胰岛素联合低分子肝素治疗高脂血症性急性胰腺炎有效性和安全性的meta分析

Efficacy and safety of insulin combined with low molecular weight heparin for hyperlipidemic acute pancreatitis:A meta-analysis

目的系统评价胰岛素联合低分子肝素治疗高脂血症性急性胰腺炎的有效性和安全性。方法检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、万方、维普、CBM数据库自建库至2020年11月,由两名评审员筛选文献、提取资料并评估质量,采用RevMan 5.3软件进行统计分析。结果共纳入9项随机对照试验(RCT)研究,共计727名患者。联合组与低分子肝素治疗组比较,显效率、总有效率、胃肠功能恢复时间、三酰甘油(TG)水平、C反应蛋白(CRP)水平、白介素-6(IL-6)水平、α肿瘤坏死因子(TNF-α)水平差异有统计学意义(P<0.05);与胰岛素组比较,胃肠功能恢复时间、住院时间、三酰甘油及CRP水平差异有统计学意义(P<0.05),IL-6水平差异无统计学意义;与常规治疗组比较,胃肠功能恢复时间、TG及CRP水平差异有统计学意义(P<0.05)。各组药物不良反应发生率均较低(P>0.05)。结论与常规内科治疗或单药治疗相比,胰岛素联合低分子肝素对高脂血症性急性胰腺炎具有显著的疗效和较好的安全性,可考虑作为一线治疗方案。

Objective To review the efficacy and safety of insulin combined with low molecular weight heparin(LMWH)hyperlipidemic acute pancreatitis systematically.Methods PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang Data,VIP and CBM were searched for related articles up to November 2020.Two reviewers independently screened the articles,extracted data,and assessed the quality.The meta-analysis was conducted with RevMan 5.3.Results Nine randomized controlled trials were included,with 727 patients in total.Compared with the combined treatment group,statistical differences was found(P<0.05)in efficiency rate,total effective rate,gastrointestinal function recovery time,triglyceride level,CRP level,IL-6 level and TNF-αlevel in LMWH group.Significant differences was found in gastrointestinal function recovery time,hospital stay,triglyceride level and CRP level(P<0.05),but not in IL-6 level as compared with the insulin group(P<0.05).Significant differences was found in gastrointestinal function recovery time,triglyceride level and CRP level in the conventional treatment group.The incidence of adverse drug reactions was low in all groups without significant difference.Conclusion Compared with conventional therapy or monotherapy,insulin combined with LMWH has better efficacy and safety for hyperlipidemic acute pancreatitis,and may be considered as a first-line treatment.