Meta-Analysis Of The Efficacy Of Artificial Liver For Acute Fatty Liver Of Pregnancy

Objective:This study collected case-control studies and retrospective studies related to the pregnancy outcome after the treatment of acute fatty liver of pregnancy(AFLP)artificial liver at home and abroad by searching the domestic and English databases,pick up the data from the studies for meta-analysis,and evaluated the effectiveness of artificial liver treatment,The therapeutic effect of artificial liver on alanine transaminase(ALT)and total bilirubin(TBIL)and comparing different medical modes of artificial liver to find the best treatment method that can save medical resources and not lose clinical treatment efficiency,providing reference for future clinical work in gynecology and obstetrics.Method:We systematically search from the English database(Pub Med,Web of science,Embase,Cochrane Library)and the Chinese database(CNKI,VIP,Wanfang Medical Database,Chinese Medical Association,and Chinese Biomedical Literature Database),and the case-control and retrospective studies related to AFLP artificial liver treatment published in each database from January 2000 to December 2022 were searched.Depend on the inclusion and exclusion criteria to select the studies,and use the Newcastle-Ottawa scale(NOS scale)to qualify each article.The extracted data was analyzed by using Review Manager5.4,STATA15.1 and STATA17.1 statistical software in combination with complement.Result:Through meta-analysis of the 28 documents included,the results are as follows:1.The OR value of the comprehensive medicine combined with artificial liver treatment mode and the comprehensive medicine treatment mode is 0.11,95% confidence interval [0.07～0.18],Z=9.00,P<0.00001<0.05,which is statistically significant.2.In terms of reducing the ALT,the MD value of the ALT decreased by 23.05,95%confidence interval [-32.5～-13.61],Z=4.78,P<0.05,which is statistically significant.3.In the aspect of reducing TBIL,the MD value of the TBIL in the treatment of integrated medicine combined with artificial liver is-59.14,the 95% confidence interval is[-71.52～-46.76],Z=9.36,P<0.05,which is statistically significant.4.In a single arm study of different artificial liver treatments,the effective rate in the PE group was 89%,with a 95% confidence interval of [0.82 to 0.94],Z=24.08,and P<0.05,which was statistically significant;The effective rate of PE+PP was 88%,with a 95%confidence interval of [0.80 to 0.94],Z=21.7,and P<0.05,which was statistically significant;The effective rate of the low dose PE+DPMAS group was 94%,with a 95%confidence interval of [0.87 to 0.99],Z=21.24,P<0.05,which was statistically significant;The effective rate of low dose PE+PP was 95%,with a 95% confidence interval of [0.82 to1.00],Z=12.76,P<0.05,which was statistically significant.Conclusion:1.During the treatment of patients with AFLP,combined treatment with artificial liver based on comprehensive medical treatment is a protective measure for AFLP,and should be implemented as soon as possible to improve the treatment effectiveness rate.2.Compared to comprehensive medical treatment,artificial liver can remove toxic substances from the body,slow down liver damage,and play an important role in promoting hepatocyte regeneration and liver function recovery.3.Compared to comprehensive medical treatment,artificial liver can accelerate bilirubin excretion,reduce the toxic effect of bilirubin on liver cells,and provide favorable conditions for the recovery of liver function.4.In different artificial liver treatment modes,the treatment effects of low dose PE+DPMAS and low dose PE+PP are more prominent,even better than PE+PP and pure PE treatment,which can alleviate the tension of blood products and further improve the treatment effectiveness.