Objective To evaluate the efficacy and safety of L-ornithine-L-aspartate (LOLA) in the treatment of hepatic encephalopathy (HE). Methods Such databases as PubMed, EMbase, Web of Science, CENTRAL, Chinese Journals Full-text Database, CBM and WanFang Data were searched from the date of their establishment to November 30, 2011 to collect the randomized controlled trials (RCTs) on LOLA in treating HE. The quality of included studies was evaluated by two reviewers independently, data were extracted and cross-checked, and then meta-analysis was performed using Review Manager 5.0 software. Results Among the total six included RCTs, 432 patients were diagnosed as type-C HE and 185 were diagnosed as type-A HE. Compared with the placebo group, for the patients with type-C HE, LOLA could significantly reduce the serum ammonia level (WMD=16.60, 95%CI 8.34 to 24.85, Plt;0.000 1) and the time of number connection test-A (NCT-A) (WMD=9.6, 95%CI 5.26 to 13.93, Plt;0.00 01), and it could also effectively improve the clinical remission rate (RR=1.36, 95%CI 1.06 to 1.73, P=0.01). However, no significant differences were found between the two groups for the patients with type-A HE (Pgt;0.05). Conclusion LOLA is effective for the patients with type-C hepatic encephalopathy, and it could be regarded as a choice in clinic. However, more high-quality RCTs are needed to further evaluate the effect of LOLA in treating type-A hepatic encephalopathy.
ObjectiveTo evaluate the efficacy of western conventional treatment based on traditional Chinese medicine retention enema on patients with hepatic encephalopathy. MethodsSuch databases as the Cochrane Library, PubMed, EMbase, VIP, CNKI, CBM and WanFang Database were searched from the inception to November 2013 to collect randomized controlled trials (RCTs) about Western conventional treatment based on traditional Chinese medicine retention enema to treat hepatic encephalopathy, and the references of the included literature were also retrieved. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated and cross-checked the methodological quality. Then meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 26 RCTs involving 1 691 patients were included. The subgroup analyses based on the length of intervention time showed that when the course of treatment intervention was less than one, the overall effective rate of the Chinese herbal retention enema group was higher than that of the control group, with a significant difference[RR=1.34, 95%CI (1.25, 1.44), P<0.000 01]; after more than one course of treatment intervention, the overall effective rate of the Chinese herbal retention enema group was higher than that of the control group, with a significant difference[RR=1.34, 95%CI (1.21, 1.48), P<0.000 01]. ConclusionOn the basis of available evidence, the western medicine treatment based on traditional Chinese medicine retention enema for hepatic encephalopathy has a certain effect. However, the heterogeneity among the included studies is large. It is necessary to design multicenter, strictly randomized and double-blind test controlled trials with large samples to validate these conclusions and to further confirm the clinical curative effect.
Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group (n=6), grade B liver function group (n=18), and grade C liver function group (n=26); according to the type of stent implantation, the patients were divided into covered stent group (n=29) and bare stent group (n=21). The 1-week and 1-, 3-, 6-, and 12-month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% (50/50), and the success rate of emergency surgery was 100.0% (3/3) in 3 patients with active bleeding. The portal vein pressure decreased from (39.46±2.82) cm H2O (1 cm H2O=0.098 kPa) before the surgery to (25.62±2.13) cm H2O after the surgery, and the difference was statistically significant (P<0.05). In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant (P>0.05); in grade C liver function group, the 1-week, 1-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant (P<0.05). The postoperative 2-year rebleeding rate was 12.0% (6/50), and the postoperative 2-year incidence of hepatic encephalopathy was 16.0% (8/50). The postoperative 2-year stent stenosis rate was 26.0% (13/50) in the 50 cases, which was 13.8% (4/29) in covered stent group and 42.9% (9/21) in bare stent group, respectively. The postoperative 2-year survival rate was 90.0% (45/50). Conclusions TIPS combined with gastric coronary vein embolization in the treatment of liver cirrhosis with gastroesophageal varices bleeding has the exact effect, low rebleeding rate, fewer complications, and can be repeated. The preoperative evaluation of patients’ liver function, the application of stent of diameter 8 mm, paying attention to the perioperative period and regular follow-up treatment are helpful to reduce or prevent the occurrence of hepatic encephalopathy, stent stenosis and other complications.
Objectives To systematically review the efficacy of polytetrafluoroethylene (PTFE) covered stent grafts vs. bare stent grafts in transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials (RCTs) and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients (1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients) were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt (HR=0.38, 95%CI 0.31 to 0.47, P<0.000 01) and survival rate (HR=0.59, 95%CI 0.44 to 0.79,P=0.000 5), lower postoperative complications rate (including gastrointestinal bleeding and refractory ascites) (HR=0.44, 95%CI 0.33 to 0.58, P<0.000 01) and encephalopathy rate (HR=0.76, 95%CI 0.57 to 0.99,P=0.05). Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.