乌司他丁治疗重症肺炎疗效的Meta分析

Clinical effectiveness of ulinastation for severe pneumonia : a meta-analysis

摘要:

目的 系统评价乌司他丁治疗重症肺炎的疗效。方法 采用Cochrane协作网提供的方法对乌司他丁治疗重症肺炎的随机对照试验进行系统评价。计算机检索Pubmed、Embase、The Cochrane Library、Clinicalkey、知网、中国生物医学文献数据库、万方及维普数据库收集乌司他丁治疗重症肺炎的随机对照试验，检索时间均为建库至2019年6月。由2位研究员独立筛选文献、提取数据及评估纳入文献的偏倚风险后，采用Cochrane协作网提供的RevMan 5.3.0软件进行Meta分析。结果 共纳入15篇文献，共计1 373例患者，Meta分析结果显示：联合使用乌司他丁组对比对照组而言，前者在患者WBC［MD=-2.37（95% CI：-2.95，-1.79）］、CRP［SMD=-2.01（95% CI：-2.86，-1.16）］、IL-8［SMD=-2.13（95% CI：-2.37，-1.89）］、TNF-α［SMD=-1.37（95% CI：-1.87，-0.86）］、氧合指数［SMD=1.78（95% CI：1.05，2.50）］、平均住院时间［MD=-7.21（95% CI：-9.21，-5.21）］及2个疗效标准的总体有效率［R=1.20（95% CI：1.12，1.28）和1.24（95% CI：1.13，1.37）］优于对照组。结论 乌司他丁能减轻重症肺炎患者体内炎症反应，改善氧合水平且减少平均住院时间，提高其治疗疗效。但由于所纳入文献质量受限，上述结论需未来更多高质量、多中心、大样本研究来加以验证。

Abstract:

Objective To systematically evaluate the efficacy of ulinastatin in the treatment of severe pneumonia.Methods A systematic review of ulinastatin in the treatment of severe pneumonia was performed systematically using a systematic review provided by the Cochrane Collaboration. The randomized controlled trials of ulinastatin treatment in patients with severe pneumonia were searched from the Cochrane Library, Pubmed, Embase, Clinicalkey, China National Knowledge Infrastructure database, Chinese Biological Medicine, VIP, and Wanfang database by computer. Data were collected from inception to June 2019. Meta-analysis was performed using RevMan 5.3.0 software provided by the Cochrane Collaboration, after two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included literature.Results A total of 15 studies involving 1373 participants were enrolled for Meta-analysis according to the inclusion and exclusion criteria. The results showed that compared with the group of routine therapies, the experimental group of ulinastatin was superior in the following aspects with significant differences: WBC [MD = -2.37 (95% CI: -2.95, -1.79)], CRP [SMD = -2.01 (95% CI: -2.86, -1.16)], IL-8 [SMD = -2.13 (95% CI: -2.37, -1.89)], TNF-α [SMD = -1.37 (95% CI: -1.87, -0.86)], oxygenation Index [SMD = 1.78 (95% CI: 1.05, 2.50)], the average length of hospital stay [MD = -7.21, (95% CI: -9.21, -5.21)], overall efficiency [R = 1.20, (95% CI: 1.12, 1.28) ] and [R = 1.24 (95% CI: 1.13, 1.37) ].Conclusions Ulinastatin can reduce the inflammatory response, improve the oxygenation level, reduce the average hospital stay, and improve the therapeutic effect of patients with severe pneumonia. However, due to the limited quality of the included literature, the above conclusions need to be verified by more high-quality, multi-center, large-scale studies in the future.