血浆置换治疗妊娠急性脂肪肝的安全性和有效性——一项系统评价和荟萃分析
Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy-a systematic review and meta-analysis.
作者信息
Siwatch Sujata, De Arka, Kaur Bandhanjot, Lamba Divjot Singh, Kaur Simarpreet, Singh Virendra, Periyasamy Aravind Gandhi
机构信息
Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India.
Department of Hepatology, PGIMER, Chandigarh, India.
出版信息
Front Med (Lausanne). 2024 Oct 18;11:1433324. doi: 10.3389/fmed.2024.1433324. eCollection 2024.
INTRODUCTION
Acute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients.
METHODS
We searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis.
RESULTS
Pooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22).
DISCUSSION
Despite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698.
引言
妊娠急性脂肪肝（AFLP）是一种发生在孕晚期的致命疾病。血浆置换/血浆分离（PP/PE）作为AFLP患者辅助治疗的安全性和有效性已得到研究。我们进行了系统评价和荟萃分析，以评估包括死亡率以及AFLP患者肝功能和肾功能酶、凝血障碍因子等生化参数改善情况在内的临床参数。
方法
我们检索了PubMed、Ovid MEDLINE、Cochrane、CINAHL、Scopus以及ClinicalTrials.gov。使用RevMan统计软件进行荟萃分析。
结果
接受PP/PE治疗的AFLP患者的合并生存比例为87.74%（95%置信区间：82.84至91.65）。通过PP/PE对死亡率的影响来研究其疗效。PE/PP与死亡率降低相关，合并比值比为0.51（95%置信区间：0.08至3.09），I=86%。排除离群研究后的敏感性分析得出合并比值比为0.19（95%置信区间：0.02至1.52），异质性降低（I=63%）。生化参数分析表明，PP/PE治疗后有显著改善，包括胆红素降低（MD：8.30，95%置信区间：6.75至9.84）、谷草转氨酶（MD：107.25，95%置信区间：52.45至162.06）、谷丙转氨酶（MD：111.08，95%置信区间：27.18至194.97）、肌酐（MD：1.66，95%置信区间：1.39至1.93）和凝血酶原时间（MD：5.08，95%置信区间：2.93至7.22）。
讨论
尽管存在一些异质性，但PP/PE在改善AFLP患者生化参数方面显示出前景。PE可作为AFLP的一种治疗方法，尤其是在严重或难治性病例中。PE为器官恢复提供了时间，并有助于为肝脏创造一个内稳态环境。需要大型随机对照试验和倾向匹配研究来更好地了解该治疗的安全性和有效性。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698 。
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