Ursodeoxycholic Acid Intervention Primary Biliary Cirrhosis The Systematic Of Review

Objective:To assess the long-term efficiency and safety of ursodeoxycholic acid treatment for primary biliary cirrhosis.Methods:According to Cochrane Reviewer's handbook and search strategy,the electronic databases were searched including the Cochrane library Issuel, Pubmed,EMBase,CBM,CNKI and WANGFANG databases.Published or unpublished articles in related journals,were manually searched and some other articles were searched with Google.Two independent reviewers evaluate the trials.Discussion or the third reviewer was invitied when discrepancy happened.After that,Homogeneity,Meta-analysis were made by RevMan4.2 software. If meta-analysis can't be done,qualitative descriptions were made.Results:There were 9 trials including 1202 patients, male 123, female 1079,cases of male to female ratio was 1:8.8, the treatment group included studies for small to medium-dose range dose.Meta-analysis showed:1)primary outcomes were not significant different in the incidence of death[PetoOR=0.80,95%confidence interval(0.47,1.35)],liver trans-plantation[[PetoOR=0.79, 95%confidence interval(0.48,1.28)], death and/or liver transplantation[PetoOR=0.78,95% confidence interval (0.54,1.13)],liver related death[PetoOR=0.89,95% confidence interval (0.36,2.22)] and liver decompensation [OR=0.82,95% confidence interval (0.48,1.41)];2) symptoms were not significant different in the pruritus [OR=0.99,95% confidence interval (0.67,1.46)], fatigue[OR=0.80,95% confidence interval(0.53,1.20)];3)liver biochemistry have significant different in the serum total bilirubin[WMD=-9.28μmol/L,95%CI (-16.2,-2.35)μmol/L], alanine aminotransferase [WMD=-34.36IU/L,95%CI (-42.89,-25.83) IU/L], aspartate aminotransferase [WMD=-29.56IU/L,95%CI (-45.93,-13.19) IU/L], alkaline phosphatase [WMD=-325.79IU/L,95%CI (-414.55,-237.03) IU/L], y-Glutamytransferase [WMD=-253.74IU/L,95%CI (-261.31,-245.66) IU/L], IgM [WMD=-1.33g/L,95%CI (-1.43,-1.22) g/L];4) histological change of liver:there were four trials reported that the patients of pathological stageⅠtoⅡwere obviously better than control group in histology after treatment. 5) adverse effect:OR value of control group and therapy group was 1.23,95%CI (0.63,2.40), P=0.54, the distinction between two groups was not statistically significant.Conclusions:1.Long-term treating PBC applied by UDCA could improve liver biochemistry, but it could not improve the symptom, extend the time of liver transplantation and decrease the incidence of death, liver trans-plantation, liver related death, and liver decompensation.2.UDCA may slow down liver histologic progression in the early-stage patients with PBC. So, patients gain early diagnosis and treatment was very important.3. The adverse effect of UDCA was rare and it's toleration was well. It was considered the choice drug of treating PBC. So, we suggested that the patients with PBC could apply the UDCA with long-term and early.