乌司他丁对感染性休克患者肾功能影响的Meta分析

Effects of ulinastatin on renal function in patients with septic shock: a metaanalysis

目的系统评价乌司他丁对感染性休克患者肾功能的影响。方法计算机检索数据库Cochrane图书馆、PubMed、EMbase、中国生物医学文献数据库、中国知网、万方和维普数据库，收集乌司他丁治疗感染性休克的随机对照试验，检索时间由建库至2015年。两名研究者对检索收集到的文献按照制定的纳入、排除标准进行独立筛选，采用Cochrane的偏倚风险评估标准评价文献质量。采用患者治疗后尿量、尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和γ-谷氨酰转移酶（γ-GTP）、血肌酐和尿素氮、连续性肾脏替代治疗比例作为评价结局的指标。采用RevMan5．3进行Meta分析。结果最终纳入符合标准的随机对照试验8项，总共410例患者。Meta分析结果显示：治疗第1、2、3日，乌司他丁组尿量高于对照组；治疗第1、3、5日，乌司他丁组尿NAG和γ-GTP水平低于对照组；治疗第1、2、3、5日，乌司他丁组血肌酐和尿素氮水平低于对照组，差异均有显著意义（P〈0．05）。乌司他丁组连续性肾脏替代治疗比例低于对照组（RR=0．50，95％CI：0．28-0．91，P=0．02）。结论乌司他丁对感染性休克患者的肾功能有改善作用。

AIM To assessment the influences of ulinastatin on renal function in patients with septic shock. METHODS The randomized controlled trials of ulinastatin treatment in patients with septic shock were searched from Coehrane library, PubMed, EMbase, Chinese Biological Medicine, China National Knowledge Infrastructure database, VIP and Wanfang database by computer. Data were collected from inception to 2015. Two researchers screened the literatures independently according to inclusion and exclusion criteria. The Cochrane＇ s bias risk assessment criteria were used to evaluate the quality of literature. The evaluating indicatorsincluded urine volume, urinary N- acetyl - beta - D - amino glycosidase enzymes （NAG） and gamma - glutamyl transferase （γ-GTP）, serum creatinine （Scr）, blood urea nitrogen （BUN） and the proportion of continuous renal replacement therapy （CRRT）. The Review Manager 5.3 software was used for Meta-analysis. RESULTS Eight randomized controlled trials involving 410 patients were included. The results of meta-analysis showed that the urine volume in the ulinastatin group was higher than that in the control group at the 1, 2, 3 day of treatment （P 〈 0.05）. Meanwhile, the urinary NAG and γ-GTP in the ulinastatin group were lower than those in the control group at 1, 3, 5 day of the treatment （P 〈 0.05）. And the Scr and BUN in the ulinastatin group were lower than those in the control group at 1, 2, 3, 5 day of the treatment （P 〈 0.05）. The proportion of CRRT in the ulinastatin group was significantly lower than that in the control group （RR = 0.50, 95%CI： 0.28- 0.91, P = 0.02）. CONCLUSION The ulinastatin could improve the renal function of patients with septic shock in partly.