Nakade Yukiomi, Murotani Kenta, Inoue Tadahisa, Kobayashi Yuji, Yamamoto Takaya, Ishii Norimitsu, Ohashi Tomohiko, Ito Kiyoaki, Fukuzawa Yoshitaka, Yoneda Masashi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.
Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute, Japan.
Hepatol Res. 2017 Dec;47(13):1417-1428. doi: 10.1111/hepr.12887. Epub 2017 Apr 1.
Several studies on the efficacy of ezetimibe, a potent inhibitor of cholesterol absorption, in treating non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been published; however, the results are inconsistent. We undertook a meta-analysis to evaluate the efficacy of ezetimibe in treating NAFLD and NASH.
PubMed, Medline, and Cochrane Library Full Text Database were searched until June 2016. The main inclusion criteria included original studies investigating the use of ezetimibe for the treatment of NAFLD and NASH. Identification of published work and data extraction were carried out by two reviewers based on the inclusion and exclusion criteria. All analyses were carried out using Comprehensive Meta-Analysis version 3 software.
An initial search identified 103 peer-reviewed articles and abstracts. Six studies (two randomized controlled and four single-arm trials) involving 273 participants with NAFLD and NASH were identified. Ezetimibe significantly reduced serum aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transpeptidase levels, and hepatic steatosis and hepatocyte ballooning. However, hepatic inflammation and fibrosis did not improve by ezetimibe treatment in patients with NAFLD and NASH. In randomized controlled trials, only hepatocyte ballooning improved with ezetimibe treatment.
Although ezetimibe attenuated serum liver enzymes and hepatic steatosis and ballooning in six studies, it improved only hepatocyte ballooning in randomized controlled trials. Larger studies and more randomized placebo-controlled trials are necessary to determine the effects of ezetimibe on NAFLD and NASH.
关于胆固醇吸收强效抑制剂依折麦布治疗非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）疗效的多项研究已发表，但结果不一致。我们进行了一项荟萃分析，以评估依折麦布治疗NAFLD和NASH的疗效。
检索截至2016年6月的PubMed、Medline和Cochrane图书馆全文数据库。主要纳入标准包括调查依折麦布用于治疗NAFLD和NASH的原始研究。由两名审阅者根据纳入和排除标准进行已发表作品的识别和数据提取。所有分析均使用综合荟萃分析第3版软件进行。
初步检索确定了103篇经同行评审的文章和摘要。确定了6项研究（2项随机对照试验和4项单臂试验），涉及273例NAFLD和NASH患者。依折麦布显著降低了血清天冬氨酸转氨酶、丙氨酸转氨酶和γ-谷氨酰转肽酶水平，以及肝脂肪变性和肝细胞气球样变。然而，依折麦布治疗并未改善NAFLD和NASH患者的肝脏炎症和纤维化。在随机对照试验中，依折麦布治疗仅改善了肝细胞气球样变。
尽管在6项研究中依折麦布降低了血清肝酶、肝脂肪变性和气球样变，但在随机对照试验中仅改善了肝细胞气球样变。需要开展更大规模的研究和更多随机安慰剂对照试验，以确定依折麦布对NAFLD和NASH的影响。
