从肠论治脓毒症所致ALI/ARDS有效性的Meta分析

The effectiveness of treatment based on intestine on acute lung injury/acute respiratory distress syndrome causedbysepsis:a Metaanalysis

目的系统评价在中医“肺与大肠相表里”理论下指导下,从肠论治脓毒症所致急性肺损伤/急性呼吸迫综合征(ALI/ARDS)的临床疗效,为临床提供循证参考。方法通过计算机检索中国知网(CNKI)、万方数据库、维普中文期刊数据库、中国生物医学文献数据库(CBMdisc)荷兰医学文摘Embase数据库、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库中,从建库至2020年10月8日发表的将通腑法作为干预措施治疗脓毒症所致ALI/ARDS的随机对照试验(RCT)。对照组采用常规西医治疗,试验组在常规西医治疗基础上联合通腑法治疗。由2名研究者筛选文献并对符合纳入标准的文献进行数据提取,运用改良Jadad量表进行质量评价,采用RevMan5.4和Stata16.0软件对数据进行Meta分析。结果最终纳入13篇文献,均为单中心RCT,其中≥4分的文献7篇,<4分的文献6篇。共纳入579例患者,其中试验组290例,对照组289例。Meta分析显示,与对照组比较,联合通腑法治疗能明显提高脓毒症所致ALI/ARDS患者氧合指数[PaO_(2)/FiO_(2),均数差(MD)=62.55,95%可信区间(95%CI)为55.74~69.37,P<0.05],降低白细胞介素-6(IL-6,MD=-29.70,95%CI为-48.34~-11.06,P<0.05)、肿瘤坏死因子-α(TNF-α,MD=-2.94,95%CI为-5.28~-0.59,P<0.05)降钙素原(PCT,MD=-1.34,95%CI为-2.17~-0.51,P<0.05)和C-反应蛋白(CRP,MD=-22.41,95%CI为-36.52~-8.29,P<0.05)水平,缩短机械通气时间(MD=-2.26,95%CI为-2.86~-1.66,P<0.05)和重症监护病房(ICU)住院时间(MD=-4.15,95%CI为-7.47~-0.84,P<0.05),降低28d病死率[相对危险度(RR)=0.43,95%CI为0.24~0.76,P<0.05]和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ,MD=-3.53,95%CI为-5.41~-1.64,P<0.05)。结论从肠论治对减轻脓毒症所致ALI/ARDS患者病情及改善预后有一定价值,但仍需进一步开展高质量的RCT以验证其疗效,为临床治疗提供更准确的循证医学证据。

PubMed database,Cochrane library database was performed to identify randomized controlled trial(RCT)that used the Tongfu method as an intervention for the treatment of ALI/ARDS induced by sepsis,published from the database establishment until October 8,2020.The control group was treated with conventional westerm medicine,and the test group was treated with the combination of Tongfu method and conventional western medicine.Screening of the literature and data extraction for those that met the inclusion criteria were performed by 2 investigators.The modified Jadad scale was used for quality assessment,and RevMan 5.4 and Stata 16.0 software were used for Meta analysis of the data.Results Thirteen articles were finally included,all of which were single center RCT studies,including 7 articles with≥4 points and 6 articles with<4 points.A total of 579 patients were included,290 in the test group and 289 in the control group.Meta-analysis showed that combined Tongfu treatment significantly increased the ALI/ARDS patient caused by sepsis oxygenation index[PaO_(2)/FiO_(2);mean difference(MD)=62.55,95%confidence interval(95%CI)was 55.74 to 69.37,P<0.05],reduced the levels of interleukin-6(IL-6;MD=-29.70,95%CI was-48.34 to-11.06,P<0.05),tumor necrosis factor-α(TNF-α;MD=-2.94,95%CI was-5.28 to-0.59,P<0.05),procalcitonin(PCT;MD=-1.34,95%CI=-2.17 to-0.51,P<0.05)and C-reactive protein(CRP;MD=-22.41,95%CI was-36.52 to-8.29,P<0.05),reduced mechanical ventilation time(MD=-2.26,95%CI was-2.86 to-1.66,P<0.05)and hospitalization time in intensive care unit(ICU;MD=-4.15,95%CI was-7.47 to-0.84,P<0.05),reduced the 28-day mortality[relative risk(RR)=0.43,95%CI was 0.24 to 0.76,P<0.05]and acute physiology and chronic health status score Ⅱ(APACHE Ⅱ;MD=-3.53,95%CI was-5.41 to-1.64,P<0.05).Conclusion Treatment based on intestine is valuable for reducing the condition and improving the prognosis of ALI/ARDS patients caused by sepsis,but further high-quality RCT studies are still needed to verify its efficacy and provide more accurate evidence-based evidence for clinical treatment.