Zhu Qianqian, Li Na, Li Fang, Zhou Zhihua, Han Qunying, Lv Yi, Sang Jiao, Liu Zhengwen
Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, China.
Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, China Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, China.
J Renin Angiotensin Aldosterone Syst. 2016 Mar 23;17(1):1470320316628717. doi: 10.1177/1470320316628717. Print 2016 Jan-Mar.
Currently, there is no effective therapy available for liver fibrosis. This study aims to evaluate the efficacy of renin angiotensin system inhibitors on liver fibrosis.
Full-text randomized controlled trials in patients with liver fibrosis were identified and included in the meta-analysis. The primary outcome measure was the histological fibrosis score of the liver. Secondary outcome measures included fibrosis area of the liver, serological levels of fibrosis markers, adverse events, and withdrawals.
From 6973 non-duplicated entries by systematic search, four randomized controlled trials with 210 patients were identified. The renin angiotensin system inhibitors therapy resulted in a marginally significant reduction in liver fibrosis score (MD = -0.30; 95% CI: -0.62-0.02, p = 0.05) and a significant reduction in liver fibrosis area (MD = -2.36%; 95% CI: -4.22%--0.50%, p = 0.01) as compared with control. The therapy was well tolerated and there was no significant difference in withdrawals between treatment and control groups (RD = 0.00; 95% CI: -0.06-0.06, p = 0.97).
Renin angiotensin system inhibitor therapy results in a reduction in liver fibrosis score and liver fibrosis area in patients with hepatic fibrosis with good safety profile. However, randomized controlled trials of high-quality will clarify the effectiveness of renin angiotensin system inhibitors on liver fibrosis.
目前，尚无有效的肝纤维化治疗方法。本研究旨在评估肾素血管紧张素系统抑制剂对肝纤维化的疗效。
检索并纳入肝纤维化患者的全文随机对照试验，进行荟萃分析。主要观察指标为肝脏组织学纤维化评分。次要观察指标包括肝脏纤维化面积、纤维化标志物的血清学水平、不良事件及退出研究情况。
通过系统检索6973条非重复记录，确定了4项随机对照试验，共210例患者。与对照组相比，肾素血管紧张素系统抑制剂治疗使肝纤维化评分有轻微显著降低（MD = -0.30；95%CI：-0.62 - 0.02，p = 0.05），肝纤维化面积显著降低（MD = -2.36%；95%CI：-4.22% - -0.50%，p = 0.01）。该治疗耐受性良好，治疗组与对照组退出研究情况无显著差异（RD = 0.00；95%CI：-0.06 - 0.06，p = 0.97）。
肾素血管紧张素系统抑制剂治疗可降低肝纤维化患者的肝纤维化评分及肝纤维化面积，安全性良好。然而，高质量的随机对照试验将阐明肾素血管紧张素系统抑制剂对肝纤维化的有效性。
