RESUMO
ObjectiveTo systematically review the clinical effect of glucocorticoids used alone or in combination with pentoxifylline in patients with severe alcoholic liver disease. MethodsPubMed, Embase, Chinese Scientific Journal Full-Text Database, CBM, China Scientific Journal Database, and Chinese Medical Association Digital Journal Database were searched for related articles published up to November 2018, and related journals and collected papers from conferences were searched manually. The clinical effect of glucocorticoids versus placebo, glucocorticoids versus pentoxifylline, and glucocorticoids combined with glucocorticoids versus glucocorticoids alone was analyzed. The effect of glucocorticoids and pentoxifylline used alone or in combination on 28-day survival rate and hepatorenal syndrome in patients with severe alcoholic liver disease was assessed. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate outcome indicators. RevMan 5.3 software was used for data analysis. ResultsA total of 22 studies were included, with 1956 patients in total. The glucocorticoid group had a significantly lower 28-day mortality rate than the control group (25.12% vs 30.67%, OR=0.71, 95%CI: 0.55-0.93, P=0.01). Subgroup analysis showed that there was a significant difference in 28-day mortality rate between the glucocorticoid group and the pentoxifylline group (OR=0.68, 95%CI: 0.48-0.97, P=0.03), while there was no significant difference between the glucocorticoid+pentoxifylline group and the glucocorticoid group (OR=0.92, 95%CI: 0.66-1.29, P=0.64). Compared with the glucocorticoid group, the glucocorticoid+pentoxifylline group had a significantly lower incidence rate of hepatorenal syndrome (3.94% vs 803%, OR=0.45, 95%CI: 0.24-0.83, P=0.01). Funnel plots showed no publication bias. ConclusionGlucocorticoids combined with pentoxifylline can reduce the incidence rate of hepatorenal syndrome in patients with severe alcoholic liver disease.