免疫抑制剂治疗百草枯中毒的Meta分析

Immunosuppressive therapy for paraquat poisoning:a Meta-analysis

目的探讨免疫抑制剂对百草枯的治疗效果。方法检索国内外1970年1月～2008年6月公开发表的免疫抑制剂治疗百草枯中毒的相关论文,包括观察性研究和随机对照试验(RCT),提取观察性研究的生存率及可信区间,对照研究的风险比(RR)为效应量进行异质性检验和统计量合计分析。结果共计8项研究入选,6项历史对照性研究,2项随机对照研究。免疫抑制剂对百草枯中毒的预后有显著改善[历史对照的观察性研究RR为0.56(95%CI=0.45～0.69)和RCT研究RR为0.76(95%CI=0.62～0.94)]。结论免疫抑制剂治疗对百草枯中毒的生存率改善明显。但目前文献存在明显异质性,证据尚不够充分,需要进行更多的RCT试验以进一步明确。

Objective To evaluate the effect of immunosuppressive therapy for paraquat poisoning. Methods The MEDLINE, OVID, and CINAHL databases etc were searched for relevant studies published from Jan 1970 to Jun 2008. Studies were included if the study design was either a randomized controlled trial or a observational study with historical controls; the study populations were patients with paraquat poisoning, who received immunosuppressive therapy; and the study provided data on mortality. RR （relative risk） and 95% CI were calculated for dichotomous outcomes. Results Six non-randomized comparative studies and two randomized controlled trials were enrolled. The relative risk of immuno- suppressive therapy in improving mortality of paraquat poisoning were 0.56 （95% CI = 0.45 - 0.69） and 0.76 （95% CI = 0.62 ~ 0.94） for non-randomised studies and randomized controlled studies, respectively. Significant heterogeneity and publication bias were noticed. Conclusion This analysis suggests that immunosuppressive therapy reduce mortality in paraquat poisoning compared with standard medical therapy. However, due to significant heterogeneity and publication ：bias, a large randomized controlled trial is required to affirm the role of immunosuppression in paraquat poisoning.