严格血糖控制对重症脑损伤患者转归的影响——临床荟萃分析

Effect of tight glycemia control on the clinical outcome in critically brain-injured patients: a Meta-analysis

目的评价严格血糖控制(tight glycemia control,TGC)对重症脑损伤患者临床转归的影响。方法应用计算机及手工检索,全面收集有关TGC在重症脑损伤患者中应用的随机对照试验。研究对象为成年患者,随机接受TGC或传统血糖控制(conventional glycemia control,CGC)方案治疗,转归指标包括病死率、远期神经功能转归、低血糖发生率等。结果共纳入16项研究,其中中文发表7项、英文9项。10项研究的改良Jadad评分≥4分,其中中文发表研究仅占1项。荟萃分析显示,与CGC相比,接受TGC患者的住院病死率和远期病死率差异无统计学意义,低血糖发生率明显增高。TGC组中存活患者的远期神经功能转归明显改善(比值比=1.37,95%可信区间:1.05～1.80)。结论 TGC可改善重症脑损伤患者远期神经功能转归,中文发表的随机对照试验的研究质量有待进一步提高。

Objective To evaluate the effect of tight glycemia control（TGC） on the clinical outcome in critically brain-injured patients. Methods All randomized controlled trials on the use of TGC in critically brain-injured patients were identified by computer and mannual retrieval. Studies were enrolled if adult patients were randomized to receive TGC or conventional glycemia control （CGC）. Extracted data included mortality, long-term neurological outcome and rate of hypoglycemia. Results Sixteen trials were enrolled in this meta-analysis, 9 were published in English and 7 in Chinese. Modified Jadad scores were mere than or equal to 4 in 10 trials, in which only 1 trial was published in Chinese. There were no significant differences in hospital mortality or late mortality between TGC and CGC groups. The rate of hypoglycemia was higher in TGC group. The combined rate of good long-term neurological outcome was significantly higher in survived patients receiving TGC （odd ratio = 1.37, 95% confidence interval： 1.05-1.80）. Conclusion TGC was beneficial at improving long-term neurological outcome in critically brain-injured patients. The quality of randomized controlled trials published in Chinese should be further improved.