PDF(Pubmed)
Abstract：
UNASSIGNED: Local ischemic preconditioning (LIPC) has been proven to be a protective strategy against hepatic ischemia-reperfusion injury (HIRI) during hepatectomy. Growing evidence suggests remote ischemic preconditioning (RIPC) has the potential to reduce liver injury in hepatectomy. Few studies have directly compared the protective effects of these two mechanical preconditioning strategies. Therefore, we performed a network meta-analysis to compare the efficacy of LIPC and RIPC for hepatic injury during liver resection.
UNASSIGNED: We searched Cochrane, PubMed, Embase, and China National Knowledge Infrastructure (CNKI) from the database inception to January 2023. We included studies directly comparing the effectiveness of LIPC and RIPC and those comparing LIPC or RIPC with no-preconditioning in liver resection. Postoperative liver function and surgical events were analyzed. Data were expressed as standardized mean differences (SMDs) or odds ratios (ORs) and analyzed using network meta-analysis with random effects model.
UNASSIGNED: Following the screening of 268 citations, we identified 26 eligible randomized clinical trials (RCTs) involving 1,476 participants (LIPC arm: 789, RIPC arm: 859, no-preconditioning arm: 1,072). LIPC and RIPC were superior to no-preconditioning in reducing postoperative serum transaminase levels [aspartate aminotransferase (AST): SMD RIPC versus no-preconditioning: -2.05, 95% confidence interval (CI): -3.39, -0.71; SMD LIPC versus no-preconditioning: -1.10, 95% CI: -2.07, -0.12; alanine aminotransferase (ALT): SMD RIPC versus no-preconditioning: -2.24, 95% CI: -4.15, -0.32; SMD LIPC versus no-preconditioning: -1.32, 95% CI: -2.63, -0.01]. No significant difference was observed between RIPC and LIPC in postoperative liver function and surgical outcomes (AST: SMD RIPC versus LIPC: -0.95, 95% CI: -2.52, 0.62; ALT: SMD RIPC versus LIPC: -0.91, 95% CI: -3.11, 1.28). In addition, the subgroup analysis revealed the potential benefits of RIPC in improving liver function, especially in patients who diagnosed with cirrhosis or underwent major resection.
UNASSIGNED: RIPC and LIPC could serve as effective strategies in relieving HIRI during hepatectomy. No significant differences were observed between LIPC and RIPC, however, RIPC may be an easily applicable strategy to relieve liver injury in hepatectomy.
UNASSIGNED: We searched Cochrane, PubMed, Embase, and China National Knowledge Infrastructure (CNKI) from the database inception to January 2023. We included studies directly comparing the effectiveness of LIPC and RIPC and those comparing LIPC or RIPC with no-preconditioning in liver resection. Postoperative liver function and surgical events were analyzed. Data were expressed as standardized mean differences (SMDs) or odds ratios (ORs) and analyzed using network meta-analysis with random effects model.
UNASSIGNED: Following the screening of 268 citations, we identified 26 eligible randomized clinical trials (RCTs) involving 1,476 participants (LIPC arm: 789, RIPC arm: 859, no-preconditioning arm: 1,072). LIPC and RIPC were superior to no-preconditioning in reducing postoperative serum transaminase levels [aspartate aminotransferase (AST): SMD RIPC versus no-preconditioning: -2.05, 95% confidence interval (CI): -3.39, -0.71; SMD LIPC versus no-preconditioning: -1.10, 95% CI: -2.07, -0.12; alanine aminotransferase (ALT): SMD RIPC versus no-preconditioning: -2.24, 95% CI: -4.15, -0.32; SMD LIPC versus no-preconditioning: -1.32, 95% CI: -2.63, -0.01]. No significant difference was observed between RIPC and LIPC in postoperative liver function and surgical outcomes (AST: SMD RIPC versus LIPC: -0.95, 95% CI: -2.52, 0.62; ALT: SMD RIPC versus LIPC: -0.91, 95% CI: -3.11, 1.28). In addition, the subgroup analysis revealed the potential benefits of RIPC in improving liver function, especially in patients who diagnosed with cirrhosis or underwent major resection.
