■由于并非所有肝功能障碍患者都适合移植,并且移植物短缺,肝支持疗法已经引起了人们的兴趣。在这方面,体外白蛋白透析设备,如单程白蛋白透析(SPAD),普罗米修斯,和分子吸附剂回收系统(MARS)在补充标准药物治疗(SMT)方面具有重要价值。然而,这些设备的有效性和安全性经常受到质疑。目的:我们进行了系统评价,以总结MARS的疗效和安全性,SPAD,和普罗米修斯作为肝功能障碍的支持性治疗。
■PubMed,Medline,科克伦图书馆,WebofScience,和GoogleScholar电子数据库被广泛搜索所有以英文发表的随机试验。此外,荟萃分析使用ReviewManager软件进行,和Cochrane的偏见风险工具嵌入在该软件用于偏见评估。
■包括总共653名患者在内的12项试验符合纳入条件。对这些试验数据的亚组分析显示,与SMT相比,MARS和Prometheus与胆红素的显着去除有关(MD=-5.14mg/dl;95%CI:-7.26--3.02;p<0.00001和MD=-8.11mg/dl;95%CI:-12.40--3.82;p=0.0002),但与SMT相比,胆汁酸和氨无关。此外,MARS在降低胆红素方面与普罗米修斯和SPAD一样有效(MD=2.98mg/dl;95%CI:-4.26-10.22;p=0.42和MD=0.67mg/dl;95%CI:-2.22-3.56;p=0.65),胆汁酸(MD=-17.06µmol/l;95%CI:-64.33-30.20;p=0.48,MD=16.21µmol/l;95%CI:-17.26-49.68;p=0.34),和氨(MD=26μmol/l;95%CI:-12.44-64.44;p=0.18)。此外,MARS在改善肝性脑病(HE)方面具有相当大的作用(RR=1.54;95%CI:1.15-2.05;p=0.004)。然而,与SMTRR相比,MARS和普罗米修斯均无死亡率获益(分别为0.86;95%CI:0.71-1.03;p=0.11,RR=0.87;95%CI:0.66-1.14;p=0.31).
■火星,SPAD,还有普罗米修斯,作为肝脏支持疗法,在减少白蛋白结合和水溶性物质方面同样有效。此外,MARS与他的进步有关。然而,所有治疗均未显著降低死亡率或不良事件.
UNASSIGNED: Because not all liver dysfunction patients are suitable for transplantations and there is a shortage of grafts, liver support therapies have gained interest. In this regard, extracorporeal albumin dialysis devices such as single-pass albumin dialysis (SPAD), Prometheus, and molecular adsorbent recycling system (MARS) have been valuable in supplementing standard medical therapy (SMT). However, the efficacy and safety of these devices is often questioned.Aim: We performed a systematic
review to summarize the efficacy and safety of MARS, SPAD, and Prometheus as supportive treatments for liver dysfunction.
UNASSIGNED: PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar electronic databases were extensively searched for all randomized trials published in English. In addition, meta-analytic analyses were performed with
Review Manager software, and Cochrane\'s risk of bias tool embedded in this software was used for bias assessment.
UNASSIGNED: Twelve trials including a total of 653 patients were eligible for inclusion. Subgroup analyses of data from these trials revealed that MARS and Prometheus were associated with significant removal of bilirubin (MD = -5.14 mg/dl; 95% CI: -7.26 - -3.02; p < 0.00001 and MD = -8.11 mg/dl; 95% CI: -12.40 - -3.82; p = 0.0002, respectively) but not bile acids and ammonia when compared to SMT. Furthermore, MARS was as effective as Prometheus and SPAD in the reduction of bilirubin (MD = 2.98 mg/dl; 95% CI: -4.26 - 10.22; p = 0.42 and MD = 0.67 mg/dl; 95% CI: -2.22 - 3.56; p = 0.65), bile acids (MD = -17.06 µmol/l; 95% CI: -64.33 - 30.20; p = 0.48 and MD = 16.21 µmol/l; 95% CI: -17.26 - 49.68; p = 0.34), and ammonia (MD = 26 µmol/l; 95% CI: -12.44 - 64.44; p = 0.18). In addition, MARS had a considerable effect in improving hepatic encephalopathy (HE) (RR = 1.54; 95% CI: 1.15-2.05; p = 0.004). However, neither MARS nor Prometheus had a mortality benefit compared to SMTRR (0.86; 95% CI: 0.71-1.03; p = 0.11 and RR = 0.87; 95% CI: 0.66-1.14; p = 0.31, respectively).
UNASSIGNED: MARS, SPAD, and Prometheus, as liver support therapies, are equally effective in reducing albumin-bound and water-soluble substances. Moreover, MARS is associated with HE improvement. However, none of the therapies was associated with a significant reduction in mortality or adverse events.