L-鳥氨酸-L-門冬氨酸治療肝性腦病的系統評價_《中國循證醫學雜志》

作者：

 胡衛 ¹ , 湯紹輝 ²

1. 武漢大學醫院（武漢 430072）；2. 暨南大學華僑醫院;

關鍵詞：

L-鳥氨酸-L-門冬氨酸肝性腦病系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120122

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目的　系統評價L-鳥氨酸-L-門冬氨酸（L-ornithine-L-aspartate，LOLA）治療肝性腦病（hepatic encephalopathy，HE）的療效和不良反應。
方法　計算機檢索PubMed、EMbase、Web of Science、The Cochrane Central Register of Controlled Trials（CENTRAL）、CNKI、VIP、WanFang Data（檢索時間截至2011年11月30日），納入LOLA治療肝性腦病的隨機對照試驗（RCT），由兩位評價員獨立評價納入研究的質量、進行資料提取和交叉核對后，采用RevMan 5.0軟件進行Meta分析。
結果　納入6個RCT，C型HE患者432例，A型HE患者185例。Meta分析結果顯示：與安慰劑相比，LOLA能明顯降低C型HE患者的血氨水平［WMD=16.60，95%CI（8.34，24.85，P lt;0.000 1］，改善數字連接試驗（NCT-A）反應時間［WMD=9.6，95%CI（5.26，13.93），P lt;0.000 1］，有效提高HE臨床緩解率［RR=1.36，95%CI（1.06，1.73），P=0.01］；但LOLA對于A型HE的療效與安慰劑相比，差異無統計學意義（P gt;0.05）。
結論　LOLA對C型HE患者療效肯定，在臨床上可作為一種治療選擇；但對A型HE的療效有待更多高質量RCT進一步評價。

引用本文： 胡衛,湯紹輝. L-鳥氨酸-L-門冬氨酸治療肝性腦病的系統評價. 中國循證醫學雜志, 2012, 12(7): 799-803. doi: 10.7507/1672-2531.20120122 復制

1.	Ferenci P, Lockwood A, Mullen K, et al. Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology, 2002, 35(65):716-721.
2.	Sibae MR, Mc Guire BM. Current trends in the treatment of hepatic encephalopathy. Ther Clin Risk Manag, 2009, 5(7):617-626.
3.	Toris GT, Bikis CN, Tsourouflis GS, et al. Hepatic encephalopathy: an updated approach from pathogenesis to treatment. Med Sci Monit, 2011, 17(2): 53-63.
4.	Jadad AR, Moore, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(23): 1-12.
5.	Kircheis G, Nilius R, Held C, et al. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double-blind study. Hepatology, 1997, 25(76): 1351-1360.
6.	Stauch S, Kircheis G, Adler G, et al. Oral L-ornithine-L-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol, 1998, 28(6): 856 -864.
7.	Ahmad I, Khan AA, Alam A, et al. L-ornithine-L-aspartate infusion efficacy in hepatic encephalopathy. J Coll Physicians Surg Pak, 2008, 18(3): 684-687.
8.	Acharya SK, Bhatia V, Sreenivas V, et al. Efficacy of L-ornithine L-aspartate in acute liver failure: a double-blind, randomized, placebo-controlled study. Gastroenterology, 2009, 136(37): 2159-2168.
9.	Schmid M, Peck-Radosavljevic M, König F, et al. A double-blind, randomized, placebo-controlled trial of intravenous L-ornithine-L-aspartate on postural control in patients with cirrhosis. Liver Int, 2010, 30(17): 574-582.
10.	Abid S, Jafri W, Mumtaz K, et al. Efficacy of L-ornithine-L-aspartate as an Adjuvant Therapy in Cirrhotic Patients with Hepatic Encephalopathy. J Coll Physicians SurgPak, 2011, 21(7): 666-671.
11.	Haussinger D, Schliess F. Pathogenetic mechanisms of hepatic encephalopathy. Gut, 2008, 57(5): 1156 -1165.
12.	許建明. 肝性腦病診治的難點與爭議. 中華消化雜志, 2011, 31(1): 2-5.
13.	Perazzo JC, Tallis S, Delfante A, et al. Hepatic encephalopathy: An approach to its multiple pathophysiological features. World J Hepatol, 2012, 4(3): 50-65.
14.	Bajaj JS. Review article: the modern management of hepatic encephalopathy. Aliment Pharmacol Ther, 2010, 31(5): 537-547.
15.	Gillmann A, Gerharz CD, Müssig K. Diagnostics and treatment of hepatic encephalopathy. Dtsch Med Wochenschr, 2012, 137(1-2): 29-33.
16.	Jiang Q, Jiang XH, Zheng MH, et al. L-Ornithine-l-aspartate in the management of hepatic encephalopathy: a meta-analysis. J Gastroenterol Hepatol, 2009, 24(42): 9-14.
17.	Soárez PC, Oliveira AC, Padovan J, et al. A critical analysis of studies assessing L-ornithine-L-aspartate (LOLA) in hepatic encephalopathy treatment. Arq Gastroenterol, 2009, 46(12): 241-247.

