Yang Chang-Zhen, Zhou Yan, Ke Meng, Gao Ru-Yue, Ye Shi-Ru, Diao Mei, Li Long
Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Front Pharmacol. 2022 Sep 14;13:956093. doi: 10.3389/fphar.2022.956093. eCollection 2022.
Postoperative adjuvant steroid therapy is regarded as the conventional treatment for patients with biliary atresia (BA) who have undergone Kasai portoenterostomy (KP). However, whether the steroid therapy can improve BA outcomes is controversial. This meta-analysis aimed to evaluate the effects of adjuvant steroid therapy on the surgical prognosis of BA. We searched related studies published in PubMed, Embase, Web of Science, Cochrane, and the Chinese National Knowledge Infrastructure database up to May 2022. Data on the effect of steroid use on the clinical prognosis of the patients, including the jaundice clearance rate (JCR), native liver survival rate (NLSR) at 6, 12, and 24 months after KP, and the incidence of cholangitis, were extracted. Subgroup analyses based on age at KP, administration method, initial dosage, and steroid type were conducted. Statistical analysis was conducted using Stata/SE 12.0. Eleven articles (a total of 1,032 patients) were included in the present meta-analysis. The results demonstrated that postoperative adjuvant steroid therapy improved JCR at the 6/12/24-month follow-up (RR: 1.35, 95% CI: 1.18-1.55, < 0.001; RR:1.49, 95% CI, 1.12-1.99, = 0.006; RR: 1.41, 95% CI: 1.14-1.75, = 0.002) and improved NLSR at the 24-month follow-up (RR: 1.31, 95% CI: 1.03-1.68, = 0.028). However, steroids could not significantly improve NLSR at the 6/12-month follow-up (RR: 1.06; 95% CI: 0.98-1.15; = 0.17; RR: 1.22; 95% CI: 0.97-1.54; = 0.095), and might not decrease the incidence of postoperative cholangitis (RR: 0.78, 95% CI: 0.60-1.01, = 0.058). Furthermore, subgroup analyses confirmed that three variables (age at KP, administration method, and initial dosage) could affect the efficacy of steroids in BA patients. Postoperative adjuvant steroid therapy can significantly improve bile flow. The superiority of steroid therapy was more remarkable in patients aged ≤70 days at KP than in those aged >70 days. Additionally, intravenous followed by oral steroid administration method and medium initial dosage seemed to have the more reliable efficiency on bile flow. And patients treated by steroid had better long-term (24-month) native liver survival, but there is no significant effect on short-term native liver survival and postoperative cholangitis. Further studies are warranted.
术后辅助性类固醇治疗被视为接受葛西肝门空肠吻合术（KP）的胆道闭锁（BA）患者的传统治疗方法。然而，类固醇治疗是否能改善BA的预后仍存在争议。这项荟萃分析旨在评估辅助性类固醇治疗对BA手术预后的影响。我们检索了截至2022年5月在PubMed、Embase、Web of Science、Cochrane和中国知网数据库中发表的相关研究。提取了使用类固醇对患者临床预后影响的数据，包括黄疸清除率（JCR）、KP术后6、12和24个月的自体肝生存率（NLSR）以及胆管炎的发生率。基于KP时的年龄、给药方法、初始剂量和类固醇类型进行了亚组分析。使用Stata/SE 12.0进行统计分析。本荟萃分析纳入了11篇文章（共1032例患者）。结果表明，术后辅助性类固醇治疗在6/12/24个月随访时改善了JCR（RR：1.35，95%CI：1.18 - 1.55，<0.001；RR：1.49，95%CI，1.12 - 1.99，=0.006；RR：1.41，95%CI：1.14 - 1.75，=0.002），并在24个月随访时改善了NLSR（RR：1.31，95%CI：1.03 - 1.68，=0.028）。然而，类固醇在6/12个月随访时不能显著改善NLSR（RR：1.06；95%CI：0.98 - 1.15；=0.17；RR：1.22；95%CI：0.97 - 1.54；=0.095），且可能不会降低术后胆管炎的发生率（RR：0.78，95%CI：0.60 - 1.01，=0.058）。此外，亚组分析证实三个变量（KP时的年龄、给药方法和初始剂量）会影响类固醇对BA患者的疗效。术后辅助性类固醇治疗可显著改善胆汁流动。KP时年龄≤70天的患者中，类固醇治疗的优势比年龄>70天的患者更显著。此外，静脉继以口服类固醇的给药方法和中等初始剂量似乎对胆汁流动具有更可靠的疗效。接受类固醇治疗的患者有更好的长期（24个月）自体肝生存率，但对短期自体肝生存率和术后胆管炎无显著影响。有必要进行进一步研究。
