DataSheet1_Effects of perioperative steroid use on surgical stress and prognosis in patients undergoing hepatectomy: a systematic review and meta-analysis of randomized controlled trials.docx

The objective of this study was to evaluate the clinical effects of perioperative steroid hormone usage in hepatectomy patients through a comprehensive systematic review and meta-analysis. Prospective randomized controlled trials (RCTs) investigating the perioperative use of steroid hormones in hepatectomy patients were systematically searched using various databases, including PubMed, Medline, Embase, the Cochrane Library, the Chinese Biomedical Literature Database, Wanfang Data, and the CNKI database. Two researchers independently screened and extracted data from selected studies. Data analysis was performed using RevMan 5.3 software. The results revealed significantly lower levels of total bilirubin (standard mean difference [SMD] = −0.7; 95% CI: −1.23 to −0.18; and p = 0.009), interleukin-6 (SMD = −1.02; 95% CI: −1.27 to −0.77; and p < 0.001), and C-reactive protein (SMD = −0 .65; 95% CI: −1 .18 to −0.11; and p = 0.02) on postoperative day 1 (POD 1), as well as a reduced incidence of postoperative complications in the steroid group compared to the placebo group. No significant differences were observed between the two groups regarding alanine aminotransferase (ALT) levels, aspartic aminotransferase (AST) levels, or specific complications such as intra-abdominal infection (p = 0.72), wound infection (p = 0.1), pleural effusion (p = 0.43), bile leakage (p = 0.66), and liver failure (p = 0.16). The meta-analysis results indicate that perioperative steroid usage can effectively alleviate liver function impairment and inflammation response following hepatectomy while improving patient prognosis.

本研究旨在通过全面的系统评价与荟萃分析，评估肝切除术患者围术期应用甾体激素的临床疗效。研究系统检索了PubMed、Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、万方数据及中国知网（China National Knowledge Infrastructure, CNKI）等多个数据库，筛选针对肝切除术患者围术期使用甾体激素的前瞻性随机对照试验（randomized controlled trial, RCT）。由两名研究者独立筛选文献并提取相关数据，采用RevMan 5.3软件完成数据分析。结果显示，术后第1天（postoperative day, POD 1），甾体激素组患者的总胆红素（标准均数差（standard mean difference, SMD）= -0.7；95%置信区间（confidence interval, CI）：-1.23 ~ -0.18；p = 0.009）、白细胞介素-6（SMD = -1.02；95%CI：-1.27 ~ -0.77；p < 0.001）及C反应蛋白（SMD = -0.65；95%CI：-1.18 ~ -0.11；p = 0.02）水平均显著低于安慰剂组，且术后并发症发生率更低。两组患者的丙氨酸氨基转移酶（alanine aminotransferase, ALT）、天冬氨酸氨基转移酶（aspartic aminotransferase, AST）水平，以及腹腔感染、切口感染、胸腔积液、胆漏、肝衰竭等特定并发症的发生率均无显著差异，对应p值分别为0.72、0.1、0.43、0.66、0.16。本荟萃分析结果表明，围术期应用甾体激素可有效缓解肝切除术后患者的肝功能损伤与炎症反应，改善患者预后。