糖皮质激素治疗重症急性胰腺炎效果的meta分析

Efficacy of glucocorticoids for treatment of severe acute pancreatitis:a meta analysis

目的评价糖皮质激素(glucocorticoids,GC)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的疗效。方法根据文献纳入标准,摘录纳入文献中相关实验设计、研究对象特征、研究结果等内容。用RevMan 5.1软件进行统计。结果有8篇文献被纳入分析,共计361例患者,其中GC治疗组184例,对照组177例。6项试验报道了SAP患者的死亡率,显示GC组的死亡率(14/145,9.655%)明显低于对照组(28/139,20.14%),其差异具有统计学意义[OR=0.42,95%CI(0.21~0.83),P=0.01];3项试验的结果显示GC组的急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)发生率(20/95,21.05%)较对照组(37/89,41.57%)明显降低,差异有统计学意义[OR=0.33,95%CI(0.16~0.65),P=0.001]。3项试验的结果显示GC治疗组中转手术率(12/87,13.79%)较对照组(26/81,32.09%)明显降低,差异有统计学意义[OR=0.29,95%CI(0.13~0.67),P=0.004]。4项试验的结果显示GC组平均住院时间低于对照组,差异具有统计学意义[标化均数差值-1.52,95%CI(-2.73^-0.32),P=0.01];结论 GC在降低SAP患者ARDS发生率和死亡率及缩短住院时间等方面明显优于常规治疗,GC可作为SAP的早期治疗的新选择,在临床上具有良好的应用前景。

Objective To evaluate the efficacy of glucocorticoids in treatment of patients with severe acute pancreatitis （SAP）. Methods According to the inclusion criteria, the experimental design, characteristics of the included objects, and the corresponding outcomes were extracted from relevant literatures. Meta-analysis was done to evaluate the results by RevMan 5.1 software. Results A total of eight articles with 184 cases in this treatment group and 177 participants in the control group were included in this meta-analysis. Data from six studies showed that the mortality rate of glucocorticoid group （14/145,9. 655~//oo ） was significantly lower than that of the control group （28/139,20.14 ~）, with the difference being statistically significant （OR =0.42,95% CI [0. 21-0. 831, P = 0.01）. Data from three studies showed that the frequency of acute respiratory distress syndrome （ARDS） of the glucocorticoid group （20/95,21.05%） was significantly lower than that of the control group （37/89, 41.57%0, OR=0.33,95% CI [0.16-0. 651 ,P=0. 001）. Data from three studies showed that the operation transferring rate in the glucocorticoid group （12/87, 13.79%） was significantly lower than that of control group （26/81,32.09%, OR= 0.29, 95 % CI [0.13-0. 671, P= 0. 004）. Compared with the control group, the glucocorticoid group also had significantly reduced the mean hospital stay in four experiments （standardized mean difference --1.52, 95% CI [-2. 73-0. 321, P=0.01）. Conclusion Glucocorticoid has advantages over conventional treatments in reducing the incidence of ARDS and mortality and shortening hospital stay in SAP patients, which provides a new and prospective therapeutic option for SAP.