生长抑素联合大黄对重症急性胰腺炎疗效的Meta分析

Meta-analysis:the clinical effect of combination therapy with Somatostatin and Rhubarb in severe acute pancreatitis

目的评价生长抑素联合大黄治疗重症急性胰腺炎(SAP)的疗效。方法计算机检索CA-JD、CNKI(1994～2012年)、WANFANG(1999～2012年)、VIP(1989～2012年)数据库中关于生长抑素联合大黄治疗SAP的临床随机对照试验(RCT),对符合标准的RCT进行Meta分析。结果共纳入11篇RCT,有598例患者符合纳入标准。Meta分析结果显示,生长抑素联合大黄组治疗SAP的腹痛缓解时间[总效应Z=8.31,WMD=-2.20,95%CI(-2.72,-1.68),P<0.00001],首次排便时间[总效应Z=7.05,WMD=-3.02,95%CI(-3.86,-2.18),P<0.00001],住院天数[总效应Z=6.45,WMD=-8.30,95%CI(-10.82,-5.78),P<0.00001],并发症[总效应Z=2.71,OR=0.52,95%CI(0.33,0.84),P=0.007],死亡率[总效应Z=2.07,OR=0.5,95%CI(0.26,0.96),P=0.04]均明显低于生长抑素组,差异具有统计学意义(P<0.05)。结论在常规综合治疗基础上,生长抑素联合大黄对SAP疗效确切,且明显优于单用生长抑素。

Objective To evaluate the effectiveness of combination therapy with somatostatin and rhubarb in severe acute pancreatitis(SAP).Methods A comprehensive search was performed in CAJD,CNKI(1994-2012),WANFANG(1999-2012)and VIP(1989-2012)databases to collect the randomized controlled trials(RCTs)which to combine with somatostatin and rhubarb in the treatment of SAP,and to analyze the RCTs in the meta-analysis way.Results 598 patients were analyzed in the 11 RCTs which met the research standards.The meta-analysis results suggested that,compared with the somatostatin group,patients had a significantly quicker abdominal pain relief [test for overall effect:Z=8.31,WMD=-2.20,95% CI(-2.72,-1.68),P<0.00001],earlier first defecation[test for overall effect:Z=7.05,WMD=-3.02,95% CI(-3.86,-2.18),P<0.00001],less hospital stay[test for overall effect:Z=6.45,WMD=-8.30,95% CI(-10.82,-5.78),P<0.00001],lower complication[test for overall effect:Z=2.71,OR=0.52,95% CI(0.33,0.84),P=0.007]and hospital death[test for overall effect:Z=2.07,OR=0.5,95% CI(0.26,0.96),P=0.04]in combination therapy group,the difference was significant(P<0.05).Conclusions On the basis of conventional therapy,the effectiveness of combination therapy with somatostatin and rhubarb is positive,and better than the simple somatostatin.