降钙素原指导脓毒症患者抗生素应用的Meta分析

Use of Procalcitonin to Guide Using of Antibiotics in Patients with Sepsis:A Meta-analysis

目的系统评价降钙素原(PCT)指导脓毒症患者抗生素应用是否优于常规经验性抗感染治疗。方法计算机检索Pub Med、The Cochrane Library(2016年9期)、EMbase、Web of Science、CBM、Wan Fang Data、VIP和CNKI数据库,搜集有关PCT指导脓毒症患者抗生素应用的随机对照试验(RCT),检索时限均从建库至2016年9月。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入15个RCT,共3 328例脓毒症患者,其中PCT组1 649例,对照组1 679例。Meta分析结果显示:PCT组的抗生素使用时间[MD=–2.37,95%CI(–2.96,–1.78),P<0.000 01]、ICU住院时间[MD=–0.26,95%CI(–0.46,–0.07),P=0.007]和总住院时间[MD=–2.78,95%CI(–4.53,–1.04),P=0.002]均明显短于对照组,且差异均有统计学意义;PCT组28天死亡率明显低于对照组,其差异有统计学意义[RR=0.78,95%CI(0.66,0.93),P=0.005];而PCT组ICU死亡率、院内死亡率及临床治愈率与对照组差异无统计学意义。结论 PCT指导抗生素的使用优于经验性抗感染治疗,不仅可以缩短抗生素的使用时间、ICU住院时间及总住院时间,还能降低脓毒症患者28天死亡率。但在降低脓毒症患者ICU死亡率、院内死亡率及临床治愈率上并未显示出明显优势。受纳入研究的数量和质量限制,上述结论仍有待于更多高质量RCT加以验证。

Objective To systematically review the efficacy of antibiotic treatment in sepsis patients under the guidance of procalcitonin. Methods Databases including PubMed, The Cochrane Library （Issue 9, 2016）, EMbase, Web of Science, CBM, WanFang Data, VIP and CNKI were electronically searched from inception to September 2016 to collect randomized controlled trials （RCTs） about antibiotic treatment in sepsis under the guidance of procalcitonin. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by RevMan 5.3 software. Results A total of 15 RCTs involving 3 328 sepsis patients were included. Among them, 1 649 were in the procalcitionin group and 1 679 patients in the control group. The results of meta-analysis showed that： the PCT group could significantly reduce the using time of antibiotics （MD= -2.37, 95%CI -2.96 to -1.78, P〈0.000 01）, the ICU length of stay （MD= -0.26, 95%CI -0.46 to -0.07, P=0.007）, the hospital length of stay （MD= -2.78, 95%CI -4.53 to -1.04, P=0.002）, as well as the 28-day mortality （MD=0.78, 95%CI 0.66 to 0.93, P=0.005）. There were no significant differences between the two groups in ICU mortality, in-hospital mortality and clinical cure rate. Conclusion Using the procalcitontin to guide the antibiotic treatment in sepsis can reduce the patients＇ use of antibiotics, ICU length of stay, in-hospital length of stay and 28-day mortality, but can not reduce the patients＇ ICU mortality, in-hospital mortality and clinical cure rate. Due to the limited quality and quantity of included studies, the current conclusions are needed more studies to validate.