维生素C对重症患者预后影响的Meta分析

Effect of vitamin C on prognosis of critically ill patients:a Meta-analysis

目的系统评价维生素C对重症患者预后的影响。方法用计算机检索中国知网、中国生物医学文献数据库、维普数据库、万方医学数据库、PubMed、Springer、Embase、Web of Science、Cochrane Library等数据库自建库至2019年5月关于维生素C用于重症患者的随机对照试验(RCT)。试验组应用维生素C,对照组应用安慰剂或其他治疗。研究结局指标包括病死率、重症加强治疗病房(ICU)住院时间、总住院时间、心房颤动(房颤)发生率。由2名研究人员分别进行文献筛选、数据提取和质量评价,应用RevMan 5.2软件对符合标准的文献进行Meta分析;采用漏斗图分析各研究是否存在发表偏倚。结果共纳入28篇文献、4?420例患者,其中试验组2?207例,对照组2?213例。Meta分析结果显示,试验组与对照组病死率差异无统计学意义〔优势比(OR)=0.90,95%可信区间(95%CI)=0.75~1.08,P=0.27〕。试验组ICU住院时间〔均数差(MD)=-0.23,95%CI=-0.29^-0.16,P<0.000?01〕和总住院时间(MD=-0.96,95%CI=-1.21^-0.70,P<0.000?01)较对照组明显缩短。亚组分析显示,对于脓毒症/脓毒性休克患者,试验组病死率明显低于对照组(OR=0.65,95%CI=0.43~0.99,P=0.04);对于心脏外科手术患者,试验组术后房颤发生率低于对照组(OR=0.43,95%CI=0.34~0.54,P<0.000?01)。漏斗图显示,病死率相关文献分布基本对称,提示发表偏倚较小。结论维生素C不能降低重症患者的病死率,但能缩短ICU住院时间和总住院时间。另外,维生素C可降低脓毒症/脓毒性休克患者的病死率以及降低接受心脏外科手术患者术后房颤的发生率。

Objective To systematically evaluate the effect of vitamin C on prognosis of critically ill patients.Methods Randomized controlled trials(RCT)about vitamin C treatment for critically ill patients were searched in CNKI,CBM,VIP database,Wanfang database,PubMed,Springer Link,Embase,Web of Science,and Cochrane Library from their inception to May 2019.Patients in the treatment group received ascorbic acid while patients in the control group received placebo or other treatment.Outcome measures included mortality,the length of intensive care unit(ICU)stay,the length of hospital stay,and incidence of atrial fibrillation.Two researchers were responsible for literature screening,data extraction and quality evaluation independently.Meta-analysis was performed with RevMan 5.2 software.The publication bias was analyzed by funnel plot.Results A total of 28 RCTs were enrolled and 4 420 patients were included(2 207 in intervention group and 2 213 in control group).Meta-analysis showed that there was no significant difference in mortality between intervention group and control group[odds ratio(OR)=0.90,95%confidence interval(95%CI)=0.75 to 1.08,P=0.27].The length of ICU stay[mean difference(MD)=-0.23,95%CI=-0.29 to-0.16,P<0.000 01]and the length of hospital stay(MD=-0.96,95%CI=-1.21 to-0.70,P<0.000 01)in intervention group were less than those in control group.Subgroup analysis showed that mortality of patients with sepsis and septic shock in intervention group was lower than that in control group(OR=0.65,95%CI=0.43 to 0.99,P=0.04).For patients undergoing cardiac surgery,the incidence of postoperative atrial fibrillation in intervention group was lower than that in control group(OR=0.43,95%CI=0.34 to 0.54,P<0.000 01).It was shown by funnel plot that there was less publication bias among studies.Conclusions Vitamin C does not reduce mortality in critically ill patients,but it can reduce the length of ICU stay and hospital stay.In addition,vitamin C can reduce mortality of patients with sepsis and septic shock and reduce the incidence of atrial fibrillation post operation in patients undergoing cardiac surgery.