摘要
目的系统评价乌司他丁（UTI）联合生长抑素治疗重症急性胰腺炎（sAP）的疗效和安全性。方法计算机检索美国《医学索引》（MEDLINE）、生物医学与药理学文摘数据库（EMbase）、Cochrane临床试验数据库、中国生物医学文献数据库（CBM）、维普（VIP）、中国期刊网全文数据库（CNKI），查找建库至2011年8月UTI联合生长抑素治疗SAP的随机对照临床试验（RCT）和半随机对照临床试验（q-RCT），文献由两位研究者按照事先制定的纳入和排除标准筛选文献，提取资料，进行方法学质量评价后，采用RevMan5．0软件进行荟萃分析（Meta分析）。结果纳人12篇RCT和5篇q—RCT，共计1169例，其中治疗组589例，对照组580例。Meta分析结果显示：UTI联合生长抑素治疗SAP较单用生长抑素治疗能提高治愈率[评价标准A：相对危险度（RR）=1．41，95％可信区间（95％CI）为（1．17，1．69），P=0．0003；评价标准B：月月=1．17，95％口（1．02，1．34），P=0．03]；降低病死率[月矗=0．45，95％CI（0．29，0．71），P=0．0006]；此外，缩短腹痛、腹胀时间[RR=-0．92，95％CI（-1．13，-0．71），P〈0．00001]、降低中转手术率[RR=O．47，95％CI（O．28，0．80），P=0．006]，但对并发症发生率无明显影响[RR=0．70，95％CI（0．45，1．08），P=0．11]。结论本系统评价结果提示，UTI联合生长抑素治疗SAP较单用生长抑素治疗疗效显著。但由于本系统评价纳入研究的质量较低，存在偏倚的高度可能性，影响了结果的论证强度，应谨慎对待上述结论，并期待更多高质量的随机双盲对照试验以提供更高质量的证据。
Objective To assess the therapeutic effectiveness and safety of ulinastatin （UTI） combined with somatostatin for treatment of severe acute panereatitis （SAP）. Methods Such databases as MEDLINE, EMbase, Cochrane library, China Biology Medicine （CBM）, VIP, and China National Knowledge Infrastructure （CNKI）were searched from their establishment date to August of 2011 to retrieve the randomized controlled trails （RCTs） and quasi- randomized controlled trails （q-RCTs） about UTI combined with somatostatin for treatment of SAP. Then the retrieved studies were screened according to the pre-defined inclusion and exclusion criteria made by two researchers, the data were extracted, the quality of the included studies was evaluated, and Meta-analyses were performed by using the Coehrane Collaboration＇s RevMan 5.0 software. Results Twelve RCTs and 5 q-RCTs involving 1169 cases were included, among which 589 cases were in the treatment group and the other 580 cases were in control group. The results of Meta-analyses indicated that, compared with control group treated by somatostatin only, the cure rate in the SAP group treated by UTI combined with somatostatin was significantly higher [evaluation criterion A ： relative risk （RR） =1.41,95% confidence interval （95%CI） 1.17 to 1.69, P=0.0003; evaluation criterion B： RR=1. 17, 95%CI 1.02 to 1.34, P=0.033, mortality rate was significantly lower （RR=0.45,95%CI 0.29 to 0.71, P=0.0006）, the relieve time of abdominal pain and distension was markedly shorter （RR=-0.92,95%CI -1.13 to -0.71, P〈0.000 01 ） and the rate of conversion to operation was remarkably lower （RR=0.47, 95%CI 0.28 to 0.80, P=0.006）, but there was no significant difference in the incidence of complications （RR=0.70,95%CI 0.45 to 1.08, P=0.11 ）. Conclusions This systematic review shows that UTI combined with somatostatin is more effective in treating SAP than the therapy with somatostatin only. However, this conclusion should be treated cautiously for the poor quality and higher possibility of bias in the included studies which may impact on the power of proof, so more double-blind RCTs with high quality are expected to provide high quality evidence.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2012年第2期73-78,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
基金项目：上海市公共卫生重点学科建设项目（08GWZX11103）
关键词
乌司他丁
生长抑素
胰腺炎
急性
重症
系统评价
Ulinastatin
Somatostatin
Severe acute pancreatitis
Systematic review
