of lactulose in patients with minimal hepatic encephalopathy (MHE).
Randomized controlled trials (RCTs) comparing lactulose with placebo or with no intervention in the management of MHE that were conducted from January 1990 to July 2011 were searched from MEDLINE, EMBASE, SCI, Cochrane Controlled Trials Register, and China Biological Medicine Database. Studies with a Jadad score higher than 3 were included in the meta-analysis and evaluated using RevMan5.0 software for relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (95% CI). Sensitivity analysis was performed on the ethnical differences and quality of the trials. Publication bias was observed using an inverted funnel plot.
Nine studies with 434 patients were included in the meta-analysis. Compared with placebo or no intervention, lactulose significantly reduced the risk of no improvement in neuropsychological tests (RR: 0.52, 95% CI: 0.44-0.62, P<0.00001), the time required for the completion of the number connection test-A (WMD: -26.95, 95% CI: -37.81 to -16.10, P<0.00001), and the mean number of abnormal neuropsychological tests (WMD: -1.76, 95% CI: -1.96 to -1.56, P<0.00001). Furthermore, the meta-analysis also showed that lactulose prevented the progression to overt hepatic encephalopathy (RR: 0.17, 95% CI: 0.06-0.52, P=0.002), reduced blood ammonia levels (WMD: -9.89 µmol/l, 95% CI: -11.01 to -8.77 µmol/l, P<0.00001), and improve health-related quality of life (WMD: -6.05, 95% CI: -6.30 to -5.20, P<0.00001). However, no significant difference was observed in the mortality of patients with MHE (RR: 0.75, 95% CI: 0.21-2.72, P=0.66), and lactulose significantly increased the incidence of diarrhea (RR: 4.38, 95% CI: 1.35-14.25, P=0.01).
Lactulose has significant beneficial effects for patients with MHE compared with placebo or no intervention.
评估乳果糖治疗轻微型肝性脑病（MHE）的临床疗效。
检索 1990 年 1 月至 2011 年 7 月 MEDLINE、EMBASE、SCI、Cochrane 对照试验注册库和中国生物医学文献数据库中关于比较乳果糖与安慰剂或不干预治疗 MHE 的随机对照试验（RCT）。对 Jadad 评分大于 3 分的研究进行荟萃分析，并使用 RevMan5.0 软件计算相对风险（RR）或加权均数差（WMD）及其 95%置信区间（95%CI）。对试验的人种差异和质量进行敏感性分析。采用倒漏斗图观察发表偏倚。
纳入 9 项研究，共 434 例患者。与安慰剂或不干预相比，乳果糖可显著降低神经心理测试无改善的风险（RR：0.52，95%CI：0.44-0.62，P<0.00001）、数字连接测试 A 完成时间（WMD：-26.95，95%CI：-37.81 至-16.10，P<0.00001）和异常神经心理测试的平均数量（WMD：-1.76，95%CI：-1.96 至-1.56，P<0.00001）。此外，荟萃分析还显示，乳果糖可预防显性肝性脑病的进展（RR：0.17，95%CI：0.06-0.52，P=0.002）、降低血氨水平（WMD：-9.89µmol/L，95%CI：-11.01 至-8.77µmol/L，P<0.00001）和改善健康相关生活质量（WMD：-6.05，95%CI：-6.30 至-5.20，P<0.00001）。然而，MHE 患者的死亡率无显著差异（RR：0.75，95%CI：0.21-2.72，P=0.66），且乳果糖显著增加腹泻的发生率（RR：4.38，95%CI：1.35-14.25，P=0.01）。
与安慰剂或不干预相比，乳果糖对 MHE 患者具有显著的有益作用。