1. Ferenci P, Lockwood A, Mullen K, et al. Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology, 2002, 35(65):716-721.
2. Sibae MR, Mc Guire BM. Current trends in the treatment of hepatic encephalopathy. Ther Clin Risk Manag, 2009, 5(7):617-626.
3. Toris GT, Bikis CN, Tsourouflis GS, et al. Hepatic encephalopathy: an updated approach from pathogenesis to treatment. Med Sci Monit, 2011, 17(2): 53-63.
4. Jadad AR, Moore, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(23): 1-12.
5. Kircheis G, Nilius R, Held C, et al. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double-blind study. Hepatology, 1997, 25(76): 1351-1360.
6. Stauch S, Kircheis G, Adler G, et al. Oral L-ornithine-L-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol, 1998, 28(6): 856 -864.
7. Ahmad I, Khan AA, Alam A, et al. L-ornithine-L-aspartate infusion efficacy in hepatic encephalopathy. J Coll Physicians Surg Pak, 2008, 18(3): 684-687.
8. Acharya SK, Bhatia V, Sreenivas V, et al. Efficacy of L-ornithine L-aspartate in acute liver failure: a double-blind, randomized, placebo-controlled study. Gastroenterology, 2009, 136(37): 2159-2168.
9. Schmid M, Peck-Radosavljevic M, König F, et al. A double-blind, randomized, placebo-controlled trial of intravenous L-ornithine-L-aspartate on postural control in patients with cirrhosis. Liver Int, 2010, 30(17): 574-582.
10. Abid S, Jafri W, Mumtaz K, et al. Efficacy of L-ornithine-L-aspartate as an Adjuvant Therapy in Cirrhotic Patients with Hepatic Encephalopathy. J Coll Physicians SurgPak, 2011, 21(7): 666-671.
11. Haussinger D, Schliess F. Pathogenetic mechanisms of hepatic encephalopathy. Gut, 2008, 57(5): 1156 -1165.
12. 許建明. 肝性腦病診治的難點與爭議. 中華消化雜志, 2011, 31(1): 2-5.
13. Perazzo JC, Tallis S, Delfante A, et al. Hepatic encephalopathy: An approach to its multiple pathophysiological features. World J Hepatol, 2012, 4(3): 50-65.
14. Bajaj JS. Review article: the modern management of hepatic encephalopathy. Aliment Pharmacol Ther, 2010, 31(5): 537-547.
15. Gillmann A, Gerharz CD, Müssig K. Diagnostics and treatment of hepatic encephalopathy. Dtsch Med Wochenschr, 2012, 137(1-2): 29-33.
16. Jiang Q, Jiang XH, Zheng MH, et al. L-Ornithine-l-aspartate in the management of hepatic encephalopathy: a meta-analysis. J Gastroenterol Hepatol, 2009, 24(42): 9-14.
17. Soárez PC, Oliveira AC, Padovan J, et al. A critical analysis of studies assessing L-ornithine-L-aspartate (LOLA) in hepatic encephalopathy treatment. Arq Gastroenterol, 2009, 46(12): 241-247.

《中國循證醫學雜志》

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《中國循證醫學雜志》

L-鳥氨酸-L-門冬氨酸治療肝性腦病的系統評價

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