UNASSIGNED: RIPC and LIPC could serve as effective strategies in relieving HIRI during hepatectomy. No significant differences were observed between LIPC and RIPC, however, RIPC may be an easily applicable strategy to relieve liver injury in hepatectomy.
摘要：
■局部缺血预处理（LIPC）已被证明是在肝切除术期间针对肝缺血再灌注损伤（HIRI）的保护性策略。越来越多的证据表明，远程缺血预处理（RIPC）有可能减少肝切除术中的肝损伤。很少有研究直接比较这两种机械预处理策略的保护作用。因此,我们进行了网络荟萃分析,以比较LIPC和RIPC对肝切除术中肝损伤的疗效.
■我们搜索了Cochrane,PubMed,Embase,和中国国家知识基础设施(CNKI)从数据库开始到2023年1月。我们纳入了直接比较LIPC和RIPC有效性的研究，以及比较LIPC或RIPC在肝切除术中无预处理的研究。分析术后肝功能及手术事件。数据表示为标准化平均差异（SMD）或比值比（ORs），并使用随机效应模型的网络荟萃分析进行分析。
■在筛选了268篇引文后，我们确定了26项符合条件的随机临床试验(RCT),涉及1,476名参与者(LIPC组:789,RIPC组:859,无预处理组:1,072).LIPC和RIPC在降低术后血清转氨酶水平方面优于未预处理[天冬氨酸转氨酶（AST）：SMDRIPC与未预处理：-2.05，95％置信区间（CI）：-3.39，-0.71；SMDLIPC与未预处理：-1.10，95％CI：-2.07，-0.12；SMI-25-AIPC：0.01％-AIPC-AIPC-A在术后肝功能和手术结果方面，RIPC和LIPC之间没有显着差异（AST：SMDRIPC与LIPC：-0.95，95％CI：-2.52，0.62；ALT：SMDRIPC与LIPC：-0.91，95％CI：-3.11，1.28）。此外,亚组分析揭示了RIPC在改善肝功能方面的潜在益处，尤其是在诊断为肝硬化或接受大切除的患者中。
■RIPC和LIPC可以作为减轻肝切除术中HIRI的有效策略。LIPC和RIPC之间没有观察到显著差异，然而,RIPC可能是减轻肝切除术中肝损伤的一种简单的策略。
■我们搜索了Cochrane,PubMed,Embase,和中国国家知识基础设施(CNKI)从数据库开始到2023年1月。我们纳入了直接比较LIPC和RIPC有效性的研究，以及比较LIPC或RIPC在肝切除术中无预处理的研究。分析术后肝功能及手术事件。数据表示为标准化平均差异（SMD）或比值比（ORs），并使用随机效应模型的网络荟萃分析进行分析。
■在筛选了268篇引文后，我们确定了26项符合条件的随机临床试验(RCT),涉及1,476名参与者(LIPC组:789,RIPC组:859,无预处理组:1,072).LIPC和RIPC在降低术后血清转氨酶水平方面优于未预处理[天冬氨酸转氨酶（AST）：SMDRIPC与未预处理：-2.05，95％置信区间（CI）：-3.39，-0.71；SMDLIPC与未预处理：-1.10，95％CI：-2.07，-0.12；SMI-25-AIPC：0.01％-AIPC-AIPC-A在术后肝功能和手术结果方面，RIPC和LIPC之间没有显着差异（AST：SMDRIPC与LIPC：-0.95，95％CI：-2.52，0.62；ALT：SMDRIPC与LIPC：-0.91，95％CI：-3.11，1.28）。此外,亚组分析揭示了RIPC在改善肝功能方面的潜在益处，尤其是在诊断为肝硬化或接受大切除的患者中。
■RIPC和LIPC可以作为减轻肝切除术中HIRI的有效策略。LIPC和RIPC之间没有观察到显著差异，然而,RIPC可能是减轻肝切除术中肝损伤的一种简单的策略。
