血必净注射液治疗脓毒症血管内皮损伤有效性及安全性的Meta分析

Efficacy and safety of Xuebijing injection in the treatment of vascular endothelial injury in sepsis patients:A meta⁃analysis

目的:系统评价血必净注射液治疗脓毒症血管内皮损伤的疗效及安全性,为血管内皮损伤提供临床用药循证参考。方法:用计算机搜索中国知网、万方及维普数据库(1995年1月2019年12月),收集血必净联合对症支持治疗对比对症支持治疗用于脓毒症的随机对照试验。按照纳入及排除标准进行文献筛选,根据Cochrane国际协作网规程进行质量控评和偏倚评估,采用Revman5.3进行Meta分析。结果:共纳入15项临床随机对照试验,共计930名患者。Meta分析结果显示,血必净注射液联合常规治疗可降低脓毒症28 d死亡率[OR=0.52,95%CI(0.38,0.71),P<0.000 1]、APACHEⅡ评分[WMD=-2.65,95%CI(-3.23,-2.08),P<0.000 01]、D-二聚体[WMD=-0.79,95%CI(-1.17,-0.40),P<0.000 1]、TNF-α[WMD=-36.71,95%CI(-43.04,-30.39),P<0.000 01]、vWF[WMD=-15.94,95%CI(-27.60,-4.28),P=0.007]、sE-selectin[WMD=-118.30,95%CI(-139.65,-96.95),P<0.000 01]、ESM-1[WMD=-135.44,95%CI(-186.30,-84.57),P<0.000 01]、sTM[WMD=-56.46,95%CI(-66.39,-46.53),P<0.000 01]水平;可有效提高血小板水平[WMD=30.78,95%CI(25.65,35.92),P<0.000 01]。结论:血必净注射液能有效减少炎症因子释放,从而改善血管内皮损伤,减轻凝血功能紊乱,阻断凝血-炎症网络。除此之外,它还可以提高血小板水平,从而修复损伤的血管内皮细胞,对减轻脓毒症病情并改善预后具有一定的价值。这一结论也为新型冠状病毒肺炎继发脓毒症的治疗提供一定依据。

Objective:To systematically evaluate the efficacy and safety of Xuebijing injection in the treatment of vascular endothelial injury in sepsis patients,in order to provide an evidence-based reference for clinical medication of vascular endothelial injury. Methods:The randomized controlled trials of sepsis comparing the thereyeatic effect between Xuebijing injection combined with conventional treatment(the experimental group)and the conventional treatment(the control group)were collected by searching CNKI,Wanfang,and VIP databases from January 1995 to December 2019. Literature was screened according to the inclusion and exclusion criteria. According to the Cochrane International Collaboration Evaluator Workbook procedure,quality evaluation and bias analysis were performed. Revman 5.3 software was used for systematic meta-analysis. Results:A total of 15 clinical randomized controlled trials with 930 patients were included. Meta-analysis results showed that Xuebijing injection combined with conventional therapy could reduce 28-day mortality of sepsis patients[OR=0.52,95% CI(0.38,0.71),P<0.000 1],APACHEⅡ score[WMD=-2.65,95% CI(-3.23,-2.08),P<0.000 01],D-dimer[WMD=-0.79,95% CI(-1.17,-0.40),P<0.000 1],TNF-α[WMD=-36.71,95% CI(-43.04,-30.39),P<0.000 01],vWF[WMD=-15.94,95% CI(-27.60,-4.28),P=0.007],sE-selectin[WMD=-118.30,95% CI(-139.65,-96.95),P<0.000 01],ESM-1[WMD=-135.44,95% CI(-186.30,-84.57),P<0.000 01],sTM[WMD=-56.46,95% CI(-66.39,-46.53),P<0.000 01];and effectively increase platelets[WMD=30.78,95% CI(25.65,35.92),P<0.000 01]. Conclusion:Xuebijing injection can effectively reduce the release of inflammatory factors,thereby improving vascular endothelial injury,reducing coagulation disorders and blocking coagulation-inflammation network. Moreover,it can increase the level of platelets,thereby repair injured vascular endothelial cells,which has a certain value for alleviation of sepsis and improvement of the prognosis. These results provide a certain basis for the treatment of sepsis secondary to COVID-19.