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目的荟萃分析乙型重型肝炎并发症对病人预后的影响,并探讨并发症成为乙型重型肝炎诊断标准的可能。方法检索截止到2009年11月国内公开发表的乙型重型肝炎相关的论文,提取文献中含有预后和并发症数据,包括肝性脑病、肝肾综合征、感染、上消化道出血和腹水,将上述效应量进行异质性检验,荟萃分析其合并后的效应量。结果共检索到2229篇文献通过遴选,最终有8项研究纳入荟萃分析,共包含1771例乙型重型肝炎病例。荟萃分析生存组(好转组)和死亡组中肝性脑病、肝肾综合征、感染、上消化道出血和腹水,均存在明显差异(P<0.05)。相对危险度依次肝性脑病、肝肾综合征、上消化道出血、感染和腹水。在荟萃分析中肝性脑病、感染和腹水在8项研究中具有同质性。上消化道出血和肝肾综合征有一定异质性。结论荟萃分析发现肝性脑病、肝肾综合征、感染、上消化道出血和腹水在死亡组和生存组之间有明显差异,肝性脑病、感染和腹水同质增加病人死亡率,考虑作为临床乙型重型肝炎预后判断指标。但由于各并发症发病率未超过半数,故各并发症不能作为乙型重型肝炎诊断标准。
Objective To analyze the influence of complication of type B severe hepatitis on the prognosis of patients and to explore the possibility of the complication becoming the diagnostic criteria of type B severe hepatitis. Methods To search for published articles about hepatitis B in China as of November 2009, the literature contains prognostic and complication data including hepatic encephalopathy, hepatorenal syndrome, infection, upper gastrointestinal bleeding and ascites, The effect of heterogeneity of the above test, meta-analysis of the combined effect of the amount. Results A total of 2229 articles were searched and finally 8 studies were included in the meta-analysis. A total of 1771 hepatitis B cases were included. There were significant differences (P <0.05) in meta-analysis between hepatic encephalopathy, hepatorenal syndrome, infection, upper gastrointestinal bleeding and ascites in the survival group (improved group) and death group. Relative risk followed by hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal bleeding, infection and ascites. In a meta-analysis of hepatic encephalopathy, infection and ascites were homogeneous in 8 studies. Upper gastrointestinal bleeding and hepatorenal syndrome have some heterogeneity. Conclusions A meta-analysis found significant differences in hepatic encephalopathy, hepatorenal syndrome, infection, upper gastrointestinal bleeding, and ascites between the death and survival groups, and hepatic encephalopathy, infection, and ascites homogenization increased patient mortality and was considered as a clinical Predictors of type B severe hepatitis prognosis. However, due to the morbidity of each complication does not exceed half, so each complication can not be used as diagnostic criteria for severe hepatitis B.