本文選題：水飛薊素 + 丙型肝炎��； 參考：《廣西醫(yī)科大學》2013年碩士論文

【摘要】：目的： 評價水飛薊素對丙型病毒性肝炎肝功能損害和臨床癥狀改善的作用。 方法： 電子和手工檢索數(shù)據(jù)庫PubMed (1975.12-2012.12)、 EMBASE(1990.12-2012.12)、Cochrane(1998.12-2012.12)、中國生物醫(yī)學文獻數(shù)據(jù)庫(1992.12-2012.12)。收集水飛薊素與安慰劑相比較治療丙型肝炎隨機對照實驗(Randomized controlled trial,RCT)的文獻,文獻質量的評估考慮四個部分：隨機分配方法、分配方案的隱藏、盲法、脫落和失訪人數(shù)及原因的描述。兩名評價者獨立進行方法質量評估并提取資料。 對提取的資料進行Meta分析,必要時進行敏感性分析和亞組分析。敏感性分析將按照以下標準進行：去掉低質量的RCT、去掉短期治療的RCT和去掉小樣本的RCT。療效評價的主要指標是轉氨酶治療前后改變,有效率。 采用Cochrane協(xié)作網(wǎng)提供的專用軟件包(Revman5.0)進行數(shù)據(jù)統(tǒng)計分析。 結果： 初檢共檢索出80篇相關文獻,通過閱讀題目、摘要,排除綜述類、非臨床類、排除診斷標準不同、干預措施不同、最終得到10篇文獻共包含688個患者符合本研究的納入標準,其中研究水飛薊素治療總有效率的有4篇,研究水飛薊素治療后谷丙轉氨酶(ALT)改變情況的有6篇。其文獻質量采用Cocharane Reviewer's Handbook5.0RCT的六條質量評估標準量表進行評分：所有入選研究的分配序列生產、分配隱藏、盲法設定均恰當,結局數(shù)據(jù)完整并選擇性報告,但沒有提供其他偏倚來源。 總共4篇文獻報道了水飛薊素治療242名丙型肝炎患者的總有效率。Meta分析顯示,水飛薊素對丙型肝炎的治療是有效果的,主要表現(xiàn)在提高生存時間,膽紅素指標及病毒載量降低。(相對危險度為2.66,95%可信區(qū)間1.88-3.75,PO.00001)。 總共有6篇RCT文獻報道了關于水飛薊素對于446例丙型肝炎患者治療后ALT改變的報道,各研究之間無統(tǒng)計學異質性(P=0.06,I2=52%),故采用固定效應模型,結果顯示：水飛薊素組治療療效優(yōu)于安慰劑組,差距有統(tǒng)計學意義(MD值為-33.44,95%可信區(qū)間：-41.28,-25.61,P0.00001)。 所有試驗沒有報告與水飛薊素有關的嚴重副作用事件。 結論： 水飛薊素治療丙型肝炎可以提高肝臟疾病患者治療的有效率,改善患者的臨床癥狀和體征,提高患者的生活質量。 水飛薊素能降低丙型肝炎對肝臟的進一步損害,可以改善和恢復肝功能。
[Abstract]:Objective: To evaluate the effect of silymarin on liver function and clinical symptoms in patients with viral hepatitis C. Methods: Electronic and manual retrieval database PubMed (1975.12-2012.12), EMBASE (1990.12-2012.12), Cochrane (1998.12-2012.12), Chinese Biomedical Literature Database (1992.12-2012.12). The literature on silymarin compared with placebo in the treatment of hepatitis C was collected. The literature quality was evaluated in four parts: random distribution method, concealment of distribution scheme, blind method. Description of the number and causes of shedding and missing visits. Two reviewers independently evaluate the quality of the method and extract the data. The extracted data were analyzed by Meta, sensitivity analysis and subgroup analysis when necessary. Sensitivity analysis will be conducted according to the following criteria: remove low-quality RCTs, remove short-term RCT and remove small sample RCTs. The main index of curative effect evaluation is the change of transaminase before and after treatment and the effective rate. A special software package provided by Cochrane Cooperative Network (Cochrane) was used to carry out statistical analysis. Results: A total of 80 related articles were retrieved at the initial examination. By reading topics, abstracts, excluding summary, non-clinical, excluding diagnostic criteria and intervention measures, 10 articles including 688 patients met the inclusion criteria of this study. The total effective rate of silymarin and alanine aminotransferase after silymarin treatment were 4 and 6, respectively. The quality of the literature was evaluated by Cocharane Reviewer's Handbook5.0RCT 's six quality assessment scales: all the selected subjects were assigned sequence production, distribution hiding, blind setting, complete outcome data and selective report. No other sources of bias were provided. The total effective rate of silymarin in the treatment of 242 patients with hepatitis C was reported. Meta-analysis showed that silymarin was effective in the treatment of hepatitis C. it mainly showed that silymarin was effective in improving survival time, decreasing bilirubin index and viral load. (the relative risk was 2.66% 95% confidence interval 1.88-3.75% PO.001). A total of 6 RCT papers reported the changes of silymarin in 446 patients with hepatitis C after treatment. There was no statistical heterogeneity among the studies, so the fixed effect model was used. The results showed that silymarin group was more effective than placebo group, and the difference of MD was -33.44% 95% CI: -41.28% -25.61% P 0.00001. No serious side effects associated with silymarin were reported in all trials. Conclusion: Silymarin treatment of hepatitis C can improve the effective rate of liver disease patients, improve the clinical symptoms and signs of patients, improve the quality of life of patients. Silymarin can reduce the further damage to liver caused by hepatitis C, and can improve and restore liver function.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R512.63

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