静脉注射免疫球蛋白治疗成人重症感染疗效评价的Meta分析

Effect of intravenous immunoglobulin on severe sepsis or septic shock in adult patients:a meta-analysis

目的从循证医学的角度综合分析静脉注射免疫球蛋白(intravenous immunoglobulin,IVIg)对重症脓毒血症或感染性休克患者疗效的系统评估。方法检索美国国立医学图书馆PubMed、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库,并辅助手工检索,检索时间段为1990—2014年。对纳入文献进行方法学质量评价,采用Meta分析专用软件RevMan 5.0进行统计分析。对有相同统计内容且可用IVIg治疗成人重症脓毒血症或感染性休克疗效合并比值比并计算95%可信区间。结果检索出IVIg对成人重症脓毒血症或感染性休克患者疗效的文献981篇,最终符合纳入标准的文献7篇。IVIg可降低成人重症感染患者的病死率,差异有统计学意义[比值比0.44,95%可信区间(0.30~0.64),Z=4.28、P<0.000 1]。结论对于重症脓毒血症或感染性休克的成人患者,IVIg可作为保护性因素降低患者的病死率。

Objective To assess the effect of intravenous immunoglobulin(IVIg)on severe sepsis or septic shock in adult patients by meta-analysis among domestic and published pertinent articles scientifically.Methods Such databases as PubMed,Cochrane Library,Chinese BioMedical Literature Database,Chinese Periodical Full-text Database,Full Text Database of Chinese Sci-Tech Periodical and Wanfangdata Databases were screened up from 1990 to 2014 for literatures including randomized controlled trials about the correlation between IVIg and severe sepsis or septic shock in adult patients.According to the inclusion and exclusion criteria,the data were extracted and the methodological quality was evaluated.The meta-analysis was conducted by RevMan 5.0 software,and the sensitivity analysis and publication bias were evaluated at the same time.Results A total of seven randomized controlled trials were included,and the results which combined odd ratio(OR)values and 95%confidence interval(CI)were that IVIg could decrease the mortality of severe sepsis and septic shock[OR=0.44,95%CI(0.30-0.64),Z=4.28,P<0.000 1].Conclusion IVIg could decrease the overall mortality of severe sepsis and septic shock in adult patients.