This is not the most recent version of the article. View current version (10 FEB 2014)

Intervention Review

Dopaminergic agonists for hepatic encephalopathy

  1. Bodil Als-Nielsen1,*,
  2. Lise Lotte Gluud2,
  3. Christian Gluud2

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 18 OCT 2004

Assessed as up-to-date: 23 AUG 2004

DOI: 10.1002/14651858.CD003047.pub2


How to Cite

Als-Nielsen B, Gluud LL, Gluud C. Dopaminergic agonists for hepatic encephalopathy. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003047. DOI: 10.1002/14651858.CD003047.pub2.

Author Information

  1. 1

    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Cochrane Hepato-Biliary Group, Copenhagen, Denmark

  2. 2

    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University Hospital, Cochrane Hepato-Biliary Group, Copenhagen, Denmark

*Bodil Als-Nielsen, Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Dept. 3344, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. bodil.als@dadlnet.dk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2004

SEARCH

This is not the most recent version of the article. View current version (10 FEB 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Hepatic encephalopathy may be associated with an impairment of the dopaminergic neurotransmission. Dopaminergic agonists may therefore have a beneficial effect on patients with hepatic encephalopathy.

Objectives

To evaluate the beneficial and harmful effects of dopaminergic agonists for patients with hepatic encephalopathy.

Search methods

Trials were identified through The Cochrane Hepato-Biliary Group Controlled Trials Register (July 2004), The Cochrane Central Register of Controlled Trials (Issue 3, 2004), MEDLINE (1966-2004/07), EMBASE (1980-2004/07), manual searches of bibliographies and journals, authors of trials, and pharmaceutical companies.

Selection criteria

All randomised trials comparing dopaminergic agonists versus placebo or no intervention for hepatic encephalopathy.

Data collection and analysis

Trial inclusion and data extraction were made independently by two reviewers. Binary outcomes are reported as odds ratios (OR) with 95% confidence intervals (CI) based on a random effects model. The presence of statistical heterogeneity was explored by the chi-squared test with significance set at P < 0.1. Potential sources of heterogeneity were explored through subgroup analyses with regard to the type of hepatic encephalopathy and type of dopaminergic agonist.

Main results

Five trials were included. Four trials had low methodological quality. Compared with placebo or no treatment, dopaminergic agonists had no significant effect on the risk of no improvement (OR 0.33, 95% CI 0.01 to 11.25, two trials, 80 patients) or mortality (OR 1.11, 95% CI 0.34 to 3.54, four trials, 139 patients). There was significant heterogeneity (P = 0.09) among trial results on the risk of no improvement, but not on mortality (P = 0.19). The treatment response was not significantly different with regard to the type of hepatic encephalopathy or dopaminergic agonist, but the analyses had very low power to detect potential differences. There was a nonsignificant trend that dopaminergic agonists may be associated with adverse events (OR 8.33, 95% CI 0.37 to 187.74, 2 trials, 13 patients). All adverse events (n = 7) occurred in the experimental group.

Authors' conclusions

This review does not provide evidence that dopaminergic agonists are of benefit to patients with acute or chronic hepatic encephalopathy, or fulminant hepatic failure. The review is limited by the small number of trials performed within this field, the low number of patients randomised in each trial, and the low methodological quality of included trials. Accordingly, there is also insufficient evidence to exclude a potential beneficial effect. Dopaminergic agonists should not be used for hepatic encephalopathy, but may be assessed in future randomised clinical trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

No evidence to support or refute that dopaminergic agonists have an effect on hepatic encephalopathy

Hepatic encephalopathy occurs in patients with chronic liver disease or fulminant liver failure. Hepatic encephalopathy is associated with changes in mental state, ranging from minor signs of altered brain function to deep coma. Treatment with dopaminergic agonists has been proposed to ameliorate the symptoms. This review does not provide any evidence that dopaminergic agonists have an effect on patients with hepatic encephalopathy. Dopaminergic agonists should not be used for hepatic encephalopathy in clinical practice, but may be assessed in future randomised clinical trials.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用多巴胺受體(Dopaminergic agonists)治療肝性腦病變

肝性腦病變可能和多巴胺的神經傳遞受損有關。因此,多巴胺受體(Dopaminergic agonists)可能有利於肝性腦病的病人。

目標

評估多巴胺受體(Dopaminergic agonists)對肝性腦病變的病人的利弊。

搜尋策略

透過搜尋The Cochrane HepatoBiliary Group Controlled Trials Register (2004年7月), The Cochrane Central Register of Controlled Trials (2004年第3期), MEDLINE (1966年−2004年7月), EMBASE (1980年−2004年7月), 手動搜索目錄和期刊,聯繫試驗作者和製藥公司

選擇標準

所有比較多巴胺受體(Dopaminergic agonists),安慰劑或無干預法用於肝性腦病變的隨機試驗。

資料收集與分析

兩位評論作家單獨提取收錄試驗並提取資料。根據隨機效果模式, 二分法結果記錄成相對風險度比數比 (OR) ,95% 信賴區間(CI) 。 透過卡方檢驗研究統計學意義上的一致性,顯著水平設定為P < 0.1。透過肝性腦病變類型和多巴胺受體(Dopaminergic agonists)類型的亞組分析,我們研究異質性的潛在來源。

主要結論

我們收納包括5個試驗。其中四個試驗的方法學品質不高。 比較安慰劑或無干預法, 多巴胺受體(Dopaminergic agonists)對於沒有改善(OR 0.33, 95% CI 0.01 11.25, 2個試驗, 80位病人)或死亡率(OR 1.11, 95% CI 0.34 3.54,4次試驗, 139 位病人)方面的風險,沒有顯著作用。 試驗結果中,在沒有改善的風險方面,沒有顯著異質性 (P = 0.09),但是死亡率方面,存在顯著異質性 (P = 0.19)。在肝性腦病變或多巴胺受體(Dopaminergic agonists)的類型方面,結果反應沒有顯著差異,但是這些分析不足以研究出潛在差異。多巴胺受體(Dopaminergic agonists)和不良事件相關的趨勢不明顯(OR 8.33, 95% CI 0.37 187.74, 2個試驗, 13 位病人)。 所有不良事件 (n = 7) 發生在實驗組。

作者結論

本次文獻回顧沒有提出證據,指明多巴胺受體(Dopaminergic agonists)對於急、慢性肝性腦病變,或猛爆性肝衰竭病人是否有利。 受限於該領域內的試驗較少,試驗隨機挑選的病人人數少,方法學品質不高,導致本次文獻回顧沒有得出結論性的結果。 相對的亦缺乏證據來排除潛在其有利療效。多巴胺受體(Dopaminergic agonists)不應用於肝性腦病變,但是這一點需要在未來的隨機臨床試驗做出評估。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據支持或反對多巴胺受體(Dopaminergic agonists)對患有慢性肝病或爆發性肝臟衰竭病人出現肝性腦病變的療效。 肝性腦病變和心理狀態的變化相關,從大腦功能改變的微弱跡象發展成為深度昏迷。多巴胺受體(Dopaminergic agonists)曾被建議使用來改善此類症狀。 本次文獻回顧沒有提出證據,指明多巴胺受體(Dopaminergic agonists)對於肝性腦病變的病人之療效。多巴胺受體(Dopaminergic agonists)不應該在臨床實踐中用於治療肝性腦病變,但是這一點需要在未來的隨機臨床試驗中作出評估。