远端缺血预处理对肝癌肝切除术患者预后影响的Meta分析

doi:10.3877/cma.j.issn.2095-3232.2021.03.014

目的

系统评价远端缺血预处理（RIPC）对肝癌肝切除术患者预后的影响。

方法

计算机检索PubMed、Medline、Embase、Cochrane Library（CENTRAL）、CBM、CNKI、维普和万方等数据库，搜集关于RIPC对肝切除术患者预后影响的随机对照试验（RCT），检索时间段为建库至2020年3月。英文检索词主要包括：hepatectomy、liver resection、remote ischemic preconditioning、limb ischemic preconditioning、randomized control trial。中文检索词主要包括：肝切除术、肝切除手术、肝脏手术、远程缺血预处理、远端缺血预处理、肢体缺血预处理、随机对照试验。根据纳入、排除标准查找相关文献，提取数据后采用RevMan 5.3及STATA 14.0软件进行Meta分析。

结果

最终纳入7项RCT研究，共395例患者。结果显示，RIPC组术中输血量明显低于对照组（SMD=-0.39，95%CI：-0.62～-0.15；P<0.05）。RIPC组术后第1天AST、ALT水平均低于对照组（SMD=-1.65，-1.87；95%CI：-2.74～-0.57，-3.03～-0.72；P<0.05）。

结论

RIPC有益于肝癌肝切除术患者术后早期肝功能恢复。

关键词: 肝肿瘤, 肝切除术, 缺血预处理, 预后, Meta分析, 随机对照试验

Objective

To systematically evaluate the effect of remote ischemic preconditioning (RIPC) on the clinical prognosis of patients with liver cancer undergoing hepatectomy.

Methods

Randomized controlled trials (RCT) evaluating the effect of RIPC on clinical prognosis of patients undergoing hepatectomy from the inception until March, 2020 were retrieved from PubMed, MEDLINE, Embase, Cochrane Library (CENTRAL), CBM, CNKI, Chongqing VIP and Wanfang databases. The search terms were hepatectomy, liver resection, remote ischemic preconditioning, limb ischemic preconditioning and randomized control trial in both English and Chinese. Literature were included according to the inclusion and exclusion criteria. Relevant data were extracted and subjected to Meta-analysis with RevMan 5.3 and STATA 14.0 software.

Results

7 RCTs consisting of 395 cases were eventually included. In RIPC group, the volume of intraoperative blood transfusion was significantly lower than that in control group (SMD=-0.39, 95%CI: -0.62 to -0.15; P<0.05). In RIPC group, the levels of AST and ALT at postoperative 1 d were significantly lower compared with those in control group (SMD=-1.65, -1.87; 95%CI: -2.74 to -0.57, -3.03 to -0.72; P<0.05).

Conclusion

RIPC contributes to the early recovery of liver function after hepatectomy in liver cancer patients.

Key words: Liver neoplasms, Hepatectomy, Ischemic preconditioning, Prognosis, Meta-analysis, Randomized controlled trial

表1 纳入研究的基本特征

纳入研究	年份	例数（R/C）	年龄均数（岁，R/C）	性别（例，男/女）	Pringle阻断时间（min，R/C）	R组干预措施	结局指标
Kanoria等^[8]	2016	8/8	68/70	13/3	0/0	3×10 min/10 min下肢	①③④⑥⑨
Liu等^[9]	2019	69/67	52/52	118/18	22.0/22.3	3×5 min/5 min右上肢	①③④⑤⑥⑦⑨⑩⑫⑬
Rakić等^[10]	2018	20/20	64	24/16	17/17	3×5 min/5 min右上肢	④⑤⑥⑨⑭
Teo等^[11]	2020	24/26	64/67	39/11	37/29	4×5 min/5 min上肢	①②③④⑥⑨
Wu等^[12]	2019	34/39	51/50	60/13	17.2/19.4	3×5 min/5 min右上肢	①②③④⑤⑥⑦⑧⑨⑩⑪⑫⑬⑭
吴云等^[13]	2014	10/10	52/49	-	17/17	3×5 min/5 min右上肢	①⑤⑥⑦⑧⑨⑩⑪⑫⑬⑭
李霞等^[14]	2016	30/30	39/40	33/27	17.6/15.8	3×5 min/5 min右上肢	①③④⑤⑥⑨

表1 纳入研究的基本特征

纳入研究	年份	例数（R/C）	年龄均数（岁，R/C）	性别（例，男/女）	Pringle阻断时间（min，R/C）	R组干预措施	结局指标
Kanoria等^[8]	2016	8/8	68/70	13/3	0/0	3×10 min/10 min下肢	①③④⑥⑨
Liu等^[9]	2019	69/67	52/52	118/18	22.0/22.3	3×5 min/5 min右上肢	①③④⑤⑥⑦⑨⑩⑫⑬
Rakić等^[10]	2018	20/20	64	24/16	17/17	3×5 min/5 min右上肢	④⑤⑥⑨⑭
Teo等^[11]	2020	24/26	64/67	39/11	37/29	4×5 min/5 min上肢	①②③④⑥⑨
Wu等^[12]	2019	34/39	51/50	60/13	17.2/19.4	3×5 min/5 min右上肢	①②③④⑤⑥⑦⑧⑨⑩⑪⑫⑬⑭
吴云等^[13]	2014	10/10	52/49	-	17/17	3×5 min/5 min右上肢	①⑤⑥⑦⑧⑨⑩⑪⑫⑬⑭
李霞等^[14]	2016	30/30	39/40	33/27	17.6/15.8	3×5 min/5 min右上肢	①③④⑤⑥⑨

