Department of Emergency, The First People's Hospital of Qujing, Qujing 655000, China.
Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai 201100, China.
Ann Palliat Med. 2020 May;9(3):774-787. doi: 10.21037/apm.2020.04.28. Epub 2020 Apr 21.
Vascular occlusion during hepatectomy accompanies ischemia-reperfusion (IR) injury, which can cause liver dysfunction and affect patients' outcome. Ulinastatin or urinary trypsin inhibitor (UTI), a polyvalent inhibitor of various enzymes, has been confirmed of anti-IR injury effect in recent studies. Here we performed a systematic review and meta-analysis to assess the benefits of perioperation UTI using to protect liver function in hepatectomy.
Randomized controlled trials (RCTs) evaluating UTI in hepatectomy were identified. Two independent reviewers extracted data on basic characteristics and risk of bias in the studies, and on outcomes such as alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (TBIL) from 1 to 7 days after operation.
A total of 9 RCTs including 408 UTI and 372 control participants were identified. There was no significant difference in basic characteristics such as age or sex. The majority of the patients who underwent hepatectomy had primary liver carcinoma, liver metastases and benign liver lesions. A significant improvement in liver function was associated with UTI use not only at 1 and 3 days postoperatively, but also at 7 days (all P≤0.01). However, significant heterogeneity existed between the pooled studies (all P<0.01).
UTI has positive protective effects against IR injury in hepatectomy. However, further highquality RCTs are needed to confirm this conclusion.
肝切除术中的血管闭塞伴随着缺血再灌注（IR）损伤，这可能导致肝功能障碍并影响患者的预后。乌司他丁或尿胰蛋白酶抑制剂（UTI）是一种多种酶的多价抑制剂，最近的研究已经证实其具有抗 IR 损伤作用。在这里，我们进行了系统评价和荟萃分析，以评估围手术期 UTI 用于保护肝切除术后肝功能的益处。
确定了评估 UTI 在肝切除术中作用的随机对照试验（RCT）。两名独立的评审员提取了研究中的基本特征和偏倚风险的数据，以及术后 1 至 7 天的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和总胆红素（TBIL）等结局数据。
共纳入了 9 项 RCT，包括 408 例 UTI 和 372 例对照组参与者。两组在年龄或性别等基本特征方面没有显著差异。大多数接受肝切除术的患者患有原发性肝癌、肝转移和良性肝脏病变。使用 UTI 不仅在术后 1 天和 3 天，而且在术后 7 天，肝功能均有显著改善（均 P≤0.01）。然而，汇总研究之间存在显著的异质性（均 P<0.01）。
UTI 对肝切除术中的 IR 损伤具有积极的保护作用。然而，需要进一步的高质量 RCT 来证实这一结论。
