乌司他丁治疗重症急性胰腺炎的Meta分析

The effect of ulinastatin on treatment of severe acute pancreatitis ： a Meta-analysis

目的评价乌司他丁治疗重症急性胰腺炎的有效性和安全性。方法应用国际Cochrane协作网系统评价方法对乌司他丁治疗重症急性胰腺炎的随机对照试验（RCT）进行系统评价。计算机检索Cochrane Library、PUBMED、EMBASE、中国生物医学文献数据库、万方全文数据库各数据库建库以来的文献。检索词为急性胰腺炎（acute pancreatitis，AP）和乌司他丁（Ulinastatin，UTI）。统计学处理采用Review Manager5-3软件。结果共纳入33个RCT研究，共计1786例患者，所有纳入试验患者在治疗末均未进行随访。在乌司他丁加常规治疗与常规治疗或安慰剂加常规治疗比较的试验中，有5个试验报道了病死率，Meta分析结果显示，乌司他丁组的病死率低于对照组（RR=0．29，95％C／：0．17～0．52，P〈0．01）；16个试验在治疗结束后采用了治疗总有效率作为疗效判定指标，Meta分析结果显示：乌司他丁组的治疗总有效率明显高于对照组。在乌司他丁加常规治疗与奥曲肽加常规治疗比较的试验中，9个试验在治疗结束后采用了治疗总有效率作为疗效判定指标，Meta分析结果显示：乌司他丁组的治疗总有效率较奥曲肽对照组无明显统计差异。结论乌司他丁在改善重症急性胰腺炎近期临床疗效指标方面优于常规治疗，且病死率低于常规治疗对照组；但相较奥曲肽未见明显优势。

Objective To evaluate the efficacy and the safety of Ulinastatin in treatment of severe acute pancreatitis. Methods A systematic review of randomized controlled trials （RCT） of Ulinastatin treatmen for severe acute pancreatitis was performed. The databases included Cochrane library controlled clinical trials database, PUBMED, EMBASE, China Biology Medicine disc, Wanfang Data were searched to date. Retrieval words were acute pancreatitis and Ulinastatin. Statistical processing using Review Manager 5.3 software provided by the Cochrane collaboration network. Results A total of 33 trials involving 1 786 patients were included, and all patients of the trials were not followed up at the end of the treatment. In the trials of Ulinastatin plus routine treatment vs routine treatment or placebo plus routine treatment,and 5 trials reported the fatality rate. Meta-analysis showed that the mortality rate in Ulinastatin group was lower than that in control group（RR = 0.29, 95%CI ： 0.17-0.52, P 〈 0.01）, and 16 trials used the total efficiency of treatment as outcome criteria. Meta-analysis results showed the total effective rate in the Ulinastatin group was significantly higher than that in control grouIn the trials of Ulinastatin plus routine treatment vs octreotide plus routine treatment, 9 trials used the total efficiency of treatment as outcome criteria. Meta-analysis results showed there was no statistically significant difference in total effective rate between Ulinastatin group and octreotide group. Conclusions Ulinastatin treatment was superior to conventional therapy in improving the short-term clinical efficacy of severe acute pancreatitis,and the mortality rate was lower than that in conventional treatment. But no obvious advantage was fotmd in ulinastatin treatment compared with octreotide treatment.