Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Eur J Gastroenterol Hepatol. 2012 Nov;24(11):1247-53. doi: 10.1097/MEG.0b013e3283572ec0.
The aim of this study was to evaluate the effects of ursodeoxycholic acid on patients with nonalcoholic steatohepatitis using meta-analysis. PubMed, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Databases, and article references were searched. We included randomized controlled trials using liver biopsy as a reference standard. We identified three eligible studies. Among histological responses, only lobular inflammation improved in the high-dose ursodeoxycholic acid subgroup compared with the control group [mean deviation (MD): -0.23 (-0.40, -0.06), P=0.008]. However, fibrosis may tend to increase [MD: 0.08 (-0.04, 0.20), P=0.17]. Among biochemical responses, γ-glutamyl transpeptidase reduction was significantly greater in the ursodeoxycholic acid group than in the placebo group, and the reduction tendency was only shown in the high-dose subgroup [MD: -35.58 (-52.60, -18.56), P<0.0001]. Serum total bilirubin increased in the high-dose ursodeoxycholic acid subgroup compared with the control group [MD: 0.43 (0.14, 0.72), P=0.004]. Ursodeoxycholic acid-treated patients did not differ significantly from control patients with regard to alanine transaminase, aspartate aminotransferase, and alkaline phosphatase activities. Adverse events were nonspecific and considered of no major clinical relevance. Ursodeoxycholic acid in monotherapy has no substantial positive effect on nonalcoholic steatohepatitis.
本研究旨在通过荟萃分析评估熊去氧胆酸对非酒精性脂肪性肝炎患者的影响。检索了 PubMed、EMBASE、Web of Science、Cochrane 图书馆、中国生物医学文献数据库和文章参考文献。我们纳入了使用肝活检作为参考标准的随机对照试验。我们确定了三项符合条件的研究。在组织学反应方面，只有高剂量熊去氧胆酸亚组与对照组相比，肝小叶炎症得到改善[平均差异（MD）：-0.23（-0.40，-0.06），P=0.008]。然而，纤维化可能有增加的趋势[MD：0.08（-0.04，0.20），P=0.17]。在生化反应方面，熊去氧胆酸组γ-谷氨酰转肽酶降低幅度明显大于安慰剂组，且仅在高剂量亚组显示出降低趋势[MD：-35.58（-52.60，-18.56），P<0.0001]。与对照组相比，高剂量熊去氧胆酸组血清总胆红素增加[MD：0.43（0.14，0.72），P=0.004]。与对照组相比，熊去氧胆酸治疗组的丙氨酸氨基转移酶、天冬氨酸氨基转移酶和碱性磷酸酶活性无显著差异。不良反应是非特异性的，认为没有重大的临床相关性。熊去氧胆酸单药治疗对非酒精性脂肪性肝炎没有实质性的积极作用。
