二甲双胍与维生素E治疗非酒精性脂肪性肝病的系统评价

骆菁怡; 张立婷; 鲁明霞; 刘雅莉; 肖萍

doi:10.3969/j.issn.1001-5256.2014.12.021

二甲双胍与维生素E治疗非酒精性脂肪性肝病的系统评价

DOI: 10.3969/j.issn.1001-5256.2014.12.021

1. 兰州大学第一临床医学院
2. 兰州大学第一医院感染科
3. 兰州大学第一医院东岗分院肝病科
4. 兰州大学循证医学中心
5. 兰州大学第一医院传染病研究室

基金项目:

“十一五”国家科技重大专项基金项目(2008ZX10002-005-3)；

详细信息

中图分类号: R575.5
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出版历程
- 收稿日期: 2014-03-27
- 出版日期: 2014-12-20

Systematic review of metformin versus vitamin E in treatment of nonalcoholic fatty liver disease

The First Clinical Medical College, Lanzhou University

Research funding:

摘要

摘要:
目的比较二甲双胍与维生素E治疗非酒精性脂肪性肝病(NAFLD)的疗效及不良反应的差异。方法检索Pub Med、EMbase、Cochrane Library、Web of Science、中国知网、万方数据库、维普及中国生物医学文献数据库(CBM)2014年4月10日前发表的有关二甲双胍与维生素E治疗NAFLD的随机对照试验(RCT),对符合纳入标准的临床研究进行Meta分析。结果共纳入4篇RCT,3篇为英文,1篇为中文。Meta分析结果显示,有效率:口服二甲双胍与口服维生素E后的血清ALT变化量相比,二甲双胍的有效率更高(P<0.000 1);口服二甲双胍与口服维生素E后的血清AST、身体质量指数(BMI)、空腹血糖、甘油三酯的变化量差异均无统计学意义(P值分别为0.30、0.39、0.82、0.74);二甲双胍治疗后的肝活组织检查脂肪变性得分变化量、小叶炎性得分变化量及气球样改变不如口服维生素E后的变化量。安全性:二甲双胍能够有效降低患者血清ALT和GGT水平,而不会造成肝细胞损伤(P值分别为0.008、0.01)。不良反应发生率:仅1篇文献报道二甲双胍组患者出现轻微腹泻及腹...
- 脂肪肝 /
- 二甲双胍 /
- 维生素E /
- Meta分析
Abstract:
Objective To compare the clinical efficacy and adverse effects of metformin versus vitamin E in the treatment of nonalcoholic fatty liver disease (NAFLD) . Methods Randomized controlled trials (RCTs) of NAFLD treatment with metformin and vitamin E, which were published before April 10, 2014, were retrieved from international and domestic biomedical databases including the Pub Med, EMbase, Cochrane Library, Web of Science, CNKI, WANFANG, VIP, and CBM. Clinical trials that met the inclusion criteria were chosen for meta-analysis. Results Four RCTs were included, of which three were published in English and one in Chinese. Meta-analysis data showed that metformin had a significantly higher effective rate than vitamin E in terms of serum alanine aminotransferase (ALT) alternation post oral treatment (P < 0. 0001) . There were no significant differences in body mass index (BMI) and serum aspartate aminotransferase (AST) , fasting blood glucose (FBG) , and triglyceride (TG) levels post oral treatment (P = 0. 30, 0. 39, 0. 82, and 0. 74, respectively) . Liver biopsy showed that after metformin treatment, the alterations in fatty degeneration and lobular inflammation scores, as well as balloon-like changes, were less than those post vitamin E treatment. Regarding clinical safety, metformin effectively reduced serum ALT and gamma-glutamyl transferase levels without causing hepatocyte damage (P = 0. 008 and 0. 01, respectively) . Only one RCT mentioned the occurrence of mild diarrhea and abdominal pain or discomfort in the metformin group, but there was no significant difference from the vitamin group. Conclusion Among NAFLD patients, metformin reduces serum ALT levels more significantly than vitamin E, while the latter has its advantage in improving the results of liver biopsy. However, these two drugs have no significant differences in reducing BMI and AST, FBG, and TG levels. This study included limited numbers of original references and patients, and it might involve selection and implementation biases. RCTs of higher quality are expected to provide more effective evidence for assessing the clinical efficacy and adverse reactions of metformin versus vitamin E.
- fatty liver /
- metformin /
- vitamin E /
- Meta-analysis

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