图1 RIPC组与对照组肝癌肝切除患者术后第1天AST水平比较Meta分析

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424.
[2]	Yang JD, Hainaut P, Gores GJ, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(10):589-604.
[3]	Weiss MJ, Ito H, Araujo RL, et al. Hepatic pedicle clamping during hepatic resection for colorectal liver metastases: no impact on survival or hepatic recurrence[J]. Ann Surg Oncol, 2013, 20(1):285-294.
[4]	Nishio T, Taura K, Koyama Y, et al. Prediction of posthepatectomy liver failure based on liver stiffness measurement in patients with hepatocellular carcinoma[J]. Surgery, 2016, 159(2):399-408.
[5]	Simillis C, Robertson FP, Afxentiou T, et al. A network meta-analysis comparing perioperative outcomes of interventions aiming to decrease ischemia reperfusion injury during elective liver resection[J]. Surgery, 2016, 159(4):1157-1169.
[6]	Billah M, Ridiandries A, Allahwala U, et al. Circulating mediators of remote ischemic preconditioning: search for the missing link between non-lethal ischemia and cardioprotection[J]. Oncotarget, 2019, 10(2): 216-244.
[7]	Tapuria N, Junnarkar SP, Dutt N, et al. Effect of remote ischemic preconditioning on hepatic microcirculation and function ina rat model of hepatic ischemia reperfusion injury[J]. HPB, 2009, 11(2):108-117.
[8]	Kanoria S, Robertson FP, Mehta NN, et al. Effect of remote ischaemic preconditioning on liver injury in patients undergoing major hepatectomy for colorectal liver metastasis: a pilot randomised controlled feasibility trial[J]. World J Surg, 2017, 41(5):1322-1330.
[9]	Liu X, Cao L, Zhang T, et al. Effect of remote ischemic preconditioning in patients undergoing hepatectomy with portal triad clamping: a randomized controlled trial[J]. Anesth Analg, 2019, 129(6):1742-1748.
[10]	Rakić M, Patrlj L, Amić F, et al. Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections[J]. Int J Surg, 2018, 54(Pt A): 248-253.
[11]	Teo JY, Ho AFW, Bulluck H, et al. Effect of remote ischemic preconditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial[J]. HPB, 2020, 22(9):1250-1257.
[12]	Wu G, Chen M, Wang X, et al. Effect of remote ischemic preconditioning on hepatic ischemia-reperfusion injury in patients undergoing liver resection: a randomized controlled trial[J]. Minerva Anestesiol, 2020, 86(3):252-260.
[13]	吴云，张野，胡宪文, 等. 远端缺血预处理对肝脏切除术后肝功能的影响[J]. 安徽医科大学学报, 2014, 49(10):1472-1475.
[14]	李霞. 肢体远隔缺血预处理对肝脏手术血清TNF-α及HMGB1水平的影响[D]. 南昌：南昌大学, 2016.
[15]	Remote Preconditioning Trialists' Group, Healy DA, Khan WA, et al. Remote preconditioning and major clinical complications following adult cardiovascular surgery: systematic review and meta-analysis[J]. Int J Cardiol, 2014, 176(1):20-31.
[16]	Benstoem C, Stoppe C, Liakopoulos OJ, et al. Remote ischaemic preconditioning for coronary artery bypass grafting (with or without valve surgery)[J]. Cochrane Database Syst Rev, 2017, 5(5): CD011719.
[17]	Weng SF, Kai J, Guha IN, et al. The value of aspartate aminotransferase and alanine aminotransferase in cardiovascular disease risk assessment[J]. Open Heart, 2015, 2(1):e000272.
[18]	Agrawal S, Dhiman RK, Limdi JK. Evaluation of abnormal liver function tests[J]. Postgrad Med J, 2016, 92(1086):223-234.
[19]	Mouton R, Soar J. Remote ischaemic preconditioning: an intervention for anaesthetists?[J]. Br J Anaesth, 2017, 118(3):288-291.
[20]	Saidi RF, Kenari SK. Liver ischemia/reperfusion injury:an overview[J]. J Invest Surg, 2014, 27(6):366-379.
[21]	Kottenberg E, Musiolik J, Thielmann M, et al. Interference of propofol with signal transducer and activator of transcription5 activation and cardioprotection by remote ischemic preconditioning during coronary artery bypass grafting[J]. J Thorac Cardiovasc Surg, 2014, 147(1):376-382.
[22]	Heusch G, Bøtker HE, Przyklenk K, et al. Remote ischemic conditioning[J]. J Am Coll Cardiol, 2015, 65(2):177-195.

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Effect of remote ischemic preconditioning on clinical prognosis of liver cancer patients undergoing hepatectomy: a Meta-analysis

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Effect of remote ischemic preconditioning on clinical prognosis of liver cancer patients undergoing hepatectomy: a Meta-analysis