糖皮质激素用于急性重症胰腺炎疗效的系统评价

Systematic Review of Efficacy of Glucocorticoids for Severe Acute Pancreatitis

目的:系统评价糖皮质激素对重症急性胰腺炎(severe acute pancreatitis,SAP)病情及预后的影响。方法:计算机检索Pub Med、Medline、Cochrane图书馆、EMBase、中文科技期刊数据库、中国期刊全文数据库以及万方学术期刊全文数据库等,检索时限为2007年1月1日至2020年9月1日,纳入常规治疗+糖皮质激素(研究组)对比常规治疗(对照组)治疗SAP的随机对照试验(randomized controlled trial,RCT),采用改良Jadad评分量表进行文献质量评价后,应用Rev Man 5.3统计软件对腹痛缓解时间、血淀粉酶恢复时间、全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)评分、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、住院时间、并发症发生率和死亡率等指标进行荟萃分析(Meta分析)。结果:共纳入12个RCT,涉及1119例SAP患者。Meta分析结果显示,研究组患者的腹痛缓解时间(MD=-2.03,95%CI=-2.94~-1.13,P<0.0001)、血淀粉酶恢复时间(MD=-2.44,95%CI=-3.40~-1.48,P<0.00001)和住院时间(MD=-7.83,95%CI=-12.02~-3.64,P=0.002)均明显短于对照组,并发症发生率(OR=0.16,95%CI=0.09~0.27,P<0.00001)、死亡率(OR=0.16,95%CI=0.07~0.38,P<0.0001)均明显低于对照组,上述差异均有统计学意义;患者入院后第5日与入院时的SIRS评分、APACHEⅡ评分变化情况,两组比较,差异均无统计学意义(P>0.05)。结论:早期应用糖皮质激素治疗SAP有助于缓解病情,改善预后。

OBJECTIVE:To systematically evaluate the effects of glucocorticoids on the condition and prognosis of severe acute pancreatitis(SAP).METHODS:PubMed,Medline,the Cochrane Library,EMBase,VIP,CNKI and Wanfang database were retrieved to collect randomized controlled trial(RCT)of conventional treatment+glucocorticoid(study group)and conventional treatment(control group)for SAP.The retrieval time was from Jan.1 st,2007 to Sept.1 st,2020.The improved Jadad scale was used to evaluate the quality of literature.RevMan 5.3 statistical software was used for Meta-analysis to evaluate the relief time of abdominal pain,recovery time of blood amylase,systemic inflammatory response syndrome(SIRS)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ),length of stay,complication rate and mortality rate.RESULTS:A total of 12 RCT were included,with 1119 patients with SAP.Meta-analysis results showed that the relief time of abdominal pain(MD=-2.03,95%CI=-2.94--1.13,P<0.0001),recovery time of blood amylase(MD=-2.44,95%CI=-3.40--1.48,P<0.00001)and length of stay(MD=-7.83,95%CI=-12.02--3.64,P=0.002)in the study group were significantly shorter than those in the control group,and the incidence of complications(OR=0.16,95%CI=0.09-0.27,P<0.00001),mortality rate(OR=0.16,95%CI=0.07-0.38,P<0.0001)were significantly lower than those in the control group,and the above differences were statistically significant.The difference of SIRS score and APACHEⅡscore on the 5 th day after admission and the time of admission between two groups was not statistically significant(P>0.05).CONCLUSIONS:Early application of glucocorticoids for SAP can help to relieve the condition and improve the prognosis.