乌司他丁治疗急性重症胰腺炎的meta分析

Effectiveness of Ulinastatin in treatment of severe acute pancreatitis;a meta-analysis

目的系统评价乌司他丁治疗急性重症胰腺炎的疗效。方法检索Medline数据库、CNKI数据库,维普数据库和万方数据库,查询有关应用乌司他丁治疗急性重症胰腺炎的随机对照临床试验文献,检索时限为2001年至2011年。由2名评价者独立选择试验、提取资料和评估方法学质量后,采用RevMan 5.1版软件进行meta分析。结果按照筛选标准,共有23篇随机对照临床试验文献1 131例急性重症胰腺炎患者纳入分析。其meta分析结果显示,乌司他丁组的资料总有效率明显高于对照组(RR=1.15,95%CI:1.07～1.24,P=0.000 2);乌司他丁组的急性重症胰腺炎相关病死率低于对照组(RR=0.51,95%CI:0.27～0.97,P=0.04);乌司他丁组治疗10 d后阳性症状及体征的病例数少于对照组(RR=0.50,95%CI:0.28～0.88,P=0.02;RR=0.54,95%CI:0.33～0.87,P=0.01)。而在腹痛消失时间、治疗5 d后阳性症状及体征的病例数、血淀粉酶恢复等指标方面,乌司他丁组和对照组无明显差异(P>0.05)。结论乌司他丁治疗急性重症胰腺炎的疗效优于常规治疗,其效果主要体现在病程中晚期。

Objective To evaluate the effectiveness of Ulinastatin in treatment of severe acute pancreatitis. Methods The databases such as Medline, CNKI, VIP and WanFang Data were searched for collecting randomized controlled clinical trials on Ulinastatin in treatment of severe acute pancreatitis from January 2001 to December 2011. Studies were screened, data were extracted and the quality of methodology was assessed by two reviewers independently. RevMan 5.1 software was used to complete meta-analyses. Results Twenty three trials involving 1 131 patients were included. Meta-analysis showed that the clinical effective rate in Ulinastatin group was higher than that in control group （RR = 1.15,95% CI： 1.07 -1.24,P =0. 000 2）. The fatality rate related to severe acute pancreatitis in Ulinastatin group was lower than that in control group （ RR = 0.51,95 % CI： 0.27 - 0.97, P = 0.04）. The cases in Ulinastatin group with positive symptoms and signs after ten-day-treatment was less than that in control group （ RR = 0.50,95% CI： 0.28 - 0.88 ,P = 0.02 ; RR = 0.54,95% CI ： 0.33 - 0.87, P = 0.01 ）. No statistic significant difference was found between the two groups in aspects of the remission time of abdominal pain, the cases with positive symptoms and signs after five-day treatment and the time for serum amylase returning normal （P 〉0.05 ）. Conclusion Ulinastatin for severe acute pancreatitis is superior to routine therapies and the effects mainly take place in middle and late course of disease treatment.