自我管理干预在炎症性肠病患者中应用效果的系统评价

Systematic evaluation of self-management intervention in patients with inflammatory bowel disease

目的评价自我管理在炎症性肠病患者中的应用效果。方法计算机检索中收集Cochrance Library、PubMed、Embase、Science Direct、MEDLINE、中国知网、维普、万方、中国生物医学文献等数据库关于炎症性肠病患者自我管理的随机对照试验,并辅以人工检索、Google学术检索。由2名研究者严格按照纳入和排除标准筛选文献,提取资料、评价质量,然后采用Revman 5.3进行Meta分析或描述性分析。结果共纳入7项随机对照试验,2 401例患者,Meta分析结果显示,自我管理有助于提高炎症性肠病患者的生活质量[MD=4.86,P=0.02];个性化的疾病自我管理指导有助于降低复发率,尚不能证明系统化的疾病自我管理指导能改善复发率;自我管理有助于降低炎症性肠病患者门诊率[MD=-1.12,P<0.001],且个性化疾病自我管理指导的效果优于系统化疾病自我管理指导。描述性分析结果显示:炎症性肠病患者对疾病自我管理的需求性高,自我管理能有效减少炎症性肠病患者的经济花费,提高患者自我效能感,但在改善患者焦虑抑郁方面仍需高质量研究的进一步验证。结论炎症性肠病患者自我管理具有提高患者的生活质量、降低门诊量、减少经济花费等优点,且个性化自我管理指导在降低疾病复发率方面有积极作用,建议临床选择性的应用。

Objective To evaluate the effect of self-management in patients with inflammatory bowel disease(IBD).Methods The randomized controlled trials(RCTs)on self-management in IBD patients were collected from the Cochrane library,PubMed,Embase,Science Direct,MEDLINE,CNKI,VIP Data,WanFang Data and CBM,supplemented by artificial retrieval and Google academic retrieval.Two reviewers selected the studies according to the inclusion and exclusion criteria,extracted the data and evaluated the quality.Meta-analysis or descriptive analysis was used Revman 5.3.Results Totally,7 RCTs were included in 2 401 patients.Meta-analysis showed that self-management could improve the quality of life of IBD patients[MD=4.86,P=0.02].Individualized self-management could reduce the recurrence rate,but it couldn't prove that systematic disease self-management guidance can improve the recurrence rate.Self-management helps to reduce the rate of IBD outpatient[MD=1.12,P<0.001],and individualized disease self-management guidance effect is better than that of systemic disease self-management guidance.Descriptive analysis showed that IBD patients have high demands for disease self-management,which could effectively reduce the economic costs,improve the self-efficacy of patients,but might have no obvious change in improving patients'anxiety and depression.Conclusion Self-management in IBD patients has the advantage of improving patient's quality of life,reducing the amount of outpatient visits and economic costs and so on,also individualized self-management has a positive effect on reducing recurrence rate.So we recommend that hospital leaders could selectively develop self-management program in clinic.