| Aim: We performed a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of glucocorticoids plus conventional therapy in treating hepatitis B-related liver failure.Methods: A randomized controlled trials for the treatment of hepatitis B-related liver failure using glucocorticoid as an intervention was obtained by retrieving the Chinese National Knowledge Infrastructure,Wanfang database,PubMed database,the Cochrane library and Google Scholar.The Primary outcomes were efficacy of glucocorticoid plus conventional therapy and mortality rate.The secondary outcomes were the incidence of complications.Meta-analysis was performed by using Stata12.0 software.Results: Ten studies with 891 patients were included.Meta-analysis showed that conventional therapy plus glucocorticoids could improve the effectiveness of the treatment of HBV-associated liver failure [OR = 3.98,95%CI(2.80,5.66),P = 0.000] and reduce the mortality rate [OR = 0.38,95%CI(0.20,0.74),P = 0.004].The subgroup analysis with different observation times showed that the mortality rate of glucocorticoid combined with conventional treatment was lower than that of conventional treatment alone,and the mortality rate was reduced at 28 days after treatment [OR = 0.24,95%CI(0.09,0.66),P = 0.006],and there was no statistically significant difference in the mortality rate after 56 days of treatment [OR = 0.69,95%CI(0.22,2.14),P = 0.517].A subgroup analysis based on different routes of drug administration showed that the mortality rate of glucocorticoid through intravenous administration was lower than that of conventional treatment alone [OR = 0.40,95%CI(0.18,0.89),P = 0.025],and the difference in mortality rate after oral administration was not statistically significant [OR = 0.38,95%CI(0.10,1.46),P = 0.161].In terms of complications,the analysis showed that glucocorticoid combination therapy did not increase the risk of complications.Conclusions: Our findings suggest that glucocorticoid plus conventional therapy for HBV-related hepatic failure is more effective than conventional treatment,and the short-term(28-day)mortality rate is reduced without increasing the incidence of complications.Furthermore,glucocorticoids are better administered intravenously than oral.The combination of glucocorticoid and conventional treatment could be an effective and safe strategy in treating patients with hepatitis B-related liver failure. |
